Characterizing and detecting delirium with clinical and computational measures of speech and language disturbance.

BACKGROUND: Delirium is a critically underdiagnosed syndrome of altered mental status affecting more than 50% of older adults admitted to hospital. Few studies have incorporated speech and language disturbance in delirium detection. We sought to describe speech and language disturbances in delirium, and provide a proof of concept for detecting delirium using computational speech and language features. METHODS: Participants underwent delirium assessment and completed language tasks. Speech and language disturbances were rated using standardized clinical scales. Recordings and transcripts were processed using an automated pipeline to extract acoustic and textual features. We used binomial, elastic net, machine learning models to predict delirium status. RESULTS: We included 33 older adults admitted to hospital, of whom 10 met criteria for delirium. The group with delirium scored higher on total language disturbances and incoherence, and lower on category fluency. Both groups scored lower on category fluency than the normative population. Cognitive dysfunction as a continuous measure was correlated with higher total language disturbance, incoherence, loss of goal and lower category fluency. Including computational language features in the model predicting delirium status increased accuracy to 78%. LIMITATIONS: This was a proof-of-concept study with limited sample size, without a set-aside cross-validation sample. Subsequent studies are needed before establishing a generalizable model for detecting delirium. CONCLUSION: Language impairments were elevated among patients with delirium and may also be used to identify subthreshold cognitive disturbances. Computational speech and language features are promising as accurate, noninvasive and efficient biomarkers of delirium.

Facility-Level Emissions and Synergistic Control of Energy-Related Air Pollutants and Carbon Dioxide in China.

Boilers involve ∼60% of primary energy consumption in China and emit more air pollutants and CO2 than any other infrastructures. Here, we established a nationwide, facility-level emission data set considering over 185,000 active boilers in China by fusing multiple data sources and jointly using various technical means. The emission uncertainties and spatial allocations were significantly improved. We found that coal-fired power plant boilers were not the most emission-intensive boilers with regard to SO2, NOx, PM, and mercury but emitted the highest CO2. However, biomass- and municipal waste-fired combustion, regarded as zero-carbon technologies, emitted a large fraction of SO2, NOx, and PM. Future biomass or municipal waste mixing in coal-fired power plant boilers can make full use of the advantages of zero-carbon fuel and the pollution control devices of coal-fired power plants. We identified small-size boilers, medium-size boilers using circulating fluidized bed boilers, and large-size boilers located in China's coal mine bases as the main high emitters. Future focuses on high-emitter control can substantially mitigate the emissions of SO2 by 66%, NOx by 49%, PM by 90%, mercury by 51%, and CO2 by 46% at the most. Our study sheds light on other countries wishing to reduce their energy-related emissions and thus the related impacts on humans, ecosystems, and climates.

Fusion dsRNA in targeting salivary protein genes enhance the RNAi-based aphid control.

RNA interference (RNAi) is a promising tool for pest control and relies on sequence-specific gene silencing. Salivary proteins are cooperatively secreted into plants to guarantee the feeding of aphids; thus they have potential to develop as selective targets for RNAi-based pest control strategy. For this purpose, we firstly analyzed 18 salivary proteomes of various aphid species, and these salivary proteins can be mainly categorized into seven functional groups. Secondly, we created a work-flow for fusion dsRNA design that can target multiple genes but were selectively safe to beneficial insects. Based on this approach, seven fusion dsRNAs were designed to feed the green peach aphid, which induced a significant reduction in aphid fitness. Among them, ingestion of dsperoxidase induced the highest mortality in aphids, which was also significantly higher than that of traditional dsRNAs in targeting three peroxidases separately. In addition, dsperoxidase-fed green peach aphids triggered the highest H2O2 content of host plants as well as the attraction to natural enemies (ladybeetle and parasitic wasp) but repellent to other control aphids. Our results indicate that the fusion dsRNA design approach can improve aphid control capacity, and the fusion dsRNA targeting salivary protein-encoding genes can enhance the direct and indirect defenses of host plants, thus providing a new strategy for RNAi-based aphid control.

