Investigating the molecular mechanisms between type 1 diabetes and mild cognitive impairment using bioinformatics analysis, with a focus on immune response.

The immune system is involved in the development and progression of several diseases. Type 1 diabetes mellitus (T1DM), an autoimmune disorder, influences the progression of several other conditions; however, the link between T1DM and mild cognitive impairment (MCI) remains unclear. This study investigated the underlying immune response mechanisms that contribute to the development and progression of T1DM and MCI. Microarray datasets for MCI (GSE63060) and T1DM (GSE30208) were retrieved from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified using the limma package. To explore the functional implications of these DEGs, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted using ClusterProfiler. Protein-protein interaction networks for the DEGs were constructed using the STRING database and visualized using Cytoscape. The Molecular Complex Detection algorithm was used to analyze DEGs. Immune cell infiltration in patients with T1DM and MCI was analyzed using the xCell method. Gene set enrichment analysis was used to gain in-depth insights into the functional characteristics of T1DM and MCI. Immune-related genes were obtained from the GeneCards and ImmPort databases. Machine learning algorithms were used to identify potential hub genes associated with immunity for T1DM and MCI diagnosis, and the diagnostic value was assessed using the receiver operating characteristic curve. The identified genes were validated using quantitative polymerase chain reaction. In the T1DM and MCI datasets, 610 DEGs showed consistent trends, of which 232 and 378 were upregulated and downregulated, respectively. Immune response analysis revealed significant changes in the immune cells associated with MCI and T1DM. Using immune-related genes, DEGs, and machine learning techniques, we identified CD3D in the MCI and T1DM groups. We observed a gradual decline in the cognitive function of mice with T1DM as the disease progressed. CD3D expression increased with increasing disease severity; CD3D primarily affected CD4+ T cells. This study revealed a complex interaction between T1DM and MCI, providing novel insights into the intricate relationship between immune dysregulation and cognitive impairment and expanding our understanding of these two interconnected disorders. These findings will facilitate the development of therapeutic interventions and identification of potential therapeutic targets.

Perfect Is Perfect: Nickel Prussian Blue Analogue as A High-Efficiency Electrocatalyst for Hydrogen Peroxide Production.

Prussian blue analogues (PBA) are a large family of functional materials with diverse applications such as in electrochemical fields. However, their use in the emerging two-electron oxygen reduction reaction for clean production of hydrogen peroxide (H2O2) is lagging. Herein, a general solvent exchange induced reconstruction strategy is demonstrated, through which an abnormal NiNi-PBA superstructure is synthesized as a high-performance electrocatalyst for H2O2 generation. The resultant NiNi-PBA superstructure has a stoichiometric composition with saturated lattice water, and a leaf-like morphology composed of interconnected small-size nanosheets with identical orientation and predominate {210} side surface exposure. Our studies show that the Ni-N centers on {210} facets are the active sites, and the saturated lattice H2O favors a six-coordinated environment that results in high selectivity. The "perfect" structure including stoichiometric composition and ideal facet exposure leads to a high selectivity of ~100% and H2O2 yield of 5.7 mol g-1 h-1, superior to the reported MOF-based electrocatalysts and most other electrocatalysts.

MOF-on-MOF Heterostructured Electrocatalysts for Efficient Nitrate Reduction to Ammonia.

Electrocatalytic nitrate reduction reaction (NO3 -RR) is an important route for sustainable NH3 synthesis and environmental remediation. Metal-organic frameworks (MOFs) are one family of promising NO3 -RR electrocatalysts, however, there is plenty of room to improve in their performance, calling for new design principles. Herein, a MOF-on-MOF heterostructured electrocatalyst with interfacial dual active sites and build-in electric field is fabricated for efficient NO3 -RR to NH3 production. By growing Co-HHTP (HHTP=2,3,6,7,10,11-hexahydroxytriphenylene) nanorods on Ni-BDC (BDC=1,4-benzenedicarboxylate) nanosheets, experimental and theoretical investigations demonstrate the formation of Ni-O-Co bonds at the interface of MOF-on-MOF heterostructure, leading to dual active sites tailed for NO3 -RR. The Ni sites facilitate the adsorption and activation of NO3 -, while the Co sites boost the H2O decomposition to supply active hydrogen (Hads) for N-containing intermediates hydrogenation on adjacent Ni sites, cooperatively reducing the energy barriers of NO3 -RR process. Together with the accelerated electron transfer enabled by built-in electric field, remarkable NO3 -RR performance is achieved with an NH3 yield rate of 11.46 mg h-1 cm-2 and a Faradaic efficiency of 98.4 %, outperforming most reported MOF-based electrocatalysts. This work provides new insights into the design of high-performance NO3 -RR electrocatalysts.

