Analysis of 1782 Pediatric Hoarseness Cases: A Clinical Retrospect Study.

OBJECTIVE: This study aims to clarify the clinical characteristics of pediatric voice disorders. METHODS: The clinical data of 1782 pediatric patients presenting with voice disorders were retrospectively analyzed. These cases were categorized into four age-based cohorts: 0-3, 4-7, 8-11, and 12-15years. Variables such as gender disparities, laryngoscopic manifestation, disease types, and acoustic parameters were thoroughly examined. RESULTS: A total of 1782 children with acoustic hoarseness were included in this study, comprising 1325 males and 457 females. When the sex ratio among the children in each group was compared, males were found to outnumber females. A notable male predominance was observed across all age groups. Laryngoscopic results revealed that the most prevalent condition was vocal cord nodules (1363 cases, 76.48%), followed by vocal cord polyps (271 cases, 15.20%). Other diseases included laryngeal papillomas, vocal fold movement impairment, vocal cord cysts, functional dysphonia, leukoplakia of the vocal cords, and benign laryngeal tumors such as laryngeal amyloidosis and subglottic granular cell tumors. Among these, adenoid hypertrophy was presented in 382 children (21.44%). Additionally, the Reflux Finding Score (RFS) was conducted, and 799 cases (44.83%) were found to have a score above 7. The distribution of various diseases across different age groups indicated that children with vocal cord nodules (637 cases, 46.74%), vocal cord polyps (109 cases, 40.22%), and laryngeal papillomas (35, 36.84%) were predominantly found in the 4-7 years age group. Pediatric acute laryngitis (three cases, 75%) and vocal fold movement impairment (eight cases, 36.36%) were more common in the 0-3 years age group. Functional dysphonia (four cases, 66.67%) and vocal cord leukoplakia (four cases, 80%) were mainly observed in the 12-15 years age group, while vocal cord cysts were predominantly seen in the 8-11 years age group (four cases, 57.14%). A comparative analysis of acoustic parameters among 153 children showed statistically significant differences in jitter, fundamental frequency (F0), voice handicap index (VHI), reflux symptom index (RSI), and RFS across different pathologies. CONCLUSION: This study highlighted that vocal cord nodules, vocal cord polyps, and laryngeal papillomas were the primary causes of pediatric hoarseness, although the possibility of tumors and rare diseases cannot be disregarded. There was a noticeable gender bias towards males, and functional dysphonia was significantly more prevalent in older children.

circ-Erbb2ip from adipose-derived mesenchymal stem cell-derived exosomes promotes wound healing in diabetic mice by inducing the miR-670-5p/Nrf1 axis.

BACKGROUND: To investigate the mechanism of exosomes (Exo) secretion by hypoxic pretreated adipose-derived mesenchymal stem cells (ADSCs) promoting skin wound healing in diabetic (DM) mice. METHODS: High-throughput sequencing was used to investigate abnormal expression of circRNA in hypoxic pretreatment ADSCs exosome (HExo) and ADSCs exosome (Exo). Bioinformatics analysis and luciferase reporting analysis were used to clarify the interacted relationship among circRNA, miRNA and mRNA. EPCs cells were employ to analysis the ROS, inflammatory cytokines expression, angiogenic differentiation function under hypoxic condition by using immunofluorescence, ELISA detection and tube forming experiment. DM ulceration mice model were constructed and the therapeutic effect of Exo were detected using immunohistochemistry, immunofluorescence. RESULTS: The result show that HExo have more treatment effect than Exo in promotes cutaneous wound healing of DM mice. High-throughput sequencing found that circ-Erbb2ip play a role in HExo mediated tissues repair. Downregulation circ-Erbb2ip decreased the therapeutic effect of HExo to wound healing in diabetic mice. Bioinformatics analysis and luciferase reporting analysis confirmed that both miR-670-5p and Nrf1 were downstream targets of circ-Erbb2ip. Downregulation of Nrf1 or overexpression of miR-670-5p reversed the protective effect of circ-Erbb2ip to EPCs after exposure to high glucose microenvironment. Upregulation circ-Erbb2ip increased the therapeutic effect of Exo to wound healing in diabetic mice by increased angiogenesis and decreased ROS, inflammatory cytokines expression. CONCLUSION: In conclusion, ADSC-Exos containing circ-Erbb2ip promotes wound healing by targeting miR-670-5p/Nrf1 pathway, and their effects in promoting soft tissue wound healing warrant further study.