Degradation Profiling of Nardosinone at High Temperature and in Simulated Gastric and Intestinal Fluids.

Nardosinone, a predominant bioactive product from Nardostachys jatamansi DC, is well-known for its promising therapeutic applications, such as being used as a drug on anti-inflammatory, antidepressant, cardioprotective, anti-neuroinflammatory, anti-arrhythmic, anti-periodontitis, etc. However, its stability under varying environmental conditions and its degradation products remain unclear. In this study, four main degradation products, including two previously undescribed compounds [2-deoxokanshone M (64.23%) and 2-deoxokanshone L (1.10%)] and two known compounds [desoxo-narchinol A (2.17%) and isonardosinone (3.44%)], were firstly afforded from the refluxed products of nardosinone in boiling water; their structures were identified using an analysis of the extensive NMR and X-ray diffraction data and the simulation and comparison of electronic circular dichroism spectra. Compared with nardosinone, 2-deoxokanshone M exhibited potent vasodilatory activity without any of the significant anti-neuroinflammatory activity that nardosinone contains. Secondly, UPLC-PDA and UHPLC-DAD/Q-TOF MS analyses on the degradation patterns of nardosinone revealed that nardosinone degraded more easily under high temperatures and in simulated gastric fluid compared with the simulated intestinal fluid. A plausible degradation pathway of nardosinone was finally proposed using nardosinonediol as the initial intermediate and involved multiple chemical reactions, including peroxy ring-opening, keto-enol tautomerization, oxidation, isopropyl cleavage, and pinacol rearrangement. Our findings may supply certain guidance and scientific evidence for the quality control and reasonable application of nardosinone-related products.

Bisphenol A impairs macrophages through inhibiting autophagy via AMPK/mTOR signaling pathway and inducing apoptosis.

Bisphenol A (BPA) is a widespread endocrine disruptor that induces the impairment of immune cells, but the mechanism remains unknown. Macrophages are one of the most important immune cells in innate and adaptive immunity. In this study, we aimed to probe the effects of BPA on the damage of RAW264.7 cells and its mechanisms of action, especially focusing on the relationship between autophagy and apoptosis. Cells were pretreated with 10 mg/L LPS, or added autophagy activator RAPA, autophagy inhibitor 3-MA or Bcl-2 inhibitor ABT-737, then treated with BPA (0, 10, 100 and 200 µmol/L) for 12 h. Results have shown that BPA decreased the cell viability and disrupted secretory function by promoting pro-inflammatory cytokines TNF-α and IL-6 and reducing anti-inflammatory cytokines IL-10 TGF-ß, as well as phagocytic ability. Moreover, autophagy was inhibited by BPA through decreasing p-AMPK/AMPK and increasing p-mTOR/mTOR, and further down-regulating autophagy proteins ATG6, LC3II/I ratio, and up-regulating autophagy flux protein p62. Additionally, BPA significantly increased Bax/Bcl-2 ratio, Caspase-3 expression and apoptosis rate. We found that RAPA ameliorated the cell viability, Bax/Bcl-2 ratio, and macrophage function damage induced by BPA. Intriguingly, ABT-737 might promote ATG6 expression. In summary, our study demonstrated that the effects of BPA on macrophages seemed to be mediated by inhibiting AMPK/mTOR-dependent autophagy and inducing apoptosis via endogenous mitochondrial pathway. Both Bcl-2 and ATG6 were involved in the regulation of apoptosis and autophagy by BPA. These findings provide a broader perspective for understanding the interaction between autophagy and apoptosis in BPA-induced immune cell injury.

Psychometric properties of Brief Coping Orientation to Problems Experienced in patients with multiple chronic conditions: A preliminary study.

