A time-course transcriptome analysis revealing the potential molecular mechanism of early gonadal differentiation in the Chinese giant salamander.

The Chinese giant salamander (CGS) Andrias davidianus is the largest extant amphibian and has recently become an important species for aquaculture with high economic value. Meanwhile, its wild populations and diversity are in urgent need of protection. Exploring the mechanism of its early gonadal differentiation will contribute to the development of CGS aquaculture and the recovery of its wild population. In this study, transcriptomic and phenotypic research was conducted on the critical time points of early gonadal differentiation of CGS. The results indicate that around 210 days post-hatching (dph) is the critical window for female CGS's gonadal differentiation, while 270 dph is that of male CGS. Besides, the TRPM1 gene may be the crucial gene among many candidates determining the sex of CGS. More importantly, in our study, key genes involved in CGS's gonadal differentiation and development are identified and their potential pathways and regulatory models at early stage are outlined. This is an initial exploration of the molecular mechanisms of CGS's early gonadal differentiation at multiple time points, providing essential theoretical foundations for its captive breeding and offering unique insights into the conservation of genetic diversity in wild populations from the perspective of sex development.

Early prediction of drug-resistant epilepsy using clinical and EEG features based on convolutional neural network.

OBJECTIVE: Machine learning utilization in electroencephalogram (EEG) analysis and epilepsy care is fast evolving. Thus, we aim to develop and validate two one-dimensional convolutional neural network (CNN) algorithms for predicting drug-resistant epilepsy (DRE) in patients with newly-diagnosed epilepsy based on EEG and clinical features. METHODS: We included a total of 1010 EEG signal epochs and 15 clinical features from 101 patients with epilepsy. Each patient had 10 epochs of EEG signal data, with each signal recorded for 90 s. The ratio of development set and validation set was 80:20, and ten-fold cross validation was performed. First, a CNN algorithm was used to extract EEG features automatically. Then, Two one-dimensional CNNs were crafted.. Accuracy, specificity, precision, sensitivity, F1-score, kappa statistics, mean square error (MSE) and area under the curve (AUC) were calculated to evaluate the classifiers performance. RESULTS: The clinical-EEG model showed good performance and clinical practical value, with the accuracy, specificity, precision, sensitivity, F1-score, kappa statistics, best MSE and AUC in test set were 0.99, 0.72, 0.82, 0.96, 0.89, 0.83, 32.00, 0.81, respectively, and the accuracy in validation set was 0.84. In the EEG model, the accuracy, specificity, precision, sensitivity, F1-score, kappa statistics, best MSE and AUC in test set were 0.99, 0.59, 0.82, 0.90, 0.86, 0.72, 181.76, 0.76, respectively, and the accuracy in validation set was 0.81. CONCLUSION: We constructed a clinical-EEG model showed good potential for predicting DRE in patients with newly-diagnosed epilepsy, which could help identify patients at high risk of developing DRE at earlier stages.

Identity of the holotype and type locality of Rhabdophis leonardi (Wall, 1923) (Colubridae: Natricinae), with notes on the morphology and natural history of the species in southwestern China.

The original description of Natrix leonardi (currently Rhabdophis leonardi) by Frank Wall in 1923, based on a specimen from the "Upper Burma Hills," lacked important morphological details that have complicated the assignment of recently collected material. Furthermore, although the holotype was never lost, its location has been misreported in one important taxonomic reference, leading to further confusion. We report the correct repository of the holotype (Natural History Museum, London), together with its current catalog number. We also describe key features of that specimen that were omitted from the original description, and provide new details on the morphology of the species, including sexual dichromatism unusual for the genus, based upon specimens from southern Sichuan, China. Rhabdophis leonardi is distinguished from its congeners by the following characters: 15 or 17 DSR at midbody and 6 supralabials; distinct annulus around the neck, broad and red in males, and narrow and orange with a black border in females; dorsal ground color light green or olive; some lateral and dorsal scales possessing black edges, the frequency of black edges gradually increasing from anterior to posterior, forming irregular and ill-defined transverse black bands; eye with prominent green iris; black ventral spots with a red edge, most numerous at midbody but extending halfway down the length of the tail. In southwestern China, this species is frequently found at 1730-2230 m elevation. It has been documented to prey upon anuran amphibians, including toads. A recently published phylogenetic analysis showed this species to be deeply nested with the genus Rhabdophis, as a member of the R. nuchalis Group. That analysis also revealed the existence of two closely related but geographically distinct subclades in the molecular analysis, one of which may represent an unnamed taxon.

