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We investigated the influence of 17ß-estradiol (17ß-E2) on cartilage extracellular matrix (ECM) homeostasis in postmenopausal women. We focused on the roles of estrogen receptors (ESR) and SOX6 in 17ß-E2-mediated stimulation of ECM metabolism during chondrocyte (CH) degeneration. We compared the expression of anabolic genes (collagen II and aggrecan) and catabolic genes (MMPs and TIMPs) in IL-1ß-induced CH degeneration in vitro, with and without 17ß-E2 supplementation. We separately silenced the SOX6, ESR1, and ESR2 genes in CHs to determine their impact on 17ß-E2 treatment. Additionally, we used Chromatin immunoprecipitation followed by DNA sequencing (ChIP-seq) and luciferase assays to investigate protein-DNA interactions within ESR2 and SOX6-promoter complexes. After three days of IL-1ß treatment, ESR1/2, SOX6, collagen II, aggrecan, and TIMP1/3 were decreased, while MMP3/9/13 were increased. The addition of 17ß-E2 partially reversed these effects, but silencing SOX6, ESR1, or ESR2 weakened the protective effects of 17ß-E2. Silencing ESR2, but not ESR1, abolished the upregulation of SOX6 induced by 17ß-E2. ESR2 was found to bind the SOX6 promoter and regulate SOX6 expression. 17ß-E2 upregulates SOX6 through ESR2 mediation, and the synergistic effect of 17ß-E2 and ESR2 on SOX6 balances ECM metabolism in CHs.
Subject(s)
Chondrocytes , Estradiol , Estrogen Receptor beta , Extracellular Matrix , Interleukin-1beta , SOXD Transcription Factors , Chondrocytes/metabolism , Chondrocytes/drug effects , Estradiol/pharmacology , Humans , Estrogen Receptor beta/metabolism , Estrogen Receptor beta/genetics , Female , Extracellular Matrix/metabolism , Extracellular Matrix/drug effects , SOXD Transcription Factors/metabolism , SOXD Transcription Factors/genetics , Interleukin-1beta/metabolism , Interleukin-1beta/pharmacology , Estrogen Receptor alpha/metabolism , Estrogen Receptor alpha/genetics , Promoter Regions, Genetic/genetics , Cells, CulturedABSTRACT
Accurate segmentation of oral surgery-related tissues from cone beam computed tomography (CBCT) images can significantly accelerate treatment planning and improve surgical accuracy. In this paper, we propose a fully automated tissue segmentation system for dental implant surgery. Specifically, we propose an image preprocessing method based on data distribution histograms, which can adaptively process CBCT images with different parameters. Based on this, we use the bone segmentation network to obtain the segmentation results of alveolar bone, teeth, and maxillary sinus. We use the tooth and mandibular regions as the ROI regions of tooth segmentation and mandibular nerve tube segmentation to achieve the corresponding tasks. The tooth segmentation results can obtain the order information of the dentition. The corresponding experimental results show that our method can achieve higher segmentation accuracy and efficiency compared to existing methods. Its average Dice scores on the tooth, alveolar bone, maxillary sinus, and mandibular canal segmentation tasks were 96.5%, 95.4%, 93.6%, and 94.8%, respectively. These results demonstrate that it can accelerate the development of digital dentistry.
Subject(s)
Cone-Beam Computed Tomography , Cone-Beam Computed Tomography/methods , Humans , Alveolar Process/diagnostic imaging , Image Processing, Computer-Assisted/methods , Artificial Intelligence , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Mandible/diagnostic imaging , Mandible/surgery , Tooth/diagnostic imagingABSTRACT
Using a mixed-ligand approach, we successfully obtained two Mn(II)-based coordination compounds, namely [Mn2(L1)(TBIP)·H2O]n (1) and [Mn2(L2)(NPTA)·H2O]n (2) (where L1 and L2 are 1,4-bis(thiabenzimidazol-1-ylmethyl)benzene and 1,2-bis(thiabenzimidazol-1-ylmethyl)benzene, H2NPTA is 2-nitroterephthalic acid, and H2TBIP is 5-tert-butylisophthalic acid). Fluorescence performance testing of complexes 1 and 2 showed excellent green and blue fluorescence properties. Based on this, we further prepared HA/CMCS hydrogels using natural polysaccharides hyaluronic acid (HA) and carboxymethyl chitosan (CMCS) as raw materials and studied their internal structural characteristics using scanning electron microscopy. Using "Duhuo Jisheng Decoction" as a drug model, two metal gel scaffolds loaded with "Duhuo Jisheng Decoction" were prepared, and their potential for treating knee osteoarthritis was evaluated.