BACKGROUND: Multiple chronic conditions (MCCs) are highly prevalent in primary care. Coping is an important psychological factor that influences patients' ability to adapt physically and mentally to MCCs. Testing a reliable and valid psychometric inventory is necessary to identify coping strategies before developing coping-oriented interventions. PURPOSE: The purpose of this study is to examine the psychometric properties of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE-CN) inventory in patients with MCCs. METHOD: This study adopted a cross-sectional design. A convenience sample of 290 Chinese patients with MCCs was recruited from a tertiary hospital in East China. The Brief COPE-CN, sociodemographic characteristics and clinical data were collected using a self-reported questionnaire from November 2017 to May 2018. Factor analysis and reliability analysis were performed. RESULTS: The mean age of the participants was 58.5 years (range from 23 to 95 years), and approximately half of the participants were female (49.3%). Most participants had two chronic conditions (82.1%) and reported having had MCCs for more than 2 years. The explanatory factor analysis (EFA) identified five factors in the Brief COPE-CN that explained 58.4% of the total variance. The Cronbach's α coefficients ranged from .65 to .85 for the five subscales. CONCLUSIONS: The psychometric properties of the Brief COPE-CN were acceptable for use with Chinese patients with MCCs. With further evaluation, this instrument may help health-care professionals understand patients' coping and develop coping-based interventions to promote coping in this population.

Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis.

Background: The presence of left atrial/left atrial appendage thrombosis is associated with a higher risk of thromboembolic events in patients with atrial fibrillation. The optimal antithrombotic strategy is not established to date. Objective: Our aim was to compare the efficacy and safety profile of novel oral anticoagulants with warfarin in the treatment of left atrial/left atrial appendage thrombosis. Methods: We conducted a systematic search in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and 3 Chinese databases for all randomized controlled trials and cohort studies (PROSPERO, CRD42021238952) from inception to 7 May 2021. Two authors independently performed the articles selection, data extraction, and quality assessment. The efficacy outcome was the resolution of left atrial/left atrial appendage thrombosis, and the safety outcomes were bleeding and stroke/transient ischemic attack. Results: One randomized controlled trial and 5 cohort studies were included, with a total of 353 patients. Compared with warfarin, novel oral anticoagulants were associated with increased probability of left atrial/left atrial appendage thrombosis resolution (OR = 2.20; 95% CI, 1.35-3.60; I 2 = 0%). Compared with warfarin, novel oral anticoagulants had a similar risk of bleeding (OR = 0.91; 95% CI, 0.39-2.13; I 2 = 0%). There was no evidence of increased risk of stroke/transient ischemic attack (OR = 0.42; 95% CI, 0.12-1.45; I 2 = 0%). Conclusions: Novel oral anticoagulants were more effective than warfarin in promoting the resolution of left atrial/left atrial appendage thrombosis, without increased risks of bleeding and stroke/transient ischemic attack. Our study provides valuable insight into clinical practice. Further well-designed randomized controlled trials are needed to fully evaluate the benefits and risks in these patients. PROSPERO Registration No.: CRD42021238952.

[Analysis of clinical features and EBF3 gene variant in a child with hypotonia, ataxia and developmental delay].

OBJECTIVE: To explore the genetic basis for a child featuring hypotonia, ataxia, and delayed development syndrome (HADDS). METHODS: Whole exome sequencing was carried out for the child. Candidate variant was verified by Sanger sequencing of the child and his parents. RESULTS: The child was found to harbor a de novo heterozygous c.625G>A (p.Arg209Trp) variant of the EBF3 gene, which has caused substitution of Arginine by Tryptophan. The variant may has impaired the binding affinity of EBF3 with DNA and altered its subcellular localization, and ultimately decreased the transcriptional activity of the EBF3 gene. CONCLUSION: The c.625G>A variant of the EBF3 gene probably underlay the pathogenesis of HADDS in this child. Above finding has expanded the spectrum of EBF3 variants and enriched the clinical manifestations of the HADDS.

Case report : a novel ASXL3 gene variant in a Sudanese boy.

