Regional integration policies and urban green innovation: Fresh evidence from urban agglomeration expansion.

Climate change is a non-traditional security crisis affecting the global economy and diplomatic progress. In order to curtail carbon emissions and alleviate the perils of climate change at their roots, urban green innovation (UGI) has emerged as a pivotal technological solution. Using the expansion of the Yangtze River Delta urban agglomeration in China as a case study, this paper develops a quasi-experimental model to analyze the effects of regional integration policies on UGI. The main findings are: (1) Regional integration policies significantly enhance UGI and their impact is more pronounced with the expansion of urban agglomerations; (2) Regional integration policies contribute to the advancement of exploitative green innovation while tending to diminish exploratory green innovation; (3) The green innovation effects (GIEs) created by the expansion of regional integration policies are largely influenced by governmental mechanisms on environmental governance as well as residents' green preferences. Based on these findings, recommendations are put forward to promote UGI from the perspective of policy implementation.

Combined serum free light chain predicts prognosis in acute kidney injury following cardiovascular surgery.

OBJECTIVES: Increased polyclonal free light chains (FLCs) are found in inflammatory conditions. Inflammation is recognized in the progression of acute kidney injury (AKI). This study was aimed to determine whether polyclonal combined FLC (cFLC) was associated with prognosis of AKI patients. METHODS: This prospective cohort included 145 adults with hospital-acquired AKI following cardiovascular surgery between 2014 and 2016, according to the KDIGO creatinine criteria. The primary end point of the study was all-cause death during follow-up. RESULTS: The median of serum cFLC concentration in the cohort was 42.0 (31.9-60.3 mg/L) and levels of cFLC in patients with AKI stage 3 were higher than those in AKI stage 1 and stage 2. cFLC levels correlated significantly with renal function biomarkers, high sensitivity C-reactive protein (hsCRP), and sequential organ failure assessment (SOFA) score. Patients were organized into the following two groups: the low-cFLC group (cFLC <43.3 mg/L) and the high-cFLC group (cFLC ≥ 43.3 mg/L). A total of 17 (11.0%) patient deaths occurred within 90 d, 13 (18.8%) in the high-cFLC group. Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-d survival (log-rank p = .012), and Cox regression analysis showed that an cFLC level ≥43.3 mg/L was significantly associated with a 5.0-fold increased risk of death (adjusted hazard ratio [HR], 5.95; 95% confidence interval [CI], 1.04- 33.91; p = .045) compared with an cFLC level <43.3 mg/L. CONCLUSIONS: Serum cFLC levels were significantly elevated and might be an independent predictor of mortality in patients with AKI following cardiovascular surgery.

Does the construction of innovative cities promote urban green innovation?

As a typical example of an innovative governance environment, innovative city has become the focus of political and academic circles. Discussing the green innovation effect of this policy is beneficial in providing decision support for enhancing urban green innovation capability and solving the dilemma of urban resources. Based on data from 241 cities in China from 2005 to 2017, this paper takes innovative city construction as a "quasi-natural experiment" and uses the difference-in-differences method to empirically study the impact of China's innovative city construction on urban green innovation. The results show that innovative urban construction: has a positive effect on improving urban green innovation, and that this effect will gradually increase with time; promotes urban green innovation by expanding the scope of technology application, improving the efficiency of resource allocation and promoting the adjustment of industrial structure; and presents heterogeneity in cities' location, size and hierarchy. Finally, this paper proposes that the government should promote innovative policies in an orderly manner on the basis of following the principle of adapting measures to local conditions, as well as incorporating green innovation performance into the evaluation system for innovative city construction.

The histone H3 lysine-27 demethylase UTX plays a critical role in colorectal cancer cell proliferation.

