Development of pH-responsive intelligent films based on κ-carrageenan/straw lignin and anthocyanin from Padus virginiana peel for real-time monitoring of chicken.

A series of intelligent films with pH-responsive properties were prepared using Padus virginiana peel extract (PVE) as a smart response factor, κ-carrageenan (κC) as a matrix, and complexed with rice straw lignin (SL). Following the addition of 5 mL PVE at a concentration of 430.99 mg/L, tensile strength and elongation at break of the films increased to a maximum value of 21.25 ± 0.75 MPa and 24.04 ± 0.69 %, respectively. The water vapour permeability of the films decreased with increasing PVE addition, and the minimum value was 5.85 ± 0.09 × 10-11 g m-1 s-1 Pa-1. All the films had favourable thermal stability, transparency, haze and antioxidant properties. PVE-containing films all exhibited excellent pH and ammonia response properties. The higher the humidity of the environment, the faster the ammonia response, and the films were capable of rapid discoloration at 75 % relative humidity. κC/SL-PVE5 can be used to monitor the freshness of chicken breast meat. When the total volatile basic nitrogen of chicken breast meat was increased to 14.27 mg/100 g, κC/SL-PVE5 changed from pink to greyish-yellow. In conclusion, κC/SL-PVE intelligent films hold great promise for real-time monitoring of meat freshness.

Cassia Seed Gum Films Incorporated with Partridge Tea Extract as an Edible Antioxidant Food Packaging Film for Preservation of Chicken Jerky.

The use of edible packaging films to delay food spoilage has attracted widespread attention. In this study, partridge tea extract (PTE) was added to cassia gum (CG) to prepare CG/PTE films. The microstructure, optical, mechanical, barrier, and antioxidant properties of CG/PTE films were investigated, and the effect of PTE on CG films was shown. The films had high transparency and smooth surface structure. Additionally, PTE significantly improved the elongation at break and antioxidant activity of films. At 2.5% of PTE, the 2,2-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging rate of the film was 46.88% after diluting 50 times, indicating excellent antioxidant property, which could be applied to food preservation. After 9 days of storage, the thiobarbituric acid reactive substances values (TBARS) of chicken jerk packaged with films containing 0% and 2.5% PTE increased from 0.12% to 1.04% and 0.11% to 0.40%, respectively. This study suggests that CG/PTE films can be used to preserve cooked meat.

Optimizing the medical equipment investment in primary care centres in rural China: evidence from a panel threshold model.

BACKGROUND: The previous "one-size-fits-all" practice in resource allocation can no longer adapt to the spatial variation in population and health needs. This study aimed to investigate the spatially heterogeneous effect of medical equipment investment in the township health centres in rural China to optimize the investment strategies. METHODS: Based on the national-scale stratified multistage cluster sampling, 319 township health centres from six provinces were included in the study. The retrospective data from 2013 to 2017 were collected for each sampled township health centres and the corresponding township community. The panel threshold regression model was applied to estimate the nonlinear effect of medical equipment increment on the service utilization due to the township communities' urbanization degree. The influence of township community remoteness on the effects of equipment increment was investigated through subgroup analysis. RESULTS: Among the township health centres in the neighbouring towns of the county seat (travel time to the county seat < 1 h), the significant effect of medical equipment increment was only found in the township health centres of the towns with high urbanization degrees (the proportion of the residents living in the built-up area > 69.89%), of which the effect size was 774.81 (95% CI 495.63, 1053.98, p < 0.05). Among the township health centres in the remote towns (travel time ≥ 1 h), the effect of medical equipment increment in the township health centres of the low urbanized towns (urban ≤ 5.99%, ß = 1052.54, p < 0.01) was around four times the size of that of the counterparts (urban > 5.99%, ß = 237.00, p < 0.01). CONCLUSION: This study demonstrated the spatially heterogeneous effect of medical equipment investment in the primary care centres in rural China. The priority of the equipment investment was suggested to be given to the township health centres in the remote towns with a low urbanization degree and those in the highly-urbanized neighbouring towns of the county seats.