BACKGROUND: Bainbridge-Ropers syndrome (BRPS) [OMIM#615485] is a neurodevelopmental disorder, characterized by delayed psychomotor development with generalized hypotonia, moderate to severe intellectual disability, poor or absent speech, feeding difficulties, growth failure, dysmorphic craniofacial features and minor skeletal features. The aim of this study was to investigate the genetic etiology of a Sudanese boy with severe developmental delay, intellectual disability, and craniofacial phenotype using trio-based whole-exome sequencing. To our knowledge, no patients with ASXL3 gene variant c.3043C>T have been reported detailedly in literature. CASE PRESENTATION: The patient (male, 3 years 6 months) was the first born of a healthy non-consanguineous couple originating from Sudan, treated for "psychomotor retardation" for more than 8 months in Yiwu. The patient exhibited severely delayed milestones in physiological and intellectual developmental stages, language impairment, poor eye-contact, lack of subtle motions of fingers, fear of claustrophobic space, hypotonia, clinodactyly, autistic features. Peripheral blood samples were collected from the patient and his parents. Trio-based whole-exome sequencing(Trio-WES) identified a de novo heterozygous ASXL3 gene variant c.3043C>T;p.Q1015X. Sanger sequencing verified variants of this family. CONCLUSION: Trio-WES analysis identified a de novo nonsense variant (c.3043C>T) of ASXL3 gene in a Sudanese boy. To our knowledge, the patient with this variant has not been reported previously in literature. This study presents a new case for ASXL3 gene variants, which expanded the mutational and phenotypic spectrum.

Effects of shear reduction shoes on joint loading, ground reaction force and free moment across different cutting angles.

This study examined the effects of shear reduction shoes on braking and propulsion ground reaction forces (GRFs), free moments, and joint moments when cutting towards different directions. Fifteen male university basketball players performed sidestep cutting towards 45°, 90° and 135° directions with maximum-effort in shear reduction and control shoes. Two-way (angle x shoe) ANOVAs with repeated measures were performed to determine the interaction and main effects of cutting angle and shoe for all tested variables. Results showed that cutting angles had significant influence on most of the variables, except for the peak-free moment, peak ankle eversion moment and maximum loading rate of resultant shear GRF. The shear reduction shoes significantly delayed the timing to the first peaks of vertical and resultant shear GRFs compared with the control shoes. During propulsion, the shear reduction shoes generated smaller peak propulsion resultant shear and vertical ground reaction forces. Additionally, the shear reduction shoes did not induce distinct frontal and transverse moments at the ankle and knee joints compared with the control shoes. These results suggest that the application of shear reduction structure could be beneficial to attenuate vertical and shear impact peaks, offering additional insights to reduce shear-related injuries.

[Analysis of APC gene variants in a pedigree affected with familial adenomatous polyposis].

OBJECTIVE: To explore the genetic basis for a pedigree affected with familial adenomatous polyposis (FAP). METHODS: The proband, with recurrence of blood in the stool, was diagnosed with FAP by endoscopy, pathological examination and a family history. She was subjected to next generation sequencing to detect genetic variant. Suspected variant was verified by Sanger sequencing of members from her pedigree. RESULTS: The proband, her mother and brother were found to carry a heterozygous c.532-1G>A variant of the APC gene, which may lead to aberrant splicing of mRNA resulting in a truncated protein, which may lose its normal function and promote the tumorigenesis. Based on the American College of Medical Genetics and Genomics standards and guidelines, c.532-1G>A variant of APC gene was predicted to be pathogenic(PVS1+PP1+PP4+PP5). CONCLUSION: The c.532-1G>A variant of the APC gene probably underlay the pathogenesis of FAP in this pedigree.

Isostructural Atomically Dispersed Rhodium Catalysts Supported on SAPO-37 and on HY Zeolite.