A rare case report of the successful withdrawal of a stent balloon that failed to deflate.

BACKGROUND: In current percutaneous coronary intervention (PCI) practice, the balloon used in the procedure should be deflated a short time after balloon dilation to avoid having prolonged balloon dilation in the coronary artery, which would block the coronary artery and cause myocardial ischemia. It is very rare for a dilated stent balloon to fail to deflate. A 44-year-old male was admitted to the hospital due to chest pain after exercise. Coronary angiography showed severe proximal stenosis of the right coronary artery (RCA) consistent with a diagnosis of coronary artery disease, and coronary stent implantation was required. After the last stent balloon was dilated, the stent balloon could not be deflated and continued to expand, resulting in blockage of the RCA blood flow. The patient then suffered decreased blood pressure and heart rate. Finally, the stent balloon in its expanded state was forcefully and directly withdrawn from the RCA and successfully removed from the body. CONCLUSION: Deflation failure of a stent balloon is an extremely rare complication of PCI. Various treatment strategies can be considered based on hemodynamic status. In the case described herein, the balloon was pulled out of the RCA directly to restore blood flow, which kept the patient safe.

Safety Assessment of Microcatheter-Protected Rotational Atherectomy with the Double Guiding Catheter Technique for Severely Calcified Left Main Bifurcation.

Background: Rotational atherectomy (RA) is a tool for calcium modification, but there is a risk of losing the side branch in left main coronary artery (LM) bifurcation lesions, resulting in disastrous consequences. Microcatheter-protected RA with the double guiding catheter (GC) technique for severely calcified LM bifurcations has been described previously, but its safety warrants further investigation. Methods: Various sizes of coronary calcification vascular simulators were utilized to model calcified LM bifurcation lesions for RA in in vitro. The damage to the side branch protective microcatheters and guidewires was accessed after microcatheter-protected RA with the double GC technique. In clinical practice, microcatheter-protected RA with the double GC technique was carried out in two patients. Results: In vitro, none of the protective microcatheters or guidewires were completely fractured, although the majority of them were damaged to varying degrees. In clinical practice, we successfully carried out two cases of percutaneous coronary intervention for severely calcified LM bifurcation with microcatheter-protected RA using the double GC technique. Conclusion: RA of severely calcified LM bifurcation lesions may be successfully performed using microcatheter-protected RA with the double GC technique, potentially reducing the risk of side branch occlusion. Since majority of protective microcatheters or guidewires were damaged, there was still some risk, and it is recommended to use this technique only in highly selected patient population of severely calcified true (Medina 1, 1, 1) LM bifurcations.

Mechanisms of Caspases 3/7/8/9 in the Degeneration of External Gills of Chinese Giant Salamanders (Andrias davidianus).

Metamorphosis is a critical stage in the adaptive development of amphibians from aquatic to terrestrial animals. Metamorphosis of the Chinese giant salamander is mainly manifested by the loss of external gills with consequent changes in the respiratory pattern. The loss of the external gill is regulated by the pathway of apoptosis in which caspase genes are the key factors. This study cloned and expressed the caspase 3/7/8/9 genes of the Chinese giant salamander. The main results were as follows: the complete open reading frames (ORFs) were 885 bp, 960 bp, 1461 bp and 1279 bp, respectively; caspase 3/7/8/9 genes all contained the CASc domain, and most of the motifs were located in CASc domain; and caspase 8 possessed two DED structural domains and caspase 9 possessed a CARD structural domain. Furthermore, results from the tissue distribution analysis indicated that caspase 3/7/8/9 genes were all significantly expressed in the external gill, and at 9 and 10 months of age (MOA), which is the peak time for the loss, the EXPRESSION level of caspase 3/7/8/9 genes was obviously high, which was consistent with the histological result. Moreover, the loss of external gills of the Chinese giant salamander may result from activation of both the apoptosis-related death receptor pathway and the mitochondrial pathway. Finally, it was discovered that thyroid hormone (TH) treatment could both advance the time point at which the external gills of the Chinese giant salamander began to degenerate and shorten this process. Interestingly, at the peak of its metamorphosis (9 MOA), the Chinese giant salamander further accelerated the metamorphosis rate of TH treatment, which suggested a promotive effect on the loss of external gills via the superimposition of the exogenous TH and caspase genes. The study of caspase genes in this experiment was conducive to understanding the mechanism of external gill loss in the Chinese giant salamander, as well as improving our understanding of the metamorphosis development of some Caudata species.