Incorporation of Bayberry Tannin into a Locust Bean Gum/Carboxycellulose Nanocrystals/ZnO Coating: Properties and Its Application in Banana Preservation.

The application of polysaccharide-based coatings to prolong the shelf-life of fruits has attracted increasing attention. This study aims to develop a fruit coating comprising locust bean gum/carboxycellulose nanocrystals/ZnO (LCZ) blended with bayberry tannins (BT). The results revealed a significant increase from 4.89% and 11.04% to 29.92% and 45.01% in the free radical scavenging rates of 2,2-diphenyl-1-picrylhydrazyl and 2,2'-azino-di-[3-ethylbenzthiazthiazoline sulfonate] with the percentage of BT increasing from 0% to 5%, respectively. At a 5% of BT, the antibacterial activity against both E.coli and S. aureus exceeded 90% while simultaneously achieving excellent UV shielding (transmittance of 380-200 nm ≤ 0.19%). After 3 days of storage, uncoated bananas showed signs of browning, and their titratable acid and vitamin C (Vc) contents decreased from 0.57% to 0.30% and from 7.37 mg/100 g to 4.77 mg/100 g, respectively. However, bananas coated with LCZ containing 3% BT not only exhibited a better appearance, but also possessed higher titratable acid (0.44%) and Vc content (5.31 mg/100 g). This study provides a sustainable and multifunctional coating for fruit preservation.

Cohort analysis of relevant factors for negative emotions during the perioperative period in choledocholithiasis patients treated with ERCP and the impact on prognosis.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an emerging option in the management of common bile duct stones and has a high success rate for biliary stone extraction. However, due to the lack of knowledge and understanding of this technique, some patients often experience varying degrees of anxiety and depression. There is little research on the factors associated with negative emotions. This study aimed to investigate the risk factors for negative emotions in choledocholithiasis patients treated with ERCP and the impact on prognosis to provide a reference for improving patients' prognosis. Methods: We analyzed the data of 364 patients with choledocholithiasis treated with ERCP at our hospital between July 2019 and June 2022. Patients' emotional state was assessed using the SAS and SDS scales. The t-test and chi-square test were used to analyze the relationship between patients' negative emotions and prognosis. The patient's prognosis was assessed at one month postoperatively using the SF-36 scale. Binary logistic regression and multiple linear regression were used to analyze the independent risk factors for negative emotions and prognosis in patients. Results: In this study, the prevalence of anxiety was 10.4%, the prevalence of depression was 8.8% and the prevalence of negative emotions was 15.4%. Binary logistic regression analysis showed that gender [odds ratio (OR) =0.379, P=0.023], fertility status (OR =0.164, P=0.032), monthly household income (OR =0.180, P=0.001) and so on were independent risk factors for the anxiety. Fertility status (OR =0.173, P=0.038), marital status (OR =0.210, P=0.043), TBIL on the first postoperative day (OR =1.079, P=0.002) and so on were independent risk factors for depression. Multiple linear regression analysis revealed that the presence of negative emotions (P=0.001) was an important risk factor for prognosis. Conclusions: Patients with choledocholithiasis treated with ERCP are prone to anxiety, depression and other psychological disorders. Therefore, clinical work should not only focus on the patient's condition, but also pay attention to the patient's family situation and emotional changes, and give timely psychological counselling and prevent complications, reduce the patient's suffering and improve the patient's prognosis.

A Combinational Optimization Method for Efficient Production of Indigo by the Recombinant Escherichia coli with Expression of Monooxygenase and Malate Dehydrogenase.