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Metal-support interaction (MSI) provides great possibilities to tune the activity, selectivity, and stability of heterogeneous catalysts. Herein, the Au/ZnO catalyst is prepared by commercial ZnO and chloroauric acid, and the structure evolution of the catalyst pretreated by H2 and O2 gas at varied temperature is investigated to provide mechanistic insights of MSI. It is found that the H2 treatment at 300 °C and above can induce the formation of both the ZnOx overlayer and bulk Au-Zn alloy. In contrast, the O2 treatment can form the ZnOx overlayer at 500 °C and above without the formation of Au-Zn alloy. It is also revealed that the ZnOx overlayer is dynamically stable (permeable), which can provide access for reactant molecules during the reaction process. And, the Au-Zn alloy can recover to Au and ZnO under the CO oxidation reaction condition, which can be deemed as a re-activation process that endows H2 -treated samples with the superior activity and stability.
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Background: This study aims to identify new therapeutic targets and explore the molecular mechanism of ankylosing spondylitis (AS), a rheumatic immune disease that mainly affects the sacroiliac and spinal joints. Despite extensive research, the exact cause of AS is still unknown. The research team utilized a bioinformatics approach to achieve their objectives. Methods: The GSE73754 dataset was downloaded from GEO database. Autophagy-related genes (ARGs) were collected from the Human Autophagy-dedicated Database. The limma package was used to screen for differentially expressed genes (DEGs), which were then intersected with the autophagy-related genes (ARGs) to identify differentially expressed autophagy-related genes (DEARGs). Subsequently, the DEARGs associated with AS were subjected to GO-BP and KEGG enrichment analyses using the clusterProfiler package. Core genes were identified using the cytoHubba plug-in of Cytoscape and were validated by clinical blood samples. Additionally, the Cell algorithm was utilized to evaluate the proportion of immune cell infiltration. Results: A total of 29 DEARGs were identified, which were found to be mainly enriched in autophagy, apoptosis, and necroptosis through functional enrichment analysis. Two core genes, HSPA5 and SQSTM1, were confirmed to have diagnostic value in AS. Immune cell infiltration analysis revealed CD8+ T cells, CD8+ T effector memory (Tem), natural killer (NK) cells, T gamma delta (Tgd) cells, and T-helper 1 (Th1) cells as major participants in AS development. Furthermore, HSPA5 expression was significantly correlated with Th1 cells, CD8+ T cells, CD4+ memory cells, and macrophages. Conclusion: This study suggested that HSPA5 and SQSTM1 can serve as useful diagnostic biomarkers for AS. These findings lay the foundation for identifying crucial mRNAs in the whole blood of AS patients, which may aid in the development of novel markers for AS.