BACKGROUND: Ubiquitously transcribed tetratricopeptide repeat, X chromosome (UTX) is an H3K27me3 demethylase, a permissive mark associated with active gene transcription. UTX has been linked to various human cancers. Colorectal cancer (CRC) ranks 3rd among the most common cancers worldwide. However, the role of UTX in colorectal cancer has rarely been reported. METHODS: RT-qPCR, immunoblotting assays (WB), and immunohistochemistry staining were conducted to explore the UTX expression levels in CRC tissues and surrounding normal tissues. CCK-8 assays, colony formation assays, and flow cytometry were also used to determine the potential role of UTX in CRC cell proliferation in vitro. A cell line-derived xenograft model was performed to determine on the role of UTX in HCT116 cell proliferation in vivo. The protein expression levels of UTX, KIF14, AKT, and GAPDH were examined by WB. RESULTS: Compared with surrounding normal tissues, UTX was upregulated in CRC tissues. Knockdown of UTX significantly inhibited proliferation and caused G0/G1 cell cycle arrest in CRC cell lines, and overexpression of UTX significantly promoted proliferation in CRC cells. Furthermore, knockdown of UTX significantly inhibited tumour growth in vivo. In addition, knockdown of UTX decreased the expression of KIF14 and pAKT and increased the expression of P21. CONCLUSIONS: Our findings indicate that knockdown of UTX inhibits CRC cell proliferation and causes G0/G1 cell cycle arrest through downregulating expression of KIF 14 and pAKT. Thus, UTX may serve as a novel biomarker in CRC.

Prediction Model of Cardiac Risk for Dental Extraction in Elderly Patients with Cardiovascular Diseases.

BACKGROUND: With the rapidly increasing population of elderly people, dental extraction in elderly individuals with cardiovascular diseases (CVDs) has become quite common. The issue of how to assure the safety of elderly patients with CVDs undergoing dental extraction has perplexed dentists and internists for many years. And it is important to derive an appropriate risk prediction tool for this population. OBJECTIVES: The aim of this retrospective, observational study was to establish and validate a prediction model based on the random forest (RF) algorithm for the risk of cardiac complications of dental extraction in elderly patients with CVDs. METHODS: Between August 2017 and May 2018, a total of 603 patients who fulfilled the inclusion criteria were used to create a training set. An independent test set contained 230 patients between June 2018 and July 2018. Data regarding clinical parameters, laboratory tests, clinical examinations before dental extraction, and 1-week follow-up were retrieved. Predictors were identified by using logistic regression (LR) with penalized LASSO (least absolute shrinkage and selection operator) variable selection. Then, a prediction model was constructed based on the RF algorithm by using a 5-fold cross-validation method. RESULTS: The training set, based on 603 participants, including 282 men and 321 women, had an average participant age of 72.38 ± 8.31 years. Using feature selection methods, 11 predictors for risk of cardiac complications were screened out. When the RF model was constructed, its overall classification accuracy was 0.82 at the optimal cutoff value of 18.5%. In comparison to the LR model, the RF model showed a superior predictive performance. The AUROC (area under the receiver operating characteristic curve) scores of the RF and LR models were 0.83 and 0.80, respectively, in the independent test set. The AUPRC (area under the precision-recall curve) scores of the RF and LR models were 0.56 and 0.35, respectively, in the independent test set. CONCLUSION: The RF-based prediction model is expected to be applicable for preoperative clinical assessment for preventing cardiac complications in elderly patients with CVDs undergoing dental extraction. The findings may aid physicians and dentists in making more informed recommendations to prevent cardiac complications in this patient population.

Serum indoxyl sulfate is associated with mortality in hospital-acquired acute kidney injury: a prospective cohort study.

BACKGROUND: Protein-bound uremic toxins are associated with poor outcomes in patients with chronic kidney disease. The aim of this study is to investigate the relationship between indoxyl sulfate (IS), a protein-bound solute, and 90-day mortality in patients with acute kidney injury. METHODS: Adults with hospital-acquired AKI (HA-AKI) were enrolled in this prospective cohort study between 2014 and 2015, according to the KDIGO creatinine criteria. The primary end point was all-cause death during follow-up. RESULTS: The mean serum IS level in patients with HA-AKI was 2.74 ± 0.75 µg/ml, which was higher than that in healthy subjects (1.73 ± 0.11 µg/ml, P < 0.001) and critically ill patients (2.46 ± 0.35 µg/ml, P = 0.016) but was lower than that in patients with chronic kidney disease (3.07 ± 0.31 µg/ml, P < 0.001). Furthermore, serum IS levels (2.83 ± 0.55 µg/ml) remained elevated in patients with HA-AKI on the seventh day after AKI diagnosis. Patients with HA-AKI were divided into the following two groups according to the median serum IS level: the low-IS group and the high-IS group. A total of 94 (35.9%) patient deaths occurred within 90 days, including 76 (29.0%) in the low-IS group and 112 (42.7%) in the high-IS group (P = 0.019). Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-day survival (log-rank P = 0.007), and Cox regression analysis showed that an IS level ≥ 2.74 µg/ml was significantly associated with a 2.0-fold increased risk of death (adjusted hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.76 to 4.86; P < 0.001) compared with an IS level < 2.74 µg/ml. CONCLUSIONS: Serum IS levels were significantly elevated in patients with HA-AKI compared to those in healthy subjects and critically ill patients and were associated with a worse prognosis of HA-AKI. TRIAL REGISTRATION: www.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.