Social isolation transitions and psychological distress among older adults in rural China: A longitudinal study before and during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic could increase the number of older adults who are socially isolated including community-dwelling older adults, and result in the secondary damage of mental health. This study aimed to examine the longitudinal association between social isolation transitions and psychological distress among the community-dwelling older adults before and during the COVID-19 pandemic in rural China. METHODS: A total of 2749 community-dwelling older adults aged 60 years and older in rural Shandong, China were included. We used the generalized estimating equations (GEE) model to estimate the impact of social isolation transitions on psychological distress before and during the COVID-19 pandemic. RESULTS: The percentage of high and very high psychological distress (K10 ≥ 22) was 23.54% and 31.36% before and during the COVID-19 pandemic, respectively, indicating a 7.82% increase (P < 0.001). Compared with the group remaining nonisolated, "became socially isolated" and "remained isolated" groups were more likely to have a deterioration of psychological distress after experiencing the COVID-19 pandemic (became socially isolated: b = 0.92, P < 0.001; remained isolated: b = 0.98, P < 0.001). LIMITATIONS: The main variables in this study were measured by self-report information, which might result in recall bias. CONCLUSIONS: During the COVID-19 pandemic, psychological distress increased among the community-dwelling older adults in rural China. There was a significant risk of psychological distress among those who had transitioned from nonisolation before the pandemic to social isolation after experiencing the pandemic, thus intervention on social isolation process during the pandemic may be important to protect older adults' mental health.

Family Doctor Contract Services and Awareness of Blood Pressure Measurement Among Hypertension Patients: A Cross-Sectional Study in Rural Shandong, China.

Background: Some studies found that family doctor contract services (FDCSs) had positive impact on the self-measurement behaviors of hypertension patients. However, evidence concerning the association between FDCSs and blood pressure measurement awareness among hypertension patients is not clear. Objective: This study aims to explore the relationship between FDCSs and blood pressure measurement awareness among the hypertension patients, and examine whether there is a difference in this relationship among middle-aged and aged adults in rural Shandong, China. Methods: A multi-stage stratified random sampling was adopted in 2018 in Shandong Province to conduct a questionnaire survey among the sample residents, in which 982 hypertension patients were included in the study. Pearson chi-square test and logistic regression model were employed using SPSS 24.0 to explore the association between FDCSs and blood pressure measurement awareness. Results: 76.8% of hypertension patients would measure blood pressure regularly. The blood pressure measurement awareness of the signing group was significantly higher than that of the non-signing group when controlling other variables (P < 0.001, OR = 2.075, 95% CI 1.391-3.095). The interaction of age and contracting status were significantly correlated with blood pressure measurement awareness (P = 0.042, OR = 1.747, 95% CI 1.020-2.992; P = 0.019, OR = 2.060, 95% CI 1.129-3.759). Factors including gender (P = 0.011, OR = 0.499, 95% CI 0.291-0.855), household income (P = 0.031, OR = 1.764, 95% CI 1.052-2.956), smoking status (P = 0.002, OR = 0.439, 95% CI 0.260-0.739), sports habits (P < 0.001, OR = 2.338, 95% CI 1.679-3.257), self-reported health (P = 0.031, OR = 1.608, 95% CI 1.043-2.477), distance to the village clinic (P = 0.006, OR = 1.952, 95% CI 1.208-3.153) and medications (P < 0.001, OR = 3.345, 95% CI 2.282-4.904) were also found to be associated with the blood pressure measurement awareness of hypertension patients. Conclusion: The government should take efforts to strengthen publicity and education of family doctors and pay more attention to uncontracted, middle-aged, female patients and patients with unhealthy life behaviors to improve the blood pressure measurement awareness.