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OBJECTIVE: To develop the wed-based system for predicting risk of (pre)frailty among community-dwelling older adults. MATERIALS AND METHODS: (Pre)frailty was determined by physical frailty phenotype scale. A total of 2802 robust older adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS) 2013-2015 survey were randomly assigned to derivation or internal validation cohort at a ratio of 8:2. Logistic regression, Random Forest, Support Vector Machine and eXtreme Gradient Boosting (XGBoost) were used to construct (pre)frailty prediction models. The Grid search and 5-fold cross validation were combined to find the optimal parameters. All models were evaluated externally using the temporal validation method via the CHARLS 2011-2013 survey. The (pre)frailty predictive system was web-based and built upon representational state transfer application program interfaces. RESULTS: The incidence of (pre)frailty was 34.2 % in derivation cohort, 34.8 % in internal validation cohort, and 32.4 % in external validation cohort. The XGBoost model achieved better prediction performance in derivation and internal validation cohorts, and all models had similar performance in external validation cohort. For internal validation cohort, XGBoost model showed acceptable discrimination (AUC: 0.701, 95 % CI: [0.655-0.746]), calibration (p-value of Hosmer-Lemeshow test > 0.05; good agreement on calibration plot), overall performance (Brier score: 0.200), and clinical usefulness (decision curve analysis: more net benefit than default strategies within the threshold of 0.15-0.80). The top 3 of 14 important predictors generally available in community were age, waist circumference and cognitive function. We embedded XGBoost model into the server and this (pre)frailty predictive system is accessible at http://www.frailtyprediction.com.cn. A nomogram was also conducted to enhance the practical use. CONCLUSIONS: A user-friendly web-based system was developed with good performance to assist healthcare providers to measure the probability of being (pre)frail among community-dwelling older adults in the next two years, facilitating the early identification of high-risk population of (pre)frailty. Further research is needed to validate this preliminary system across more controlled cohorts.
Subject(s)
Frailty , Humans , Frailty/diagnosis , Frailty/epidemiology , Independent Living , Longitudinal Studies , Prospective Studies , Risk AssessmentABSTRACT
This study aims to discover whether temperature has an effect on axial dispersion in a photopolymer-based holographic lens. A typical coaxial holographic lens is recorded in the acrylamide polymer system. The axial dispersion spectrum is read and collected by using a supercontinuum source and spectrometer. The temperature effects on axial dispersion in a photopolymer-based holographic lens are investigated experimentally. With increasing temperature from 23°C to 70°C, the diffraction spectrum shifts, and the axial dispersion is shortened evidently. The peak wavelength of the dispersion spectrum shifts from 629.05 to 612.50 nm with an obvious blueshift of 16.55 nm. The spatial position of the peak wavelength also decreases from around 40 to 22 mm from the material surface. Simultaneously, the position sensitivity of the device reduces from 2.53 to 1.50 nm/mm. The shortening of the effective focal length and reduction of the diffraction intensity indicate that the high temperature above 40°C is a disadvantageous factor for actual use of a holographic lens-based spectral confocal measuring device. In practical application, a constant temperature is a significant means to ensure the measurement accuracy and range.
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Background: Marmesine, a major active ingredient isolated from Radix Angelicae biseratae (Duhuo), has been reported to have multiple pharmacological activities. However, its therapeutic effects against knee osteoarthritis (OA) remain poorly investigated. The present study is aimed at uncovering the core targets and signaling pathways of marmesine against osteoarthritis using a combined method of bioinformatics and network pharmacology. Methods: We utilized SwissTargetPrediction and PharmMapper to collect the potential targets of marmesine. OA-related differentially expressed genes (DEGs) were identified from GSE98918 dataset. Then, the intersection genes between DEGs and candidate genes of marmesine were subjected to protein-protein interaction (PPI) network construction and functional enrichment analysis. The core targets were verified using the molecular docking technology. Results: A total of 320 marmesine-related genes and 5649 DEGs and 60 ingredient-disease targets between them were identified. The results of functional enrichment analyses revealed that response to oxygen levels, neuroinflammatory response, PI3K-Akt signaling pathway, MAPK signaling pathway, FoxO signaling pathway, and osteoclast differentiation was identified as the potential mechanisms of marmesine against OA. EGFR, CASP3, MMP9, PPARG, and MAPK1 served as hub genes regulated by marmesine in the treatment of OA, and the molecular docking further verified the results. Conclusion: Marmesine exerts the therapeutic effects against OA through multitarget and multipathways, in which EGFR, CASP3, MMP9, PPARG, and MAPK1 might be hub genes. Our research indicated that the combination of bioinformatics and network pharmacology could serve as an effective approach for investigating the potential mechanisms of natural product.