MnO nanoparticles embedded in a carbon matrix as high performance lithium-ion battery anodes: preparation, microstructure and electrochemistry.

Nano-sized MnO intimately embedded in a porous carbon matrix has been synthesized by a facile method in which the manganese-salts/glycerol sol was used as the precursor. The glycerol plays roles of the chelating agent, the carbon source and the solvent. The X-ray diffraction (XRD) and Raman results indicate that the carbon layer may have an obvious effect on the microstructure of MnO. The first-principles density functional theory (DFT) calculations further reveal a considerable charge transfer from MnO to the carbon, leading to a decrease of lattice parameters of MnO and the bond length of Mn-O in the MnO/C composite. The modified microstructure could improve electrochemical performance and meanwhile may explain the phenomenon of exceeding the theoretical capacity. The prepared MnO/C nanocomposite as an anode material displays superior Li-battery performance with a large reversible capacity, excellent cyclic performance and good rate capability.

Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of virtual reality interventions for improving balance in people after stroke. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: Studies were obtained by searching the following databases: MEDLINE, CINAHL, EMBASE, Web of Science and CENTRAL. Two reviewers assessed studies for inclusion, extracted data and assessed trial quality. RESULTS: Sixteen studies involving 428 participants were included. People who received virtual reality interventions showed marked improvements in Berg Balance Scale (mean difference: 1.46, 95% confidence interval: 0.09-2.83, P<0.05, I²=0%) and Timed Up and Go Test (mean difference: -1.62, 95% confidence interval: -3.07- -0.16, P<0.05, I²=24%) compared with controls. CONCLUSIONS: This meta-analysis of randomized controlled trials supports the use of virtual reality to improve balance after stroke.

Protective effect of Sheng-Mai Yin, a traditional Chinese preparation, against doxorubicin-induced cardiac toxicity in rats.

BACKGROUND: Sheng-Mai Yin (SMY), a modern Chinese formula based on Traditional Chinese Medicine theory, has been used to treat cardiovascular diseases in Eastern Asia. Our study focuses on the cardioprotection of SMY against doxorubicin (DOX)-induced cardiac toxicity in vivo. METHODS: Rats were injected with DOX (2.5 mg/kg) in six injections over a 2-week period. SMY was administrated intragastrically at the dose of 8.35, 16.7 and 33.4 g/kg, or 16.7 g/kg only twice a day concurrently with DOX for the 2-weeks. A series of assays were performed to detect the effects of SMY on: (i) heart weight index (HWI) and left ventricular mass index (LVMI); (ii) cardiac function; (iii) heart tissue morphology; (iv) the contents of carboxy terminal propeptide of procollagen typeI (PICP), amino terminal propeptide of procollagen type III (PШNP), transforming growth factor-ß1 (TGF-ß1), B-type natriuretic peptide (BNP), monocyte chemoattractant protein-1 (MCP-1), interferon gamma (INF-γ) and interleukin 6 (IL-6) by ELISA; (v) the mRNA levels of TGF-ß1 and toll-like receptor-2 (TLR2); and (vi) protein level of TGF-ß1. RESULTS: Rats treated with SMY displayed the reductions of BNP and CK-MB increased by DOX in a dose-dependent manner. Moderate dose of SMY exhibited the correction for the increased HWI, LVMI, and the injured cardiac function, as well as the collagen accumulation. In addition, cardioprotection of SMY against DOX-induced cardiac toxicity was demonstrated by the reduction of myocardial fibrosis, characterized by the suppression of PICP, PШNP and TGF-ß1, as well as the anti-inflammation and the regulation for cardiac immune microenvironment, characterized by the inhibition of TLR2, MCP-1, INF-γ and IL-6. CONCLUSIONS: SMY may protect heart function through the restriction of myocardial fibrosis induced by DOX, which suggests the potentially therapeutic effect of SMY on DOX-induced cardiomyopathy.

Reliability and validity of center of pressure measures for balance assessment in older adults.