Enabling Logistics Automation in Nanofactory: Cobalt Phosphide Embedded Metal-Organic Frameworks for Efficient Electrocatalytic Nitrate Reduction to Ammonia.

Electrocatalytic nitrate reduction reaction (NitRR) in neutral condition offers a promising strategy for green ammonia synthesis and wastewater treatment, the rational design of electrocatalysts is the cornerstone. Inspired by modern factory design where both machines and logistics matter for manufacturing, it is reported that cobalt phosphide (CoP) nanoparticles embedded in zinc-based zeolite imidazole frameworks (Zn-ZIF) function as a nanofactory with high performance. By selective phosphorization of ZnCo bimetallic zeolite imidazole framework (ZnCo-ZIF), the generated CoP nanoparticles act as "machines" (active sites) for molecular manufacturing (NO3 - to NH4 + conversion). The purposely retained framework (Zn-ZIFs) with positive charge promotes logistics automation, i.e., the automatic delivery of NO3 - reactants and timely discharge of NH4 + products in-and-out the nanofactory due to electrostatic interaction. Moreover, the interaction between Zn-ZIF and CoP modulates the Co sites into electron insufficient state with upshifted d-band center, facilitating the reduction/hydrogenation of NO3 - to ammonia and restricting the competitive hydrogen evolution. Consequently, the assembled CoP/Zn-ZIF nanofactory exhibits superior NitRR performances with a high Faraday efficiency of ≈97% and a high ammonia yield of 0.89 mmol cm-1 h-1 in neutral condition, among the best of reported electrocatalysts. The work provides new insights into the design principles of efficient NitRR electrocatalysts.

Genetic or pharmacologic blockade of mPGES-2 attenuates renal lipotoxicity and diabetic kidney disease by targeting Rev-Erbα/FABP5 signaling.

Diabetic kidney disease (DKD) is one of the most common complications of diabetes, and no specific drugs are clinically available. We have previously demonstrated that inhibiting microsomal prostaglandin E synthase-2 (mPGES-2) alleviated type 2 diabetes by enhancing ß cell function and promoting insulin production. However, the involvement of mPGES-2 in DKD remains unclear. Here, we aimed to analyze the association of enhanced mPGES-2 expression with impaired metabolic homeostasis of renal lipids and subsequent renal damage. Notably, global knockout or pharmacological blockage of mPGES-2 attenuated diabetic podocyte injury and tubulointerstitial fibrosis, thereby ameliorating lipid accumulation and lipotoxicity. These findings were further confirmed in podocyte- or tubule-specific mPGES-2-deficient mice. Mechanistically, mPGES-2 and Rev-Erbα competed for heme binding to regulate fatty acid binding protein 5 expression and lipid metabolism in the diabetic kidney. Our findings suggest a potential strategy for treating DKD via mPGES-2 inhibition.

Robust Covalent Organic Framework Photocatalysts for H2O2 Production: Linkage Position Matters.

Covalent organic frameworks (COFs) are promising photocatalysts for hydrogen peroxide (H2O2) synthesis. However, the nature of organic polymers makes the balance between high activity and stability challenging. We demonstrate that the linkage position matters in the design of robust COF photocatalysts with durable high activity without sacrificial reagents. COFs with ortho- and para-linkages (o-COFs and p-COFs) were constructed by 1,3,5-triformylphloroglucinol with benzene-, pyridine-, pyrazine-orthodiamines and paradiamines. The pyrzaine-containing o-COFs with two pyridinic nitrogen atoms exhibited a H2O2 production rate of 4396 µmol g-1 h-1 together with long-time continuous H2O2 photosynthesis performance in pure water (48 h), superior to the corresponding p-COFs. A four-step reaction mechanism is proposed by density function calculations. Moreover, the active sites and origin of stability enhancement for o-COFs are clarified. This work provides a simple and effective molecular design strategy in the design of robust COF photocatalysts for artificial H2O2 photosynthesis.

Efficacy and safety of standardized Ginkgo biloba extract as adjuvant therapy for intracerebral hemorrhage in China: A systematic review and meta-analysis.