A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides.

Objective: To assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides. Methods: A total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left-sided paralysis and right-sided paralysis based on different disease courses (less than or more than 3 months). Results: Initially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis (p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis (p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis (p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = -2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis (p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings (p > .05). Conclusion: Overall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable. Level of Evidence: 4.

Immediate effect of recurrent laryngeal nerve stimulation in patients with idiopathic unilateral vocal fold paralysis.

BACKGROUND: There is a lack of effective treatment for idiopathic unilateral vocal fold paralysis (IUVFP). A better phonation was reported by patients after laryngeal nerve stimulation during our clinical examination. OBJECTIVES: This study aims to investigate immediate effect of recurrent laryngeal nerve (RLN) stimulation on phonation in patients with IUVFP. MATERIAL AND METHODS: Sixty-two patients with clinically identified IUVFP underwent RLN stimulation with needle electrodes. Laryngoscopy, acoustic analysis, and voice perception assessment were performed for quantitative comparison of vocal function and voice quality before and after the intervention. RESULTS: Laryngoscopic images showed a larger motion range of the paralyzed vocal fold (p < .01) and better glottal closure (p < .01) after RLN stimulation. Acoustic analysis revealed that the dysphonia severity index increased significantly (p < .01) while the jitter and shimmer decreased after the intervention (p < .05). According to perceptual evaluation, RLN stimulation significantly increased RBH grades in patients with IUVFP (p < .01). Furthermore, the improvement in voice perception had a moderate positive correlation with the decrease in the glottal closure. CONCLUSIONS AND SIGNIFICANCE: This study shows a short-term improvement of phonation in IUVFP patients after RLN stimulation, which provides proof-of-concept for trialing a controlled delivery of RLN stimulation and assessing durability of any observed responses.

Synthesis, Herbicidal Activity against Barnyard Grass, and Photolytic Behavior of Aryl 2,6-Dipyrimidinoxybenzoates.

In this study, we investigated the characteristics and herbicidal potential of bispyribac phenolic esters, which belong to the 2-(pyrimidin-2-yloxy)benzoic acid (PYB) class of acetohydroxyacid synthase (AHAS-)-inhibiting herbicides. These herbicides are primarily used for controlling Poaceae and broadleaf weeds. Among them, bispyribac-sodium stands out as a representative in this class. Surprisingly, other bispyribac esters, including alkanol and phenol esters exhibit considerably reduced herbicidal activity compared to bispyribac-sodium. In contrast, oxime esters (e.g., pyribenzoxim) demonstrate high activity. To further understand and develop novel PYB herbicides, we synthesized and screened a series of bispyribac phenolic esters while investigating their photochemical behaviors. Several compounds displayed excellent herbicidal activity, with compounds Ia-19 and Ic showing impressive 90% effective dosages for fresh weight inhibition of barnyard grass, measuring 0.55 and 0.60 g a.i./hm2, respectively. These values were approximately half of bispyribac-sodium or pyribenzoxim. The results indicate that the herbicidal activity of phenolic esters is influenced by both their binding ability to the AHAS enzyme and their decomposition into bispyribac acid. For instance, bispyribac phenol ester exhibited considerably reduced receptor affinity compared to bispyribac-sodium, and faced challenges in transforming into bispyribac acid, explaining its diminished herbicidal activity. However, introducing a photosensitive nitro group led to a complete transformation. This modification improved its affinity with AHAS and accelerated its decomposition into bispyribac acid, further accelerated by photocatalysis. Consequently, nitro-containing compounds displayed heightened herbicidal activity. The findings from this study open possibilities for structural optimization of phenolic esters through quantitative structure-activity relationship analysis, potentially regulating their activity-releasing period. Furthermore, the high activity of aromatic heterocyclic esters offers new insights into developing novel PYB herbicides.

Residue behavior and risk assessment of pyraclostrobin and tebuconazole in peppers under different growing conditions.