[Purpose] This study was conducted to assess the reliability and validity of center of pressure-based parameters for balance assessment. [Subjects and Methods] Two hundred and forty older adults were evaluated using a force platform and the Berg Balance Scale at 1-week intervals. The intra-class correlation coefficient and the Pearson correlation coefficient were used to test reliability and validity respectively. [Results] The reliability of the 12 selected center of pressure measures was satisfactory (intra-class correlation coefficient = 0.75-0.99) and the validity between the parameters and the Berg Balance Scale was moderate to good (r = -0.62 to -0.88). [Conclusion] Center of pressure-based parameters are reliable and valid measures in older adults.

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test.

BACKGROUND: As a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults. RESEARCH QUESTION: How does sarcopenia increase fall risk by affecting static postural control? METHODS: Forty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk. RESULTS: Sarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001-0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (ß=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (ß=10.0, P<0.001). SIGNIFICANCE: Sarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents.

Does human capital matter for energy consumption in China? Evidence from 30 Chinese provinces.

The impact of human capital on energy consumption is an important economic and environmental issue, especially in a country like China with a strong energy demand and continuously improving education levels. This study uses panel data from 30 provinces in China from 2000 to 2020 to explore the impact of human capital on energy consumption. Empirical research shows that human capital can not only reduce local energy consumption but also reduce energy consumption in surrounding areas, through structural, technological, and knowledge spillover effects. The impact of human capital on energy consumption exhibits a U-shaped curve, decreasing first and then increasing, when economic growth reaches a threshold level. As industrial structure and urbanization develop, the impact of human capital on energy consumption increases. This study inform policy by demonstrating the energy conservation and emission reduction effects of human capital and provide insights for investors and policymakers.

Self-assembly of Au nanocubes for ultrasensitive detection of Alzheimer's disease biomarkers by SERS.

Since presently Alzheimer's disease (AD) is incurable, early diagnosis of AD is crucial. Aß 1-42 and tau-441 proteins are promising core biomarkers for early diagnosis and early therapeutic intervention in AD. Here we constructed a surface-enhanced Raman spectroscopy (SERS) biosensor for highly sensitive quantitative detection of Aß 1-42 and tau proteins by preparing gold nanocube (AuNC) superlattices through evaporation self-assembly. The results showed that the method has a wide response range (0.1-10 000 ng mL-1 and 0.01-1000 ng mL-1, respectively) and high sensitivity. The detection limits of Aß1-42 and tau protein were 0.0416 ng mL-1 and 0.0087 ng mL-1, respectively. In addition, the method was able to rapidly and simultaneously detect the two biomarkers in serum, which showed the feasibility of the method in complex biological environments. The detection of Aß 1-42 and tau protein has great potential for the accurate prediction and early diagnosis of Alzheimer's disease.

Conflict of interest and FCTC implementation in China.

OBJECTIVE: To critically review the structure of tobacco control policy making in China, examine conflicts of interest within this structure, and consider how these affected the introduction of on-pack warnings. METHODS: Government policy documents and warning labels were obtained and critically reviewed. RESULTS: Few differences exist between the on-pack warnings formerly used in China and those introduced ostensibly to meet Framework Convention on Tobacco Control (FCTC) obligations. Comparison with tobacco manufactured for export or overseas consumption shows the new Chinese domestic on-pack warnings are demonstrably inferior to those required internationally. The inherent conflict of interest in the Chinese tobacco control agency structure, which must meet commercial and public health objectives, undermined the introduction of new health warnings. CONCLUSIONS: To promote more effective tobacco control policies, the conflict of interest inhibiting the public health function of the State Tobacco Monopoly Administration (STMA) must be removed. Specifically, the public health function must be separated from oversight of commercial production, and packaging must be redesigned with pictorial warnings and messages compliant with Article 11 of the FCTC.

Indoor Air Purification and Residents' Self-Rated Health: Evidence from the China Health and Nutrition Survey.

Indoor air pollution is injurious to human health, even worse than outdoor air pollution. However, there is a lack of empirical evidence using large samples in developing countries regarding whether indoor air purification can improve human health by reducing indoor air pollutants. Using the data from the China Health and Nutrition Survey in 2015, this study analyzes the relationship between indoor air purification and residents' self-rated health. We apply the generalized ordered logit model and find that indoor air purification has a significantly positive effect on residents' self-rated health. This positive effect is limited to improving the probability of residents' health level being rated "good", and there is no significant movement between the two levels of "bad" and "fair". The results also show that, as an important source of indoor air pollutants, solid fuels used in cooking significantly reduced residents' self-rated health level. Additional results show the heterogeneity of the relationship between indoor air purification and resident health among groups with different characteristics. This study provides empirical evidence for further optimizing the indoor air environment.