Subject(s)
Drugs, Chinese Herbal , Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/drug therapy , Osteoarthritis, Knee/genetics , Molecular Docking Simulation , Caspase 3 , Matrix Metalloproteinase 9 , PPAR gamma , Phosphatidylinositol 3-Kinases , ErbB Receptors , Drugs, Chinese Herbal/pharmacology , Drugs, Chinese Herbal/therapeutic useABSTRACT
There are many virulence factors of H. pylori that contribute in diverse ways to gastric disease. Therefore, designing multivalent epitope vaccines against many key virulence factors virulence factors of H. pylori is a promising strategy to control H. pylori infection. In previous studies, we constructed a multivalent epitope vaccine FVpE against four key virulence factors of H. pylori (Urease, CagA, VacA, and NAP), and oral immunization with the FVpE vaccine plus a polysaccharide adjuvant (PA) containing lycium barbarum polysaccharide and chitosan could provide protection against H. pylori infection in the Mongolian gerbil model. Oral vaccines have many advantages over injected vaccines, such as improved safety and compliance, and easier manufacturing and administration. However, the harsh gastrointestinal (GI) environment, such as gastric acid and proteolytic enzymes, limits the development of oral vaccines to some extent. Oral vaccines need a gastrointestinal delivery system with high safety, low price and promoting vaccine antigen to stimulate immune response in the gastrointestinal mucosa. Lactic acid bacteria are gastrointestinal probiotics that have unique advantages as a delivery system for oral vaccines. In this study, a M cell-targeting surface display system for L. lactis named plSAM was designed to help vaccine antigens to stimulate effective immune responses in the gastrointestinal tract, and a M cell-targeting recombinant L. lactis vaccine LL-plSAM-FVpE was constructed by using the surface display system plSAM. recombinant L. lactis vaccine LL-plSAM-FVpE could secretively express the SAM-FVpE protein and display it on the bacterial surface. Moreover, experimental results confirmed that LL-plSAM-FVpE had an enhanced M cell-targeting property. In addition, LL-plSAM-FVpE had excellent M cell-targeting property to promote the phagocytosis and transport of the antigen SAM-FVpE by gastrointestinal M cells. More importantly, oral immunization of LL-plSAM-FVpE or SAM-FVpE plus PA can stimulate IgG and sIgA antibodies and CD4+ T cell immune responses against four virulence factors of H. pylori (Urease, CagA, VacA, and NAP), thus providing protective immunity against H. pylori infection in mice. The M cell-targeting recombinant L. lactis vaccine against various key H. pylori virulence factors could be a promising vaccine candidate for controlling H. pylori infection.
Subject(s)
Helicobacter Infections , Helicobacter pylori , Adjuvants, Immunologic , Animals , Antibodies, Bacterial , Antigens , Bacterial Vaccines , Epitopes , Helicobacter Infections/prevention & control , Immunization , Mice , Mice, Inbred BALB C , Urease , Vaccines, Synthetic , Virulence FactorsABSTRACT
BACKGROUND: Fatigue, poor sleep quality and poor quality of life (QoL) are recognised as common problems for patients with inflammatory bowel disease (IBD). This study aimed to evaluate feasibility and effect of aromatherapy on these problems in patients with IBD. METHODS: Seventy IBD patients from a tertiary hospital in China were randomly assigned to an intervention group and a control group. During the 8-week intervention, the intervention group received aromatherapy through the skin and by inhalation, and the control group received routine nursing care. All patients were administered questionnaires at two sessions-the Multidimensional Fatigue Inventory, the Inflammatory Bowel Disease Questionnaire and the Pittsburgh Sleep Quality Index-before and after the intervention. The clinical trial registration number is ChiCTR2100045889. RESULTS: Postintervention fatigue and sleep problems were relieved in the intervention group compared with the control group (Pâ¯<â¯0.05). Moreover, QoL scores improved significantly in the intervention group (Pâ¯<â¯0.05). CONCLUSION: These results suggested that aromatherapy may be an effective complementary treatment method to relieve fatigue and sleep problems and improve quality of life in IBD patients.