This study evaluates the residue behavior and risks of pyraclostrobin and tebuconazole in peppers. An analytical method for the simultaneous determination of the concentration of these fungicides in peppers was developed using ultra-high performance liquid chromatography-triple quadrupole mass spectrometry. Pepper samples were extracted with acetonitrile and cleaned with primary secondary amine and graphitized carbon black. The average recoveries of pyraclostrobin and tebuconazole under three fortification levels were 86.7-101.4% and 81.7-104.4%, with relative standard deviations of 4.0-7.2% and 3.8-10.9%, respectively. The limit of quantification of both fungicides in peppers was 0.01 mg/kg. The terminal residue trial of 30% pyraclostrobin and tebuconazole suspension concentrate was investigated for samples cultivated in open fields and greenhouses. The results showed that the terminal residues of pyraclostrobin and tebuconazole in peppers were lower than the maximum residue limits established by GB 2763-2021 (0.5 mg/kg for pyraclostrobin and 2 mg/kg for tebuconazole). The results of a statistical t-test indicated that there was no significant difference between samples grown in open fields and greenhouses. According to the international estimate of short-term intake (IESTI) calculation model, provided by the Joint FAO/WHO Meeting on Pesticide Residues, the acute dietary exposure risk of both fungicides in peppers was acceptable for the general population, with an IESTI of 0-3% and 0-5% of the acute reference dose for pyraclostrobin and tebuconazole, respectively.

Dissipation and Residue of Metalaxyl-M and Azoxystrobin in Scallions and Cumulative Risk Assessment of Dietary Exposure to Hepatotoxicity.

Metalaxyl-M and azoxystrobin have been used to control various fungal diseases on scallion and other crops. In view of the adverse toxic effects of both on the mammalian liver, it is necessary to conduct a cumulative risk assessment of their dietary exposure to consumers. The residues of metalaxyl-M and azoxystrobin on scallion were determined by a quick, easy, cheap, effective, rugged, and safe method (QuEChERS) combined with high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS). The half-lives were about 1.15 and 3.89 days, respectively, and the final residues after a seven-day harvest interval were <0.001−0.088 mg/kg and 0.190−4.687 mg/kg, respectively. The cumulative dietary risk quotient of the two fungicides to Chinese consumers calculated by the probability model is 13.94%~41.25%. According to the results of the contribution analysis, the risk posed by azoxystrobin is much greater than that of metalaxyl-M. Although metalaxyl-M and azoxystrobin do not pose a cumulative risk to Chinese consumers, the risk to children and adolescents is significantly higher than that to adults. This suggests that in future research, more consideration should be given to the cumulative risk of compounds to vulnerable groups.

A retrospective analysis of mortality in a Beijing hospital Emergency Department.

OBJECTIVE: The aim of this study was to analyze the epidemiological characteristics of mortality in the emergency department of Beijing Tongren Hospital from 2014 to 2019. METHODS: A total of 781 cases in the hospital's emergency department that resulted in mortality were retrospectively screened, and epidemiological and analytical methods were used to analyze the epidemiological characteristics and the trend of adult mortality in the emergency department of our hospital. RESULTS: Of the 781 selected cases, 448 were male, and 333 were female. Mortality rates were highest in patients aged 80-89 years, and most of the patients were retired (71.57%). Infection disease was associated with the highest mortality rate (44%), followed by cardiovascular disease and malignant tumors. CONCLUSION: Infectious diseases, cardiovascular diseases, and malignant tumors are the major threats to the lives of patients in the hospital's emergency department. The cause of death differs depending on the patient's age. KEY WORDS: Death, Emergency department, Epidemiological characteristics, Etiology, Retrospective analysis.

Study on the Features of Clinical Imaging Diagnosis of Arteriosclerotic Encephalopathy.