Zeolites are widely applied supports for metal catalysts, but molecular sieves with comparable structures-silicoaluminophosphates (SAPOs)-have drawn much less attention and been overlooked as supports for atomically dispersed metals. Now, we report SAPO-37 as a support for atomically dispersed rhodium in rhodium diethylene complexes, made by the reaction of Rh(η2-C2H4)2(acetylacetonate) with the support and anchored by two Rh-O bonds at framework tetrahedral sites, as shown by infrared and extended X-ray absorption fine structure spectra. The ethylene ligands were readily replaced with CO, giving sharp νCO bands indicating highly uniform supported species. A comparison of the spectra with those of comparable rhodium complexes on zeolite HY shows that the SAPO- and zeolite-supported complexes are isostructural, providing an unmatched opportunity for determining support effects in catalysis. The two catalysts had similar initial room-temperature activities per Rh atom for ethylene conversion in the presence of H2, but the SAPO-supported catalyst was selective for ethylene hydrogenation and the zeolite-supported catalyst selective for ethylene dimerization; correspondingly, the catalyst on the SAPO was more stable than that on the zeolite during operation in a flow reactor.

NT-3 Promotes Oligodendrocyte Proliferation and Nerve Function Recovery After Spinal Cord Injury by Inhibiting Autophagy Pathway.

BACKGROUND: Spinal cord injury (SCI) is a serious medical problem, leading to lifelong disability and increasing the health burden worldwide. Traditional treatments have limited effects on neuronal function recovery. Previous studies showed that neurotrophin-3 (NT-3) promoted oligodendrocyte survival and improved neuronal functional recovery after SCI. However, the mechanism by which NT-3 promotes oligodendrocyte survival after SCI remains unclear, which limits its application. MATERIALS AND METHODS: A total of 75 female Sprague-Dawley rats were randomly divided into three groups: the NS group, NT-3 group, and NT-3 + rapamycin group. After successful modeling, the spinal cord specimens were taken at the corresponding time points. Western blot was used to detect autophagy-related proteins and Olig1 protein expression and combined with pathology, immunohistochemistry, flow cytometry, and other methods to detect the proliferation of oligodendrocytes after NT-3 application. RESULTS: NT-3 was found to significantly promote the recovery of motor function by Basso-Beattie-Bresnahan scores analysis in the rat SCI model. Furthermore, intraspinal administration of NT-3 could downregulate the expression of Beclin-1 in oligodendrocytes, indicating that NT-3 could inhibit excessive autophagy of oligodendrocytes after SCI. The effects of NT-3 on oligodendrocyte survival could be blocked by an autophagy activator rapamycin. CONCLUSIONS: This study found that NT-3 could promote the recovery of motor function after SCI in rats. The underlying reason may be that NT-3 inhibits the expression of autophagy proteins in oligodendrocytes and promotes oligodendrocyte proliferation. This study provided evidence for the future clinical application of NT-3 in SCI patients.

Enhanced core-shell CeO2:Er,Yb@W18O49 heterojunction H2 generation by multiband emissions of Er ions.

The core-shell CeO2:Er,Yb@W18O49 heterojunction is successfully synthesized via the facile solvothermal method. The octahedral CeO2:Er,Yb nanocrystal's core exhibits green (2H11/2, 4S3/2 â†’ 4I15/2), red (4F9/2 â†’ 4I15/2) and NIR (4I11/2 â†’ 4I15/2 and 4I13/2 â†’ 4I15/2) emission under 980 nm laser diode excitation, and the multiband emissions are absorbed by the W18O49 nanowire's shell, re-exciting its higher energy localized surface plasmon resonances (LSPR). With the excitation of 980 nm, the photocatalytic property of CeO2:Er,Yb@W18O49 for hydrogen (H2) evolution from ammonia borane (BH3NH3), a three-fold increase compared to W18O49, is researched. The application of natural sunlight for the production of H2 is studied, and an obvious H2 production enhancement compared to the use of W18O49 (two-fold) is also observed. This remarkable enhancement in the catalytic activity of CeO2:Er,Yb@W18O49 heterostructures is ascribed to the re-excitation of LSPR by multiband emissions of CeO2:Er,Yb.