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Aromatherapy , Inflammatory Bowel Diseases , Sleep Wake Disorders , Humans , Aromatherapy/methods , Quality of Life , Feasibility Studies , Sleep Quality , Fatigue/etiology , Fatigue/therapy , Sleep , Sleep Wake Disorders/etiology , Sleep Wake Disorders/therapy , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/therapy , Chronic DiseaseABSTRACT
In this research, pyrolysis experiment of Indonesian oil sand was performed in a fixed bed. Results show that the temperature and heating rate had significant effects on the pyrolysis products. Data studied include yields of products and the gaseous product composition of carbon monoxide, hydrogen, methane, and other hydrocarbons. Four functional group bands (aromatic hydrocarbon, oxygen, aliphatic, and hydroxyl functional groups) are observed from Fourier transform infrared spectroscopy of oil sand. The influence of pyrolysis temperature on the total pore volume and the Brunauer-Emmett-Teller (BET) specific surface area of char was also studied. With increasing temperature, the BET specific surface area showed an increasing trend in the overall temperature range. The specific surface area and the total pore volume showed similar trends except the tiny difference of 5 °C/min from 200 to 300 °C. The heating rate did not influence the development of the pore structure obviously. Mainly, three different reaction regions were observed during pyrolysis of oil sand. This study provides a theoretical foundation for further effective exploitation and economical application of oil sand.
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Bimetallic alloy catalysts show strong structural and compositional dependence on their activity, selectivity, and stability. Often referred to as the "synergetic effect" of two metal elements in the alloys, their detailed dynamic information, structurally and chemically, of catalyst surface under reaction conditions remains largely elusive. Here, using aberration-corrected environmental transmission electron microscopy, we visualize the atomic-scale synergetic surface activation of CuAu under a watergas shift reaction condition. The unique "periodic" structural activation largely determines the dominating reaction pathway, which is related to a possible "carboxyl" reaction route corroborated by density functional theorybased calculation and ab initio molecular dynamics simulation. These results demonstrate how the alloy surface is activated and catalyzes the chemical reaction, which provides insights into catalyst design with atom precision.
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BACKGROUND: Studies are scarce in China that explore the association of nutritional status, measured using the Short-Form Mini Nutritional Assessment (MNA-SF) and biochemical data, on adverse clinical outcomes among older inpatients. In this study, we aimed to determine the prevalence of malnutrition in tertiary hospitals of China and the associations between malnutrition and adverse clinical outcomes. METHODS: This prospective study involved 5,516 older inpatients (mean age 72.47 ± 5.77 years) hospitalized in tertiary hospitals between October 2018 and February 2019. The tertiary hospitals refer to the hospital with more than 500 beds and can provide complex medical care services. The MNA-SF was used to assess nutritional status. Multiple logistic regression and negative binomial regression were used to analyze the relationship between nutritional parameters and risk of hospital length of stay (LoS), mortality, and rehospitalization. RESULTS: We found that 46.19% of hospitalized patients had malnutrition or malnutrition risk, according to the MNA-SF. Death occurred in 3.45% of patients. MNA-SF scores 0-7 (odds ratio [OR] 5.738, 95% confidence interval [CI] 3.473 to 9.48) were associated with a six-fold higher likelihood of death, and scores 8-11 (OR 3.283, 95% CI 2.126-5.069) with a three-fold higher likelihood of death, compared with MNA-SF scores 12-14 in the logistic regression model, after adjusting for potential confounders. A low MNA-SF score of 0-7 (regression coefficient 0.2807, 95% CI 0.0294-0.5320; P < 0.05) and a score of 8-11 (0.2574, 95% CI 0.0863-0.4285; P < 0.01) was associated with a significantly higher (28.07 and 25.74%, respectively) likelihood of increased LoS, compared with MNA-SF score 12-14. MNA-SF scores 0-7 (OR 1.393, 95% CI 1.052-1.843) and 8-11 (OR 1.356, 95% CI 1.124-1.636) were associated with a nearly 1.5-fold higher likelihood of 90-day readmission compared with MNA-SF scores 12-14 in the logistic regression model. Moreover, hemoglobin level, female sex, education level, former smoking, BMI 24-27.9 kg/m2, age 75 years and above, and current alcohol consumption were the main factors influencing clinical outcomes in this population. CONCLUSIONS: Malnutrition increases the risk of hospital LoS, mortality, and 90-day readmission. The use of nutritional assessment tools in all hospitalized patients in China is needed. The MNA-SF combined with hemoglobin level may be used to identify older inpatients with a high risk of adverse clinical outcomes. These findings may have important implications for the planning of hospital services.