This paper discusses the imaging diagnostic features of arteriosclerotic encephalopathy and combines the spatial context information of local features to study the clinical imaging image copy detection algorithm. Moreover, this paper proposes a clinical imaging copy detection algorithm that combines the BOW model and spatial context embedding and a clinical imaging copy detection algorithm that combines the BOW model and global context verification. In addition, this paper applies the algorithm to the imaging diagnostic features of arteriosclerotic encephalopathy and sets up a controlled experiment to start research. The experimental research shows that the application of imaging diagnosis to the detection of subcortical arteriosclerotic encephalopathy has good clinical effects and rapid remission of patients' symptoms. The effectiveness of this method can be verified by a large number of clinical practices in follow-up studies.

[The application of NBI endoscopy in finding concealed primary lesions of misdiagnosis of oropharyngeal cancer].

Objective:The aim of this study is to analyze the application value of NBI endoscopy in finding the concealed primary lesions of misdiagnosis of oropharyngeal cancer. Methods:The clinical data of patients with missed oropharyngeal cancer treated in the Department of Otolaryngology Head and neck surgery, the Second Affiliated Hospital of Xi'an Jiaotong University from May 2018 to June 2021, were retrospectively studied, and the missed diagnosis was also analyzed combined with results of NBI endoscopy. Results:In 31 cases of misdiagnosis of oropharyngeal cancer patients, including 25 males and 6 females, there was no significant difference in age, BMI index, course of disease and TNM stage （P> 0.05）, and the pharyngeal or cervical symptoms were the first clinical manifestations of them, containing pharyngeal pain in 17 cases（54.8%） , pharyngeal foreign body sensation in 4 cases（12.9%） and unilateral cervical mass in 10 cases （32.3%）. No laryngoscopy was performed （21 cases） or no primary lesion was found by laryngoscopy （10 cases） at initial diagnosis. Among them, "inflammatory lesions" were given anti-inflammatory treatment with ineffective results or surgical resection was explored for suspicious lesions （17 cases）, or imaging examination （9 cases, including 6 cases with CT and MRI, 3 cases with PET-CT） and cervical lymph node biopsy （5 cases） were carried out for further diagnosis. According to these results, they were given ordinary laryngoscope （2 cases） or NBI endoscopy （29 cases） subsequently, finally they were confirmed as oropharyngeal squamous cellcarcinoma after localized biopsy at the suspicious lesions, indicating that the accuracy of NBI endoscopy in finding the concealed primary lesions of oropharyngeal cancer （93.55%） is significantly higher than that of ordinary electronic laryngoscope （6.45%）（χ²=43.613, P<0.01）. Conclusion:NBI endoscopy has unique advantages in finding oropharyngeal cancer in concealed parts such as tonsil, root of tongue, soft palate and lateral wall of oropharynx, which could reduce misdiagnosis of oropharyngeal cancer.

An efficient overexpression method for studying genes in Ricinus that transport vectorized agrochemicals.

BACKGROUND: Plant plasma membrane transporters play essential roles during the translocation of vectorized agrochemicals. Therefore, transporters associated with phloem loading of vectorized agrochemicals have drawn increasing attention. As a model system, castor bean (Ricinus communis L.) has been widely used to detect the phloem mobility of agrochemicals. However, there is still a lack of an efficient protocol for the Ricinus seedling model system that can be directly used to investigate the recognition and phloem loading functions of plasmalemma transporters toward vectorized agrochemicals. RESULTS: Here, using vacuum infiltration strategy, we overexpressed the coding gene for enhanced green fluorescent protein (eGFP) in R. communis seedlings by Agrobacterium tumefaciens-mediated transformation system. Strong fluorescence signals were observed in leaves, demonstrating that exogenous genes can be successfully overexpressed in seedlings. Subsequently, gene expression time and vacuum infiltration parameters were optimized. Observation of fluorescence and qRT-PCR analysis showed that eGFP strength and expression level reached a peak at 72 h after overexpression in seedlings. Parameter optimization showed Agrobacterium concentration at OD600 = 1.2, and infiltration for 20 min (0.09 MPa), return to atmospheric pressure, and then infiltration for another 20 min, were the suitable transformation conditions. To test the application of vacuum agroinfiltration in directly examining the loading functions of plasma membrane transporters to vectorized agrochemicals in seedlings, two LHT (lysine/histidine transporter) genes, RcLHT1 and RcLHT7, were overexpressed. Subcellular localization showed the strong fluorescent signals of the fusion proteins RcLHT1-eGFP and RcLHT7-eGFP were observed on the cell membrane of mesophyll cells, and their relative expression levels determined by qRT-PCR were up-regulated 47- and 52-fold, respectively. Furthermore, the concentrations of L-Val-PCA (L-valine-phenazine-1-carboxylic acid conjugate) in phloem sap collected from seedling sieve tubes were significantly increased 1.9- and 2.3-fold after overexpression of RcLHT1 and RcLHT7, respectively, implying their roles in recognition and phloem loading of L-Val-PCA. CONCLUSIONS: We successfully constructed a transient expression system in Ricinus seedlings and laid the foundation for researchers to directly investigate the loading functions of plasma membrane transporters to vectorized agrochemicals in the Ricinus system.