Objective: The aim of this study was to systematically review the clinical efficacy and safety of standardized Ginkgo biloba extract (GBE) in the adjuvant treatment of intracerebral hemorrhage (ICH). Methods: Relevant RCTs on GBE as adjuvant therapy for ICH were searched in seven Chinese and English databases. Data extraction of the included literature was performed after duplicate checking and screening, and Stata 15.1 software was applied for data analysis. Results: With a total of 19 RCTs, the meta-analysis results showed that: Compared with conventional treatment alone, GBE combined with conventional treatment had a higher effective rate; NIHSS score and CSS score were lower; The residual hematoma was less. The volume of cerebral edema was smaller. ADL score was higher. MoCA score was higher. The serum levels of hs-CRP, TNF-α and IL-6 were lower; No significant difference was observed in the incidence of adverse reactions between conventional treatment alone and GBE combined with conventional treatment. Conclusion: This study suggests that GBE as adjuvant therapy for ICH has better efficacy and is relatively safe compared with conventional treatment alone. However, due to the quality and quantity of included studies, further validation by more methodologically rigorous and multi-center studies with larger sample sizes is needed.

Epitaxial growth of metal-organic framework nanosheets into single-crystalline orthogonal arrays.

Construction of two-dimensional nanosheets into three-dimensional regular structures facilitates the mass transfer and exploits the maximum potential of two-dimensional building blocks in applications such as catalysis. Here, we report the synthesis of metal-organic frameworks with an orthogonal nanosheet array. The assembly involves the epitaxial growth of single crystalline metal-organic framework nanosheets with a naturally non-preferred facet exposure as the shell on a cubic metal-organic framework as the core. The nanosheets, despite of two typical shapes and crystallographic orientations, also form a single crystalline orthogonally arrayed framework. The density and size of nanosheets in the core-shell-structured composite metal-organic frameworks can be well adjusted. Moreover, metal-organic frameworks with a single composition and hollow orthogonal nanosheet array morphology can be obtained. Benefiting from the unusual facet exposure and macroporous structure, the designed structure exhibits improved electrocatalytic oxygen evolution activity compared to conventional nanosheets.

Microwave treatment on structure and digestibility characteristics of Spirulina platensis protein.

As a novel protein resource, the low digestibility of Spirulina platensis protein (SPP) limits its large-scale application. From the perspective of food processing methods, different heating treatments were explored to improve the structure and digestibility of SPP. In this study, SPP was heated by water bath and microwave at the same heating rate and heating temperature. Microwave accelerated protein denaturation and structure unfolded as the heating intensity increases, causing more exposed hydrophobic residues and enhancing surface hydrophobicity. The data of free sulfhydryl group, particle size, and gel electrophoresis, showed that microwave treatment promoted the formation of protein aggregates. The structural changes can potentially improve the accessibility of digestive enzymes, promote the in vitro digestibility rate, and further accelerate the production of small molecular peptides and the release of free amino acids. This study provided an innovative approach to improve the digestibility and therefore the utilization efficiency of SPP.

Gastrodin ameliorates cognitive dysfunction in diabetes by inhibiting PAK2 phosphorylation.

Diabetes is associated with higher prevalence of cognitive dysfunction, while the underlying mechanism is still elusive. In this study, we aim to explore the potential mechanism of diabetes-induced cognitive dysfunction and assess the therapeutic effects of Gastrodin on cognitive dysfunction. Diabetes was induced by a single injection of streptozotocin. The Morris Water Maze Test was employed to assess the functions of spatial learning and memory. Transcriptome was used to identify the potential factors involved. Western blot and immunofluorescence were applied to detect the protein expression. Our results have shown that spatial learning was impaired in diabetic rats, coupled with damaged hippocampal pyramidal neurons. Gastrodin intervention ameliorated the spatial learning impairments and neuronal damages. Transcriptomics analysis identified differential expression genes critical for diabetes-induced hippocampal damage and Gastrodin treatment, which were further confirmed by qPCR and western blot. Moreover, p21 activated kinase 2 (PAK2) was found to be important for diabetes-induced hippocampal injury and its inhibitor could promote the survival of primary hippocampal neurons. It suggested that PAK2 pathway may be involved in cognitive dysfunction in diabetes and could be a therapeutic target for Gastrodin intervention.

A novel rat model of Dravet syndrome recapitulates clinical hallmarks.