Combination of Oxalobacter Formigenes and Veillonella Parvula in Gastrointestinal Microbiota Related to Bile-Acid Metabolism as a Biomarker for Hypertensive Nephropathy.

The human microbiome is a mixed group of microorganisms, which individually consists of 10-100 trillion symbiotic microbial cells. The relationship between gastrointestinal microbiota and blood pressure has been verified and the intestinal microbiota of chronic kidney disease (CKD) patients in the distribution of bacterial species is different from the flora of people with no CKD. The purpose of this research is to study the different intestinal microbiota of hypertensive patients with and without nephropathy and to find possible biomarkers of hypertensive nephropathy (H-CKD). The subjects of this research were divided into three groups, healthy control group, hypertension group, and hypertensive nephropathy group. Sequencing, bioinformatics, and statistical analysis were performed on the 16S rRNA gene of the subjects' stool samples. This research study showed the differences of intestinal flora as biomarkers in hypertension patients with and without nephropathy; it investigated the relationship of the differences in the intestinal microbiota with bile-acid metabolism; it also explored bile-acid metabolism mechanism of intestinal microbiota differences in hypertension with or without nephropathy. In summary, the difference in the combination of O. formigenes and V. parvula in the gastrointestinal microbiota is related to bile-acid metabolism in hypertensive patients and can be one of the factors causing CKD. It is the first time to report such a biomarker or pathogenic factor of H-CKD in the world.

Risk factors of cardiac complications in patients with end-stage renal disease undergoing maintenance peritoneal dialysis.

BACKGROUND: Cardiovascular disease (CVD) is the most frequent cause of death in patients on maintenance peritoneal dialysis (PD). This study aimed to identify the risk factors associated with cardiac complications and establish a multivariate logistic regression model for cardiac complications in patients with end-stage renal disease (ESRD) requiring PD. METHODS: This retrospective study included 232 patients undergoing PD. Data of sociodemographic information, comorbidities, medication history, laboratory examination, and medical history were extracted from the medical records of patients with ESRD who underwent maintenance PD between January 2015 and June 2020. Multivariate logistic regression analysis was performed to determine the independent risk factors. RESULTS: The mean age of the study participants was 51.29±13.17 years, with female: male ratio of 87:145. Multivariate logistic regression analysis indicated that lactate dehydrogenase (odds ratio, 1.002; 95% confidence interval, 1.001-1.004; P=0.004), albumin (odds ratio, 0.947; 95% confidence interval, 0.914-0.982; P=0.003), and left atrial diameter (odds ratio, 1.096; 95% confidence interval, 1.037-1.159; P=0.001) were independent risk factors associated with cardiac complications. The area under the receiver operating characteristic curve was 0.78. CONCLUSIONS: We identified the risk factors of cardiac complications in patients with ESRD requiring PD, which may be clinically useful to assess patients in PD and start their early treatment, which can help improve their prognosis.

Mental health status and quality of life in patients with end-stage renal disease undergoing maintenance hemodialysis.