Effect of introducing amino acids into phenazine-1-carboxylic acid on phloem mobility.

To develop new phenazine carboxylic acid derivatives with better phloem mobility, five novel 7-amino acid substituted phenazine-1-carboxylic acids were synthesised by introducing amino acids into PCA at the 7-position. The phloem mobility experiments in Ricinus communis seedlings showed that retaining the carboxyl group of PCA and conjugating amino acids to its phenazine ring can also endow PCA with phloem mobility. Comparing our previous research, we found the amino acids substituted at 7-position on phenazine ring of PCA could clearly enhance the phloem mobility of PCA than that of amino acids conjugated with carboxyl group. Especially, the phloem transport concentration of the compound 7-L-isoleucine substituted PCA (7d) was 21 times higher than PCA-L-isoleucine conjugate (8d). These data suggest that the introduction of amino acids at different structural sites on the phenazine ring could effectively enhance the phloem mobility of PCA and it is worth a further study.

Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study.

BACKGROUND: There are conflicting research results about the survival differences between hemodialysis(HD) and peritoneal dialysis (PD). The present study estimated the survival and the relative mortality hazard for incident HD and PD patients with end stage renal disease (ESRD) in eastern China. METHODS: This study examined a cohort of patients with ESRD who initiated dialysis therapy in Zhejiang province between Jan of 2010 and Dec of 2014, followed up until the end of 2015. PD patients were matched in a 1:1 fashion with HD patients, and Kaplan-Meier analysis was used to explore the survival of them. The Cox proportional hazard regression model was applied to identify the factors that predict survival by treatment modality. Subgroup analyses were conducted by stratifying patients according to gender, age, causes of ESRD and comorbidities. RESULTS: Among a total of 22,379 enrolled patients (17,029 HD patients and 5350 PD patients), 5350 matched pairs were identified, and followed for a median of 29 months (3 ~ 72 months). Kaplan-Meier survival curve revealed that overall mortality rate was significantly higher in HD patients than in PD patients (log-rank test, P < 0.001), after adjusting by gender, age, primary causes of ESRD and comorbidities. HD was consistently associated with an increased risk for morality compared with PD in the matched cohort (adjusted hazard ratio (AHR): 1.140, 95%CI: 1.023 ~ 1.271). In subgroup analyses, male, younger patients, or nondiabetic patients aged less than 65 years after adjustment of covariates, initiating with PD was associated with a significantly lower mortality compared with HD. In the multivariate Cox proportional risks model, age, diabetic nephropathy (DN), other/unknown causes of ESRD, and patients with a history of cardiovascular disease or cancer showed statistical significance in explaining survival of incident ESRD patients. CONCLUSIONS: ESRD patients who initiated dialysis with PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged in Chinese population.

Synthesis and herbicidal activity against barnyard grass of novel diarylmethanone O-(2,6-bis((4,6-dimethoxypyrimidin-2-yl)oxy)benzoyl)oximes.