Brivaracetam Modulates Short-Term Synaptic Activity and Low-Frequency Spontaneous Brain Activity by Delaying Synaptic Vesicle Recycling in Two Distinct Rodent Models of Epileptic Seizures.

Brivaracetam (BRV) is an anti-seizure drug for the treatment of focal and generalized epileptic seizures shown to augment short-term synaptic fatigue by slowing down synaptic vesicle recycling rates in control animals. In this study, we sought to investigate whether altered short-term synaptic activities could be a pathological hallmark during the interictal periods of epileptic seizures in two well-established rodent models, as well as to reveal BRV's therapeutic roles in altered short-term synaptic activities and low-frequency band spontaneous brain hyperactivity in these models. In our study, the electrophysiological field excitatory post-synaptic potential (fEPSP) recordings were performed in rat hippocampal brain slices from the CA1 region by stimulation of the Schaffer collateral/commissural pathway with or without BRV (30 µM for 3 h) in control or epileptic seizure (induced by pilocarpine (PILO) or high potassium (h-K+)) models. Short-term synaptic activities were induced by 5, 10, 20, and 40-Hz stimulation sequences. The effects of BRV on pre-synaptic vesicle mobilization were visually assessed by staining the synaptic vesicles with FM1-43 dye followed by imaging with a two-photon microscope. In the fEPSP measurements, short-term synaptic fatigue was found in the control group, while short-term synaptic potentiation (STP) was detected in both PILO and h-K+ models. STP was decreased after the slices were treated with BRV (30 µM) for 3 h. BRV also exhibited its therapeutic benefits by decreasing abnormal peak power (frequency range of 8-13 Hz, 31% of variation for PILO model, 25% of variation for h-K+ model) and trough power (frequency range of 1-4 Hz, 66% of variation for PILO model, 49% of variation for h-K+ model), and FM1-43 stained synaptic vesicle mobility (64% of the variation for PILO model, 45% of the variation for h-K+ model) in these epileptic seizure models. To the best of our knowledge, this was the first report that BRV decreased the STP and abnormal low-frequency brain activities during the interictal phase of epileptic seizures by slowing down the mobilization of synaptic vesicles in two rodent models. These mechanistic findings would greatly advance our understanding of BRV's pharmacological role in pathomechanisms of epileptic seizures and its treatment strategy optimization to avoid or minimize BRV-induced possible adverse side reactions.

Association Between Perceived Medical Errors and Suicidal Ideation Among Chinese Medical Staff: The Mediating Effect of Depressive Symptoms.

Both medical errors and suicidal behaviors are important problems for medical staff. Although the association between them was implied in previous studies, their association has not been built until now. In this study, the first aim was to build the association between perceived medical errors and suicidal ideation, and we also want to explore the mediating role of depression in the association between perceived medical errors and suicidal ideation among Chinese medical staff. In this study, we interviewed 3,338 medical staff in Chinese general hospitals. Questions about suicidal ideation (SI) and perceived medical errors were interviewed for medical staff. Depressive symptoms were evaluated by the Chinese version of Center for Epidemiologic Studies Depression Scale (CES-D). Social-demographic and occupation-related variables were also assessed in the data collection. This study found that the prevalence of suicidal ideation among medical staff was 9%. After the adjustment for controlling variables, suicidal ideation was significantly associated with a higher level of depression (OR = 1.10, p < 0.001) and perceived medical errors (OR = 2.41, p < 0.001). The other associated factors were female (OR = 2.21, p < 0.001), religious belief (OR = 2.66, p < 0.001), and weekly work hours (OR = 1.02 p < 0.001). The mediating effect of depressive symptoms on the association between perceived medical errors and suicidal ideation was also supported in this study, and it can explain the 38.73% of the total effects of the perceived medical errors on suicidal ideation. The medical staff, with perceived medical errors, were in higher risk of suicidal ideation, and depressive symptoms can partially mediate the association between perceived medical errors and suicidal ideation. For the medical staff who are experiencing medical errors, some scanning on their suicidal ideation and depressive symptoms are necessary to promote their mental health.

MiR-24-3p Attenuates Doxorubicin-induced Cardiotoxicity via the Nrf2 Pathway in Mice.