BACKGROUND: This study aimed to identify the association of factors and poorer mental health status and examinate the correlation between mental health status and quality of life (QOL) in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis. METHODS: A total of 190 patients were included in this observational, cross-sectional study. Psychological states of ESRD patients undergoing maintenance hemodialysis were evaluated by the Chinese version symptom checklist-90 (SCL-90) and QOL was assessed using the Chinese Version Kidney Disease Quality of Life-Short Form (KDQOL-SF). RESULTS: A total of 190 patients with a mean age of 61.68 (13.39) years were included in this study. Multiple stepwise linear regression analyses suggested that when controlling for the confounding variables, prealbumin had the significant influence on average positive factors (Coef., -0.647; 95% CI: -1.314, 0.020; P=0.057), somatization (Coef., -1.334; 95% CI: -2.451, -0.217; P=0.020), obsessive-compulsive (Coef., -1.396; 95% CI: -2.255, -0.537; P=0.002), depression (Coef., -1.241; 95% CI: -2.252, -0.229; P=0.017), phobic anxiety (Coef., -2.576; 95% CI: -3.786, -1.367; P<0.001). In the correlation analysis, the score of average positive factors was significantly correlated with the score of the overall health rating (Coef., -0.343; P<0.001), symptom/problem (Coef., -0.337; P<0.001), effects of kidney disease on daily life (Coef., -0.198; P=0.006), burden of kidney disease (Coef., -0.233; P=0.001), cognitive function (Coef., 0.363; P<0.001), quality of social interaction (Coef., 0.292; P<0.001), social support (Coef., 0.237; P=0.001), physical functioning (Coef., -0.339; P<0.001), pain (Coef., 0.362; P<0.001), general health (Coef., -0.332; P<0.001), mental health (Coef., -0.537; P<0.001), social functioning (Coef., 0.202; P=0.005), vitality (Coef., -0.478; P<0.001), respectively. CONCLUSIONS: In our study, prealbumin, type 2 diabetes mellitus, heart rate, educational level, duration of hemodialysis, coronary artery disease, heart failure, marital status, hemoglobin A1C, hemoglobin were significantly associated with poorer mental health status of ESRD patients undergoing maintenance hemodialysis, and patients with poorer psychological states were more significantly associated with decreased QOL. The results may help clinicians to adopt an effective treatment for early interventions, thus improving the QOL in such population.

Evaluation of the construct reliability and validity of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Chinese version in maintenance hemodialysis patients.

OBJECTIVE: The study aim was to assess the construct reliability and validity of the internal structure of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Self-Rated Level 1 Cross-Cutting Symptom Measure (CCSM)-Chinese version in maintenance hemodialysis (MHD) patients, and to clarify whether the CCSM is suitable for patients with psychological issues. METHODS: Participants were 190 MHD patients. Structural equation modelling was used to establish a measurement model to confirm the reliability and validity of the internal structure of the CCSM-Chinese version, and to compare it with the Chinese version of the Symptom Checklist-90 (SCL-90). RESULTS: Of the 13 CCSM domains, 8 showed stability and validity in the initial screening of psychological symptoms. Although the Chinese version of the SCL-90 is widely used, the measurement model of the 8-domain CCSM was a better fit than the SCL-90 (CCSM: chi-square = 35.668, chi-square/degrees of freedom [CMIN/df] = 1.877; root mean square error of approximation [RMSEA] = 0.061; adjusted goodness of fit index [AGFI] = 0.931 vs. SCL-90: chi-square = 89.159, CMIN/df = 2.972; RMSEA = 0.084; AGFI = 0.879). CONCLUSION: The Chinese version of the CCSM is a useful rapid screening tool to detect psychological symptom risk in MHD patients.

Exosomal miR-106b-5p derived from melanoma cell promotes primary melanocytes epithelial-mesenchymal transition through targeting EphA4.

BACKGROUND: Cancer-secreted exosomal miRNAs regulates the biological processes of many tumours. The serum level of exosomal miR-106b-5p is significantly increased in melanoma patients. However, the role and molecular mechanisms of exosomal miR-106b-5p in melanoma remains unclear. METHODS: Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression of miR-106b-5p and EphA4 in melanoma tissues. Transmission electron microscopy (TEM) and western blotting were used to identify exosome. QRT-qPCR and Cy3-labelled miR-106b-5p were used to demonstrated the transmission of melanoma cell-secreted exosomal miR-106b-5p. Western blotting, Immunofluorescence, adhesion, transwell and scratch wound assay were used to explore the role of exosomal miR-106b-5p in melanocytes. Luciferase reporter assays and RNA-Chromatin Immunoprecipitation (ChIP) assay were used to confirm whether erythropoietin-producing hepatocellular carcinoma receptor A4 (EphA4) was a direct target of miR-106b-5p. RESULTS: We found that miR-106b-5p levels were increased in melanoma tissue, and high miR-106b-5p expression is an independent risk factor for the overall survival of patients with melanoma. miR-106b-5p is enriched in melanoma cell-secreted exosomes and transferred to melanocytes. Exosomal miR-106b-5p promotes the epithelial-to-mesenchymal transition (EMT), migration, invasion and adhesion of melanocytes. Exosomal miR-106b-5p exerted its role by targeting EphA4 to activate the ERK pathway. We demonstrated that exosomal miR-106b-5p promoted melanoma metastasis in vivo through pulmonary metastasis assay. CONCLUSIONS: Thus, melanoma cell-secreted exosomal miR-106b-5p may serve as a diagnostic indicator and potential therapeutic target in melanoma patients.