Indigo pigment is a widely used pigment, and the use of biosynthesis to ferment indigo has become a hot research topic. Based on previous research, the indigo could be biosynthesized via the styrene oxygenation pathway, which is regulated by intracellular redox-cofactor rebalancing. In this work, the malate dehydrogenase (mdh) gene was selected as an NADH regeneration element to improve the intracellular cofactor regeneration level, and it was co-expressed with the styrene monooxygenase (styAB) gene by pET-28a(+) vector in E. coli for enhancing indigo production. The PT7 and Pcat promoter was constructed to change the styAB gene and mdh gene from inducible expression to constitutive expression, since the expressing vector pET-28a(+) needs to be induced by IPTG. After different strategies of genetic manipulations, the styAB gene and mdh gene were successfully constitutively co-expressed by different promoters in E. coli, which obviously enhanced the monooxygenase activity and indigo production, as expected. The maximum yield of indigo in recombinant strains was up to 787.25 mg/L after 24 h of fermentation using 2.0 g/L tryptophan as substrate, which was nearly the highest indigo-producing ability using tryptophan as substrate in recent studies. In summary, this work provided a theoretical basis for the subsequent study of indigo biosynthesis and probably revealed a new insight into the construction of indigo biosynthesis cell factory for application.

Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China.

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.

Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study.

BACKGROUND: Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. METHODS: Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household-individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. RESULTS: In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93-23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21-0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36-0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18-0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09-0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73-48.75) were more likely to self-treat. CONCLUSION: Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

Trajectories of Outpatient Service Utilisation of Hypertensive Patients in Tertiary Hospitals in China.

This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related medical utilisation were recruited in Yichang, China from January 1 to December 31 in 2016. The latent trajectories of outpatient service utilisation were identified through latent class growth analysis. Differences in the demographic characteristics and medical utilisation among patients in different trajectories were tested by one-way ANOVA and chi-square analysis. The predictors of the trajectory groups of outpatient service utilisation were identified through multinomial logistic regression. Four trajectory groups were determined as stable-low (34.7%), low-fluctuating (13.4%), high-fluctuating (22.5%), and stable-high (29.4%). Significant differences were observed in all demographic characteristics (p < 0.001) and medical service utilisation variables (p < 0.001) among the four trajectories except for inpatient cost (p = 0.072). Determinants for outpatient service utilisation patterns include the place of residence, education level, outpatient visit times, inpatient service utilisation, and outpatient cost. Overall, hypertensive patients visiting outpatient units in the tertiary hospital were middle-aged, elderly, and well-educated, and they received poor follow-up services. The four identified latent trajectories have different characteristics and medical utilisation patterns. Trajectory group-based measurements are necessary for hypertension management and economic burden reduction.

Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis.

The health workers in rural primary care systems are at the increasing risk of job burnout. To explore the prevalence and associated factors of the job burnout among the primary healthcare worker in rural China, a cross-sectional survey was conducted among 15,627 participants in 459 township hospitals from six provinces. A combination of stratified multi-stage sampling and cluster sampling method, and a self-administrated questionnaire with the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS) were used in the investigation. Multilevel regression analyses were used to examine the potential associated factors on both individual and organisational levels. 47.6% of respondents were experiencing moderate burnout, and 3.3% were in severe burnout. Professionals working for over 40 h per week, at young age, with a college degree, and with professional titles at medium or high rank reported a higher degree of job burnout. At the institutional level, the high ratio of performance-based salary was associated with a higher level of depersonalization. Burnout has become prevalent among the primary healthcare workers in rural China, and multiple strategies are needed to reduce the work stress and some high-risk groups' vulnerability to job burnout.

End-of-life cost and its determinants for cancer patients in urban China: a population-based retrospective study.