BACKGROUND: Pyribenzoxim is an excellent herbicide that can effectively control barnyard grass. However, there are few reports of its structural analogs and structure-activity relationship (SAR), which makes pyribenzoxim an isolated case. Here, a series of diarylmethanone oxime esters characterized by pyridine heterocycles were designed and synthesized for herbicidal screening and SAR investigation against barnyard grass. RESULTS: At greenhouse treatment concentrations of 1.17-37.5 µg mL-1 , the title compounds showed a positive dose-toxicity correlation toward barnyard grass plants, with the damage becoming progressively more serious over time. At a concentration of 18.75 µg mL-1 and above, obvious damage was observed in 3 days, most plants died in 7 days, and all died in 14 days. Different degrees of damage were also seen when the concentration was lower than 9.38 µg mL-1 . The selected compounds 5-20 and 5-21 showed excellent control against Echinochloa crusgalli (L.) Beauv., Leptochloa chinensis (L.) Nees, Cyperus difformis L. and Lindernia procumbens (Krock.) Philcox in paddy fields, which was slightly better than that of pyribenzoxim. CONCLUSION: SAR analysis of greenhouse data revealed that the type and position of substituents on aromatic rings greatly influenced the activity of the compounds, although log P values showed no obvious correlation with activity. Combined with compounds 5-20 and 5-21, which showed moderate and excellent activity in greenhouse experiments, and excellent activity in controlling barnyard grass in the field, we conclude that pyribenzoxim analogs probably act as prodrugs, and this could be a focus of attention in future studies on structural optimization of the herbicide. © 2020 Society of Chemical Industry.

The relationship between hemodialysis mortality and the Chinese medical insurance type.

Objectives: In China, there are two major medical insurance models: the Urban Basic Medical Insurance (UBMI) and the New Cooperative Medical Scheme (NCMS). The aim of the present study was to evaluate the association of the medical insurance type of patients undergoing hemodialysis (HD) with their survival.Methods: We retrospectively analyzed the end-stage renal disease adult patients initiating HD between January 2010 and December 2014 in Zhejiang province, followed up through 31 December 2015. Patients who had received HD for over 3 months were separated into two groups, based on different medical insurance type. Demographic, clinical data, and clinical outcomes were analyzed. The survival rates were calculated by using the Kaplan-Meier method.Results: A total of 6779 patients (59 ± 16 years old, 4331 males (63.9%)) with UBMI and 7177 (59 ± 16 years old, 3778 males (52.8%)) with NCMS enrolled from 226 hemodialysis units. Compared with UBMI group, patients with NCMS had a smaller percentage of hypertensive nephropathy, diabetes mellitus and arteriovenous fistula, faced with more problems in anemia, hypoalbuminemia and metabolism of calcium and phosphorous. The 1-, 3- and 5-year survival rates were 95.4, 84.4, and 74.1% in UBMI group, 93.1, 79.7, and 67.7% in NCMS group, respectively. Patients with NCMS showed higher all-cause mortality compared with UBMI (p < 0.001). In multivariate Cox proportional hazards model, NCMS was independently associated with higher mortality (AHR = 1.53; 95% CI 1.38 ∼ 1.68).Conclusions: The medical insurance model was independently associated with HD patient survival, NCMS was associated with increased mortality among patients undergoing maintenance hemodialysis in China.

The relationship between hemodialysis mortality and the Chinese medical insurance type.

Objective: In China, there are two major medical insurance models: the Urban Basic Medical Insurance (UBMI) and the New Cooperative Medical Scheme (NCMS). The aim of the present study was to evaluate the association of the medical insurance type of patients undergoing hemodialysis (HD) with their survival. Methods: We retrospectively analyzed the end-stage renal disease adult patients initiating HD between January 2010 and December 2014 in Zhejiang province, followed up through 31 December 2015. Patients who had received HD for over 3 months were separated into two groups, based on different medical insurance type. Demographic, clinical data, and clinical outcomes were analyzed. The survival rates were calculated by using the Kaplan-Meier method. Results: A total of 6779 patients (59 ± 16 years old, 4331 males (63.9%)) with UBMI and 7177 (59 ± 16 years old, 3778 males (52.8%)) with NCMS enrolled from 226 hemodialysis units. Compared with UBMI group, patients with NCMS had a smaller percentage of hypertensive nephropathy, diabetes mellitus and arteriovenous fistula, faced with more problems in anemia, hypoalbuminemia and metabolism of calcium and phosphorous. The 1-, 3- and 5-year survival rates were 95.4%, 84.4%, and 74.1% in UBMI group, 93.1%, 79.7%, and 67.7% in NCMS group, respectively. Patients with NCMS showed higher all-cause mortality compared with UBMI (p < .001). In multivariate Cox proportional hazards model, NCMS was independently associated with higher mortality (AHR = 1.53; 95% CI 1.38 ∼ 1.68). Conclusions: The medical insurance model was independently associated with HD patient survival, NCMS was associated with increased mortality among patients undergoing maintenance hemodialysis in China.