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Objective: To develop and externally validate a frailty prediction model integrating physical factors, psychological variables and routine laboratory test parameters to predict the 30-day frailty risk in older adults with undernutrition. Methods: Based on an ongoing survey of geriatrics syndrome in elder adults across China (SGSE), this prognostic study identified the putative prognostic indicators for predicting the 30-day frailty risk of older adults with undernutrition. Using multivariable logistic regression analysis with backward elimination, the predictive model was subjected to internal (bootstrap) and external validation, and its calibration was evaluated by the calibration slope and its C statistic discriminative ability. The model derivation and model validation cohorts were collected between October 2018 and February 2019 from a prospective, large-scale cohort study of hospitalized older adults in tertiary hospitals in China. The modeling derivation cohort data (n = 2,194) were based on the SGSE data comprising southwest Sichuan Province, northern Beijing municipality, northwest Qinghai Province, northeast Heilongjiang Province, and eastern Zhejiang Province, with SGSE data from Hubei Province used to externally validate the model (validation cohort, n = 648). Results: The incidence of frailty in the older undernutrition derivation cohort was 13.54% and 13.43% in the validation cohort. The final model developed to estimate the individual predicted risk of 30-day frailty was presented as a regression formula: predicted risk of 30-day frailty = [1/(1+e-riskscore )], where riskscore = -0.106 + 0.034 × age + 0.796 × sex -0.361 × vision dysfunction + 0.373 × hearing dysfunction + 0.408 × urination dysfunction - 0.012 × ADL + 0.064 × depression - 0.139 × nutritional status - 0.007 × hemoglobin - 0.034 × serum albumin - 0.012 × (male: ADL). Area under the curve (AUC) of 0.71 in the derivation cohort, and discrimination of the model were similar in both cohorts, with a C statistic of nearly 0.7, with excellent calibration of observed and predicted risks. Conclusion: A new prediction model that quantifies the absolute risk of frailty of older patients suffering from undernutrition was developed and externally validated. Based on physical, psychological, and biological variables, the model provides an important assessment tool to provide different healthcare needs at different times for undernutrition frailty patients. Clinical trial registration: Chinese Clinical Trial Registry [ChiCTR1800017682].
Subject(s)
Cross-Cultural Comparison , Frail Elderly , Aged , China , Cross-Sectional Studies , Humans , Nursing HomesSubject(s)
Diabetes Mellitus , Frailty , Aged , Diabetes Mellitus/epidemiology , Frail Elderly , Frailty/epidemiology , Humans , Independent Living , PrevalenceABSTRACT
BACKGROUND: In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities. METHODS: Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates. RESULTS: We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease. CONCLUSION: CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations.
Subject(s)
Ischemic Stroke , Humans , Length of Stay , Hospital Costs , Comorbidity , Hospitalization , Retrospective StudiesSubject(s)
Frailty , Accidental Falls , Aged , China , Hospitalization , Humans , Independent Living , Prospective StudiesABSTRACT
Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions. Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result. Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of "at-risk" patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031-1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491-2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498-2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6-23.6), score of 4 (32.4, 95% CI: 24-41.4), and scores of ≥ 5 (36.8, 95% CI 28.3-45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6-27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8-43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3-57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system. Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs.
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Tensile deformation uniformity of material has been studied with a stretchable polymer based holographic sensor. The diffraction spectrum distribution of a holographic grating with a large area as a main response parameter is scanned. A linear spatial distribution of peak wavelength provides an important foundation for exploring the tensile uniformity. The same ratio of wavelength to position confirms that the tensile deformation of the material is uniform in a small spot size. Over the entire length of the materials, gradually increasing deformation accumulation is the main uniformity feature of tensile deformation. The uniformity response is expected to apply in sensing the deformation and stress fluctuation distribution in the middle of the thin surface. The non-uniform distribution of stress can be expressed by the nonlinear distribution of the grating diffraction spectrum. The optical measurement of tensile deformation uniformity further validates the applicability of a stretchable polymer based holographic sensor.