Dravet syndrome (DS) is a debilitating infantile epileptic encephalopathy characterized by seizures induced by high body temperature (hyperthermia), sudden unexpected death in epilepsy (SUDEP), cognitive impairment, and behavioral disturbances. The most common cause of DS is haploinsufficiency of the SCN1A gene, which encodes the voltage-gated sodium channel Nav1.1. In current mouse models of DS, the epileptic phenotype is strictly dependent on the genetic background and most mouse models exhibit drastically higher SUDEP rates than patients. Therefore, we sought to develop an alternative animal model for DS. Here, we report the generation and characterization of a Scn1a halploinsufficiency rat model of DS by disrupting the Scn1a allele. Scn1a+/- rats show reduced Scn1a expression in the cerebral cortex, hippocampus and thalamus. Homozygous null rats die prematurely. Heterozygous animals are highly susceptible to heat-induced seizures, the clinical hallmark of DS, but are otherwise normal in survival, growth, and behavior without seizure induction. Hyperthermia-induced seizures activate distinct sets of neurons in the hippocampus and hypothalamus in Scn1a+/- rats. Electroencephalogram (EEG) recordings in Scn1a+/- rats reveal characteristic ictal EEG with high amplitude bursts with significantly increased delta and theta power. After the initial hyperthermia-induced seizures, non-convulsive, and convulsive seizures occur spontaneously in Scn1a+/- rats. In conclusion, we generate a Scn1a haploinsufficiency rat model with phenotypes closely resembling DS, providing a unique platform for establishing therapies for DS.

H4S47 O-GlcNAcylation regulates the activation of mammalian replication origins.

The transmission and maintenance of genetic information in eukaryotic cells relies on the faithful duplication of the entire genome. In each round of division, excessive replication origins are licensed, with only a fraction activated to give rise to bi-directional replication forks in the context of chromatin. However, it remains elusive how eukaryotic replication origins are selectively activated. Here we demonstrate that O-GlcNAc transferase (OGT) enhances replication initiation by catalyzing H4S47 O-GlcNAcylation. Mutation of H4S47 impairs DBF4-dependent protein kinase (DDK) recruitment on chromatin, causing reduced phosphorylation of the replicative helicase mini-chromosome maintenance (MCM) complex and compromised DNA unwinding. Our short nascent-strand sequencing results further confirm the importance of H4S47 O-GlcNAcylation in origin activation. We propose that H4S47 O-GlcNAcylation directs origin activation through facilitating MCM phosphorylation, and this may shed light on the control of replication efficiency by chromatin environment.

Speech2EEG: Leveraging Pretrained Speech Model for EEG Signal Recognition.

Identifying meaningful brain activities is critical in brain-computer interface (BCI) applications. Recently, an increasing number of neural network approaches have been proposed to recognize EEG signals. However, these approaches depend heavily on using complex network structures to improve the performance of EEG recognition and suffer from the deficit of training data. Inspired by the waveform characteristics and processing methods shared between EEG and speech signals, we propose Speech2EEG, a novel EEG recognition method that leverages pretrained speech features to improve the accuracy of EEG recognition. Specifically, a pretrained speech processing model is adapted to the EEG domain to extract multichannel temporal embeddings. Then, several aggregation methods, including the weighted average, channelwise aggregation, and channel-and-depthwise aggregation, are implemented to exploit and integrate the multichannel temporal embeddings. Finally, a classification network is used to predict EEG categories based on the integrated features. Our work is the first to explore the use of pretrained speech models for EEG signal analysis as well as the effective ways to integrate the multichannel temporal embeddings from the EEG signal. Extensive experimental results suggest that the proposed Speech2EEG method achieves state-of-the-art performance on two challenging motor imagery (MI) datasets, the BCI IV-2a and BCI IV-2b datasets, with accuracies of 89.5% and 84.07% , respectively. Visualization analysis of the multichannel temporal embeddings show that the Speech2EEG architecture can capture useful patterns related to MI categories, which can provide a novel solution for subsequent research under the constraints of a limited dataset scale.

Spatial Specific Janus S-Scheme Photocatalyst with Enhanced H2 O2 Production Performance.