The influence of steric configuration of phenazine-1-carboxylic acid-amino acid conjugates on fungicidal activity and systemicity.

BACKGROUND: Conjugating an amino acid onto existing fungicidal parent structures has been demonstrated to be an effective way to endow non-phloem mobile fungicides with phloem mobility. To alter the systemicity of the fungicide PCA (phenazine-1-carboxylic acid), 10 amino acids derivatives of this fungicide were designed and synthesized, and their synthesis, characterization, phloem and xylem mobility in Ricinus communis L, and their fungicidal activity in vitro are described. RESULTS: The systemicity experiments in Ricinus communis system demonstrated that all conjugates exhibited obvious phloem mobility compared with non-phloem-mobile PCA, and the introduction of an L-amino acid to PCA more greatly enhanced the phloem mobility. The five D-amino acid conjugates exhibited higher xylem mobility than that of PCA and of each corresponding L-amino acid conjugate. Most conjugates were found to exhibit moderate in vitro fungicidal activities against six pathogenic fungi, which were lower than that of PCA. The results of the bioassay showed fungicidal activities of PCA-amino acid conjugates associated not only with different amino acids, but also with their conformation. Conjugation with D-amino acid contributed to the in vitro fungicidal activities of PCA-amino acid conjugates. CONCLUSIONS: The current research offers a new strategy for enhancing the systemicity of non-phloem-mobile fungicides and presents some useful information on the effects of introducing amino acids of different steric configurations on the fungicidal activity, phloem and xylem mobility of the parent fungicide. © 2019 Society of Chemical Industry.

Synthesis and bioactivities of diamide derivatives containing a phenazine-1-carboxamide scaffold.

Taking natural product phenazine-1-carboxamide (PCN) as a lead compound, a series of novel phenazine-1-carboxylic acid diamide derivatives were designed and synthesised. Their structures were confirmed by 1H-NMR and HRMS. The bioassays showed that some of the target compounds exhibited promising in vitro fungicidal activities, and exhibited excellent and selective herbicidal activities. Particularly, compounds c, h, o and s displayed root length inhibition activities against barnyard grass with the rate of more than 80%. Compound c exhibited the best activity among all the target compounds against barnyard grass stalk length with the IC50 value of 0.158 mmol/L, and compound o exhibited the best and wide spectrum inhibition against barnyard grass root length and rape in both root length and stalk length herbicidal activities with its IC50 values of 0.067, 0.048 and 0.059 mmol/L respectively. The analysis of preliminary Structure-Activity Relationships provides the theoretical basis for further design of phenazine-1-carboxylic acid.

Design, synthesis and biological activity of hydroxybenzoic acid ester conjugates of phenazine-1-carboxylic acid.

We prepared 16 novel hydroxybenzoic acid ester conjugates of phenazine-1-carboxylic acid (PCA) and investigated their biological activity. Most of the synthesized conjugates displayed some level of fungicidal activities in vitro against five phytopathogenic fungi. Nine conjugates 5b, 5c, 5d, 5e, 5h, 5i, 5m, 5n and 5o (EC50 between 3.2 µg/mL and 14.1 µg/mL) were more active than PCA (EC50 18.6 µg/mL) against Rhizoctonia solani. Especially conjugate 5c showed the higher fungicidal activity against Rhizoctonia solani which is 6.5-fold than PCA. And the results of the bioassay indicated that the fungicidal activity of conjugates was associated with their LogP, and the optimal LogP values of the more potent fungicidal activities within these conjugates ranged from 4.42 to 5.08. The systemic acquired resistance induced by PCA-SA ester conjugate 5c against rice sheath blight disease in rice seedlings was evaluated. The results revealed that PCA-SA ester conjugate 5c retained the resistance induction activity of SA against rice sheath blight.