OBJECTIVE: The nuclear factor erythroid 2 (NFE2)-related factor 2 (Nrf2) is associated with doxorubicin (DOX)-induced cardiac injury. It has been reported that microRNA-24-3p (miR-24-3p) may regulate the Keapl by mRNA degradation, whereas Keapl can suppress the activation of Nrf2. However, the role of miR-24-3p in DOX-related cardiotoxicity remains unclear. METHODS: The mice receiving DOX were used as cardiac injury model. In this study, an adenoassociated virus 9 system was used to deliver miR-24-3p or miR-scramble to mice hearts. The echocardiographic and hemodynamic analyses were used to evaluate the effects of miR-24-3p on cardiac function under DOX stimulation. ELISA and RT-PCR were used to detect protein or mRNA expressions associated with cardiac injury, inflammation response, apoptosis and oxidative stress. Western Blot were used for quantitative analysis of the roles of miR-24-3p in regulating Nrf2 expression. H9C2 cells used to verify the role of miR-24-3p in vitro. RESULTS: We found that miR-24-3p mRNA was significantly decreased in DOX-treated mice and cardiomyocytes. Overexpression of miR-24-3p blocked cardiac injury caused by DOX injection, as reflected by the reduction in the levels of cardiac troponin I, creatinine kinase isoenzyme MB and the N-terminal pro brain natriuretic peptide. Furthermore, miR-24-3p reduced oxidative stress and cell loss without affecting the inflammation response. As expected, we found that Nrf2 was upregulated by miR-24-3p supplementation, and that the protective efforts of miR-24-3p supplementation were abolished when Nrf2 was silenced. CONCLUSION: The results from this study suggest that miR-24-3p protects cardiomyocytes against DOX-induced heart injury via activation of the Nrf2 pathway. miR-24-3p supplementation may be a novel strategy to counteract the cardiac side effects of DOX treatment.

An integrative prediction algorithm of drug-refractory epilepsy based on combined clinical-EEG functional connectivity features.

OBJECTIVE: Although the use of antiepileptic drugs (AEDs) is routine, 30-40% of patients with epilepsy (PWEs) experience drug resistance. Thus, early identification of AED resistance will help optimize treatment regimens and improve patients' prognoses. However, there have been few studies on this topic to date. Here, we try to establish an integrative prediction model of AED resistance for drug-naive PWEs, and to identify the clinical and Electroencephalogram (EEG) factors that affect their outcomes. METHODS: One hundred sixty-four PWEs naive to AEDs treated at a tertiary care center from January 2014 to June 2020 were retrospectively analyzed. A total of 113 of these patients were well controlled and 53 were drug refractory with regular AED treatment for more than one year. Eighty clinical characteristics and 684 EEG functional connectivity variables based on phase lag index before drug initiation were identified. Overall, 80% of each group was chosen to establish a support vector machine (SVM) model with ten-fold cross validation, and the other 20% were used to evaluate the model's performance. Absolute weight value was used to rank the features that had impacts on classification. RESULTS: An integrative algorithm was modeled to predict AED resistance for drug-naive PWEs by SVM based on clinical characteristics and EEG functional connectivity values. The model had an accuracy of 94% [95% confidence interval (CI) 0.85-1.0], sensitivity of 95% [95% CI 0.82-1.0], specificity of 93% [95% CI 0.77-1.0], and an area under the curve (AUC) of 0.98 [95% CI 0.91-1.0]. The p values of accuracy, sensitivity specificity and AUC were calculated as 0.001, 0.001, 0.01 and 0.001, respectively. The δ band fromT4-FZ and T3-PZ, α band from T3-T6 and ß band from F7-CZ and FP2-F3 were the top five EEG features that impacted the SVM classifier. CONCLUSION: We constructed an integrative prediction algorithm of AED resistance for drug-naive PWEs. Its utility in clinical settings should be evaluated in the future.

EVALUATION OF ARTIFICIAL INTELLIGENCE-BASED QUANTITATIVE ANALYSIS TO IDENTIFY CLINICALLY SIGNIFICANT SEVERE RETINOPATHY OF PREMATURITY.