Photocatalytic oxygen reduction reaction (ORR) for H2 O2 production in the absence of sacrificing agents is a green approach and of great significance, where the design of photocatalysts with high performance is the central task. Herein, a spatial specific S-scheme heterojunction design by introducing a novel semiconducting pair with a S-scheme mechanism in a purpose-designed Janus core-shell-structured hollow morphology is reported. In this design, TiO2 nanocrystals are grown inside the inner wall of resorcinol-formaldehyde (RF) resin hollow nanocakes with a reverse bumpy ball morphology (TiO2 @RF). The S-scheme heterojunction preserves the high redox ability of the TiO2 and RF pair, the spatial specific Janus design enhances the charge separation, promotes active site exposure, and reduces the H2 O2 decomposition to a large extent. The TiO2 @RF photocatalyst shows a high H2 O2 yield of 66.6 mM g-1  h-1 and solar-to-chemical conversion efficiency of 1.11%, superior to another Janus structure (RF@TiO2 ) with the same heterojunction but a reversed Janus spatial arrangement, and most reported photocatalysts under similar reaction conditions. The work has paved the way toward the design of next-generation photocatalysts for green synthesis of H2 O2 production.

Crystal Engineering Enables Cobalt-Based Metal-Organic Frameworks as High-Performance Electrocatalysts for H2O2 Production.

Metal-organic frameworks (MOFs) with highly adjustable structures are an emerging family of electrocatalysts in two-electron oxygen reduction reaction (2e-ORR) for H2O2 production. However, the development of MOF-based 2e-ORR catalysts with high H2O2 selectivity and production rate remains challenging. Herein, an elaborate design with fine control over MOFs at both atomic and nano-scale is demonstrated, enabling the well-known Zn/Co bimetallic zeolite imidazole frameworks (ZnCo-ZIFs) as excellent 2e-ORR electrocatalysts. Experimental results combined with density functional theory simulation have shown that the atomic level control can regulate the role of water molecules participating in the ORR process, and the morphology control over desired facet exposure adjusts the coordination unsaturation degree of active sites. The structural regulation at two length scales leads to synchronous control over both the kinetics and thermodynamics for ORR on bimetallic ZIF catalysts. The optimized ZnCo-ZIF with a Zn/Co molar ratio of 9/1 and predominant {001} facet exposure exhibits a high 2e- selectivity of ∼100% and a H2O2 yield of 4.35 mol gcat-1 h-1. The findings pave a new avenue toward the development of multivariate MOFs as advanced 2e-ORR electrocatalysts.

Extremely dangerous hypopituitarism related long QT syndrome and transient ST-segment elevation: A case report.

Acquired long QT syndrome caused by hypopituitarism and transient ST-segment elevation has not been reported in cardiac arrest patients. We report a case of extremely dangerous acquired long QT syndrome and transient ST-segment elevation. A 44-year-old Chinese woman with renal failure experienced sudden cardiac arrest in the haemodialysis room. Subsequent electrocardiogram showed QT prolongation and transient ST-segment elevation. This patient's medical history, subsequent laboratory results and pituitary magnetic resonance imaging suggested hypopituitarism. Transient ST-segment elevation on the electrocardiogram was considered to be caused by repeated direct current shocks. The patient was diagnosed with acquired long QT syndrome and was not taking any antiarrhythmic drugs. Her corrected QT interval normalized after hormone replacement therapy. This case highlights the importance of the awareness of hypopituitarism; early identification and intervention can prevent the occurrence of this life-threatening arrhythmia. ST-segment elevation is not always due to acute myocardial infarction, and a variety of other causes, especially electrical cardioversion, should be considered.

A missed case of hereditary hemorrhagic telangiectasia: A case report.

Hereditary hemorrhagic telangiectasia is a rare autosomal dominant disorder characterized by abnormal blood vessel formation. When an abnormal vascular architecture affects the lungs and central nervous system, serious complications can occur. We report a missed case of hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations and cerebral arteriovenous malformations. A 22-year-old Chinese female was taken to the emergency room because of unconsciousness. Emergency head contrast-enhanced computed tomography and transthoracic contrast echocardiography showed that she had cerebral arteriovenous malformations and pulmonary arteriovenous malformations. The patient experienced multiple spontaneous epistaxis since childhood, for which she was treated at a local hospital for a brief period. Her mother also had pulmonary arteriovenous malformations. The patient was diagnosed with hereditary hemorrhagic telangiectasia according to the consensus Curaçao diagnostic criteria and eventually died of hereditary hemorrhagic telangiectasia. The case report highlights the importance of early diagnosis and intervention for hereditary hemorrhagic telangiectasia. Given that hereditary hemorrhagic telangiectasia is frequently undiagnosed, increasing the physician's awareness of hereditary hemorrhagic telangiectasia can play an important role in the timely diagnosis and treatment of these patients.