Illness Perceptions, Coping Strategies, and Quality of Life in People With Multiple Chronic Conditions.

PURPOSE: To determine whether illness perceptions, coping strategies, and sociodemographic and clinical variables are related to the quality of life (QoL) in adults with multiple chronic conditions (MCCs) living in China. DESIGN: By employing a cross-sectional design based on the transactional stress and coping theory, a convenience sample of adults with MCCs were recruited from a university-affiliated hospital between November 2017 and May 2018 in Northern Anhui, China. METHODS: A self-reported questionnaire, including the Brief Illness Perceptions Questionnaire, the Brief Coping Orientation to Problems Experienced inventory, and the Short Form Survey version 2, was administered. Sociodemographic and clinical data regarding MCCs were also collected. Descriptive statistics including frequencies, means, standard deviations, and correlation coefficients were calculated to examine the relationship between illness perceptions, coping, and QoL. Hierarchical multiple regression models were used to identify variables associated with physical and mental QoL. FINDINGS: A total of 351 participants (50% male) were recruited, with a mean age of 58.9 years (SD = 14.6). Of the participants, 83% had two chronic conditions. Participants reported impaired physical and mental QoL when compared with the general population in China. Poorer QoL was correlated with stronger illness perceptions of consequences and timeline and increased use of denial and disengagement and self-blame. Increasing age and more chronic conditions were associated with worse QoL. A higher education level was significantly associated with better physical and mental QoL. CONCLUSIONS: This study found that adults with MCCs living in China experienced impaired QoL. The strong relationship found between the participants' perceptions of MCCs, coping strategies, and QoL suggested that healthcare professionals should recognize the physical and psychological impacts of MCCs and address the significance of adaptations to MCCs in future treatment programs. The findings will help healthcare professionals design more specific interventions to modify illness perceptions and enhance certain coping strategies to improve the QoL of people with MCCs. Healthcare professionals can mobilize available resources from healthcare and social systems to enhance people's coping and adaptation to MCCs. CLINICAL RELEVANCE: With an understanding of the illness perceptions of people with MCCs, healthcare professionals could offer information related to consequences, timeline, and personal control to enable better alignment between people's expectations and their actual situations. By knowing people's coping strategies, healthcare professionals can offer additional support to people who prefer strategies of denial and disengagement and self-blame.

[Development of preparation process of icaritin-coix seed oil microemulsion based on quality by design concept].

To optimize the formulation and preparation process of icaritin-coix seed oil microemulsion(IC-MEs) based on quality by design(QbD) concept. IC-MEs were prepared by water titration. Firstly, the risk factors that may affect the quality of IC-MEs were evaluated. Then Plackett-Burman design was used to screen out prescription factors and process parameters that had a significant effect on the indicators. Finally, Box-Behnken design was used to optimize the prescription ratio of IC-MEs. Through the risk assessment and Plackett-Burman design, three formulation factors [drug loading efficiency, the ratio of mixed-oil(coix seed oil-Glycerol tributyrate) to mixed-surfactant(HS15-RH40) and water addition] were determined as the key factors affecting IC-MEs. The regression model established by Box-Behnken design had a good predictability. The optimal formula was as following: the drug loading efficiency of 0.92%, the ratio of mixed-oil(coix seed oil-glycerol tributyrate) to mixed-surfactant(HS15-RH40) of 4∶6, and the water addition of 5.7 mL. According to this prescription, IC-MEs were prepared, and its encapsulation efficiency after 1 week was 92.45%±1.00%. Therefore, the stability of IC-MEs could be improved by optimizing prescription and process parameters of IC-MEs based on the QbD concept, which can provide certain reference value for the future development of IC-MEs.

A Stable Silanol Triad in the Zeolite Catalyst SSZ-70.