OBJECTIVE: This study aimed to define the end-of-life (EOL) healthcare utilisation and its cost and determinants for cancer patients and to proactively inform related strategies in mainland China. DESIGN: A population-based retrospective study. SETTING AND PARTICIPANTS: Data from 894 cancer patients were collected in urban Yichang, China from 01 July 2015 to 30 June 2017. OUTCOME MEASURES: Emergency department (ED) visits, outpatient and inpatient hospitalisation services, intensive care unit (ICU) admission and total costs were used as the main outcomes. RESULTS: In this study, 66.8% of the 894 patients were male, and the average age was 60.4 years. Among these patients, 37.6% died at home, and patients had an average of 4.86 outpatient services, 2.23 inpatient hospitalisation services and 1.44 ED visits. Additionally, 5.9% of these patients visited the ICU at least once. During the EOL periods, the costs in the last 6 months, 3 months, 1 month and 1 week were US$18 234, US$13 043, US$6349 and US$2085, respectively. The cost increased dramatically as death approached. The estimation results of generalised linear regression models showed that aggressive care substantially affected expenditure. Patients with Urban Employee Basic Medical Insurance spent more than those with Urban Resident-based Basic Medical Insurance or the New Rural Cooperative Medical Scheme. The place of death and the survival time are also risk factors for increased EOL cost. CONCLUSION: The findings suggested that the EOL cost for cancer patients is associated with aggressive care, insurance type and survival time. Timing palliative care is urgently needed to address ineffective and irrational healthcare utilisation and to reduce costs. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the Tongji Medical College, Huazhong University of Science and Technology (IORG No.: IORG0003571). All the data used in this study were de-identified.

Multi-trajectory modeling of home blood pressure telemonitoring utilization among hypertensive patients in China: A latent class growth analysis.

BACKGROUND: Home blood pressure telemonitoring (HBPT) has great potential in improving blood pressure (BP) control among patients with hypertension. However, the longitudinal use trajectories of HBPT have not been identified yet. In addition, there has been a lack of understanding of the relationship between developmental trajectories of HBPT and BP control over time. The primary goal of this study was to identify the longitudinal trajectories of using HBPT among hypertensive patients and to explore the relationship between longitudinal trajectories of HBPT use patterns and BP control. METHODS: A total of 122 hypertensive patients were enrolled consecutively in Xiling, Huayan, Baisha and Xueyuan communities in Yichang City, Hubei Province, China. Each patient was provided with a portable monitoring device which has unlimited data service at the time of enrollment. Socio-demographics (e.g. name, age, sex, marital status) were collected at baseline. Real-time data including systolic and diastolic blood pressure were automatically uploaded to cloud platform through devices. Latent class growth analysis was conducted to determine the latent trajectory of HBPT use. Joint trajectory method was used to correlate the longitudinal trajectories of HBPT utilization and BP control status. RESULTS: Five trajectories were identified which are persistently low (47.1%), moderate with decreasing (23.9%), sharply decreasing (11.2%), high with decreasing (11.3%) and persistently high with increasing (6.6%). There was no statistically significant difference among 5 trajectories in the baseline survey in terms of age, marital status, BP (both SBP and DBP) and BP control status. However, there was a strong positive correlation between the HBPT utilization pattern and BP control status over time. CONCLUSIONS: The latent trajectories of HBPT utilization were identified in our study. However, no predictors of trajectory membership were identified. Nevertheless, we have demonstrated that HBPT was to some extent positively correlated with improved BP control, and this correlation still needs to be further proved.

[Development of a new HPLC technique for analyzing monosaccharide composition and its application in the quality control of Silybum marianum polysaccharide].

A new HPLC-UV technique for the separation and analysis of 10 monosaccharides achieved within 13.5 min using 1-phenyl-3-methyl-5-pyrazolone (PMP) as the labelling molecule of the reductive monosaccharides has been established by combining common high performance liquid chromatography-UV and C18 column. The established technique was applied to the quantification of the monosaccharide components in extract of Silybum marianum. The results showed that the tested 10 monosaccharides as PMP derivatives were baseline separated under the HPLC conditions proposed. It was confirmed that Silybum marianum extract was composed of mannose, rhamnose, glucuronic acid, galacturonic acid, glucose, xylose, galactose and arabinose with the molar ratio of 0.66:0.84:0.58:1.0:1.6:0.69:2.7:4.8. Quantitative recoveries of the compositional monosaccharides separated from the extract were in the range of 92.4%-104.0%, and the RSD values fell within 0.68%-3.81%. The results demonstrated that the proposed HPLC method was simple, rapid, convenient, and precise, and it was applicable to the analysis of the compositional monosaccharides of Silybum marianum extract.