Modified Cap-Assisted Endoscopic Mucosal Resection Versus Endoscopic Submucosal Dissection for the Treatment of Rectal Neuroendocrine Tumors ≤10 mm: A Randomized Noninferiority Trial.

INTRODUCTION: Although recent guidelines recommend endoscopic resection of rectal neuroendocrine tumors (NET) ≤10 mm, there is no consensus on which endoscopic modality should be performed. We aimed to compare the safety and efficacy of modified cap-assisted endoscopic mucosal resection (mEMR-C) and endoscopic submucosal dissection (ESD) methods for the treatment of rectal NET ≤10 mm. METHODS: A randomized noninferiority trial comparing mEMR-C and ESD was conducted. The primary outcome was the histological complete resection rate; the secondary outcomes included en bloc resection rate, operation time, complications, and so on. Subgroup analyses and follow-up were also performed. RESULTS: Ninety patients were enrolled, and 79 patients with pathologically confirmed rectal NET were finally analyzed, including 38 cases of mEMR-C and 41 cases of ESD. Histological complete resection rate was 97.4% in the mEMR-C group and 92.7% in the ESD group. The noninferiority of mEMR-C compared with that of ESD was confirmed because the absolute difference was 4.7% (2-sided 90% confidence interval, -3.3% to 12.2%; P = 0.616). En bloc resection and successful removal of rectal NET were achieved in all patients. Advantages of mEMR-C over ESD included shorter operation time (8.89 ± 4.58 vs 24.8 ± 9.14 minutes, P < 0.05) and lower hospitalization cost ($2,233.76 ± $717.70 vs $2,987.27 ± $871.81, P < 0.05). Postoperative complications were recorded in 4 patients who received mEMR-C and 2 patients in the ESD group (11.5% vs 4.9%, P = 0.509), which were all well managed using endoscopy. Similar findings were observed when subgroup analysis was performed. DISCUSSION: mEMR-C is noninferior to ESD with a similar complete resection rate. In addition, mEMR-C had shorter procedure duration time and lower hospitalization costs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03982264.

Morphological Anisotropy in Metal-Organic Framework Micro/Nanostructures.

Anisotropy plays a unique role in the structural regulation of metal-organic frameworks (MOFs) and their composites, especially at the micro- and nanoscale. However, there is a lack of a understanding of MOF micro/nanoparticles (MNPs) from the perspective of morphological anisotropy. In this Minireview, recent advances in anisotropic MOF MNPs are summarized, with a focus on how morphological anisotropy leads to innovative structures and modulates properties. First, anisotropic pristine MOF MNPs with diverse morphologies are introduced and classified by their morphology-dependent and morphology-independent anisotropy. Secondly, the anisotropy-enabled site-selective higher-order construction of MOF-based materials is highlighted. Finally, challenges and prospects for anisotropic MOFs are discussed, aiming to provide inspiration for further developments in this interesting research field.

Two-minute walk distance reference equations for middle-aged and elderly Chinese individuals with obesity.

BACKGROUND AND OBJECTIVE: While the six-minute walk test (6MWT) is often used to assess exercise capacity, the less well-known two-minute walk test (2MWT) is more feasible for some patients. In previous studies, we developed reference equations for the two-minute walk distance (2MWD) for healthy Chinese adults. However, our study did not recruit people with obesity, and the reference equations did not apply to participants with a body mass index (BMI) > 30 kg/m2. The main objective of this study was to establish reference equations for the 2MWD among middle-aged and elderly Chinese individuals with obesity. METHODS: A total of 295 individuals were recruited. The participants underwent two 2MWTs, with the longer of the two 2MWDs used for further analyses. The reference equations for the 2MWD were developed using stepwise multiple regression analysis. The newly established equations for the 2MWD were then compared with the existing equations. RESULTS: The mean 2MWD of the participants was 176±20 m. Age and BMI were identified as independent factors that influenced the 2MWD and explained 28% and 32% of the variance in walking distance for the male and female groups, respectively. The reference equations for the 2MWD were as follows: [Formula: see text]. CONCLUSION: This study resulted in the development of reference equations for predicting 2MWD among middle-aged and elderly Chinese people with obesity. These equations will be a clinically valuable tool for evaluating functional capacity, determining prognoses and monitoring treatment in middle-aged and elderly Chinese people with obesity.