Nests of three silanol groups are located on the internal pore surface of calcined zeolite SSZ-70. 2D 1 H double/triple-quantum single-quantum correlation NMR experiments enable a rigorous identification of these silanol triad nests. They reveal a close proximity to the structure directing agent (SDA), that is, N,N'-diisobutyl imidazolium cations, in the as-synthesized material, in which the defects are negatively charged (silanol dyad plus one charged SiO- siloxy group) for charge balance. It is inferred that ring strain prevents the condensation of silanol groups upon calcination and removal of the SDA to avoid energetically unfavorable three-rings. In contrast, tetrad nests, created by boron extraction from B-SSZ-70 at various other locations, are not stable and silanol condensation occurs. Infrared spectroscopic investigations of adsorbed pyridine indicate an enhanced acidity of the silanol triads, suggesting important implications in catalysis.

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study.

OBJECTIVE: To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. BACKGROUND: Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. DESIGN: A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. METHODS: This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi-structured face-to-face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. RESULTS: Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well-being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. CONCLUSIONS: This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross-culture research on this topic. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture-tailored supportive programmes such as family-based interventions, to promote the health of people with multiple chronic conditions.

Dexmedetomidine inhibits the NF-κB pathway and NLRP3 inflammasome to attenuate papain-induced osteoarthritis in rats.

Context: Dexmedetomidine (Dex) has been reported to have an anti-inflammatory effect. However, its role on osteoarthritis (OA) has not been explored. Objective: This study investigates the effect of Dex on OA rat model induced by papain. Materials and methods: The OA Wistar rat model was induced by intraluminal injection of 20 mL of papain mixed solution (4% papain 0.2 mL mixed with 0.03 mol L-1 l-cysteine 0.1 mL) into the right knee joint. Two weeks after papain injection, OA rats were treated by intra-articular injection of Dex (5, 10, or 20 µg kg-1) into the right knee (once a day, continuously for 4 weeks). Articular cartilage tissue was obtained after Dex treatment was completed. Results: The gait behavior scores (2.83 ± 0.49), PWMT (15.2 ± 1.78) and PTWL (14.81 ± 0.92) in H-DEX group were higher than that of OA group, while Mankin score (5.5 ± 0.81) was decreased (p < 0.05). Compared with the OA group, the IL-1ß (153.11 ± 16.05 pg mg-1), IL-18 (3.71 ± 0.7 pg mg-1), IL-6 (14.15 ± 1.94 pg/mg) and TNF-α (40.45 ± 10.28 pg mg-1) levels in H-DEX group were decreased (p < 0.05). MMP-13, NLRP3, and caspase-1 p10 expression in Dex groups were significantly lower than that of OA group (p < 0.05), while collagen II was increased (p < 0.05). p65 in the nucleus of Dex groups was significantly down-regulated than that of OA group (p < 0.05). Discussion and Conclusions: Dex can improve pain symptoms and cartilage tissue damage of OA rats, which may be related to its inhibition of the activation of NF-κB and NLRP3 inflammasome.

The effect of Tai Chi practice on brain white matter structure: a diffusion tensor magnetic resonance imaging study.

Diffusion tensor imaging (DTI) measures the displacement of water molecules across tissue components and thus provides information on the microstructure of brain white matter. This study examined the effect of Tai Chi and the relation of Tai Chi experiences and skills with brain white matter. Fractional anisotropy (FA) was obtained from the DTI magnetic resonance images of two group participants, namely, the long-term Tai Chi practitioners and sedentary counterparts. Whole-brain voxel-based analysis showed that the Tai Chi group had higher FA in the splenium of corpus callosum (p = 0.015) than the control group. Rank correlation analysis revealed that in the Tai Chi group, the FA value of the splenium of corpus callosum was moderately related with exercise duration (r = 0.45, p = 0.045) but highly related with skill level (r = 0.699, p = 0.001). Long-term Tai Chi practice could benefit to the brain white matter, and these impacts were correlated with exercise duration and skill level.