PURPOSE: To evaluate the screening potential of a deep learning algorithm-derived severity score by determining its ability to detect clinically significant severe retinopathy of prematurity (ROP). METHODS: Fundus photographs were collected, and standard panel diagnosis was generated for each examination by combining three independent image-based gradings. All images were analyzed using a deep learning algorithm, and a quantitative assessment of retinal vascular abnormality (DeepROP score) was assigned on a 1 to 100 scale. The area under the receiver operating curve and distribution pattern of all diagnostic parameters and categories of ROP were analyzed. The correlation between the DeepROP score and expert rank ordering according to overall ROP severity of 50 examinations was calculated. RESULTS: A total of 9,882 individual examinations with 54,626 images from 2,801 infants were analyzed. Fifty-six examinations (0.6%) demonstrated Type 1 ROP and 54 examinations (0.5%) demonstrated Type 2 ROP. The DeepROP score had an area under the receiver operating curve of 0.981 for detecting Type 1 ROP and 0.986 for Type 2 ROP. There was a statistically significant correlation between the expert rank ordering of overall disease severity and the DeepROP score (correlation coefficient 0.758, P < 0.001). When hypothetical referral cutoff score of 35 was selected, all cases of severe ROP (Type 1 and Type 2 ROP) was captured and 8,562 eyes (87.6%) with no or mild ROP were excluded. CONCLUSION: The DeepROP score determined by deep learning algorithm was an objective and quantitative indicator for the severity of ROP, and it had potential in automated detecting clinically significant severe ROP.

Social capital and self-rated health among Chinese rural empty nesters: A multiple mediation model through sleep quality and psychological distress.

BACKGROUND: many studies explore the relationship between social capital and self-rated health. However, few studies clarified the mechanisms underlying the relationship between social capital and self-rated health among Chinese rural empty nesters. This study aimed to explore the multiple mediating roles of sleep quality and psychological distress between this relationship. METHODS: A total of 2,254 rural empty-nest older adults were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. Logistic regressions were performed to assess the relationships between social capital and self-rated health. The multiple mediating roles of sleep quality and psychological distress was analyzed using Mplus 8.3. RESULTS: we found that social capital has a significant directly affect self-rated health (ß=0.127, 68.65% CI=0.082-0.171), and through three significantly mediation pathways: (1) the path through sleep quality (ß=0.013, 95% CI=0.005-0.021), which accounted for 7.03% of the total effect; (2) the path through psychological distress (ß=0.037, 95% CI=0.024-0.049), which accounted for 20.00% of the total effect; (3) the path through sleep quality and psychological distress (ß=0.008, 95% CI=0.004-0.013), which accounted for 4.32% of the total effect. The total mediating effect was 31.35%. CONCLUSIONS: sleep quality and psychological distress mediate the relationship between social capital and self-rated health. Attention should be paid to mental health and sleep quality of empty nester through primary health, strengthen the attention to social resources, provide intervention and treatment for the empty nesters with sleep problem and psychological distress.

Predicting scale of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A retrospective study.

OBJECTIVE: To establish and validate a predictive formula for calculating the possibility of developing delayed neurological sequelae (DNS) after acute carbon monoxide (CO) poisoning to facilitate better decision-making about treatment strategies. METHODS: This study retrospectively enrolled 605 consecutive patients who had been newly diagnosed with CO poisoning from the Central Hospital of Enshi Prefecture between January 1, 2015 and December 31, 2020. The cohort was randomly divided into two subgroups: the development cohort (n = 104) and validation cohort (n = 44). Univariate analysis and backward elimination of multivariate logistic regression were used to identify predictive factors, and a predictive formula was established. The performance was assessed using the area under the curve (AUC), the mean AUC of five-fold cross-validation, and calibration plots. RESULTS: The formula included four commonly available predictors: initial GCS score, duration of exposure, CK, and abnormal findings on MRI. We next created a formula to calculate the risk score for developing DNS: Risk score = -4.54 + 3.35 * (Abnormal findings on MRI = yes) - 0.51 * (Initial GCS score) + 0.65 * (Duration of exposure) + 0.01 * (CK). Then, the probability of developing DNS could be calculated: Probability of DNS = 1/(1 + e Risk score). The model revealed good discrimination with AUC, and mean AUC of fivefold cross-validation in two cohort, and the calibration plots showed good calibration. CONCLUSIONS: This study established a prediction predictive formula for predicting developing of DNS, which could facilitate better decision-making about treatment strategies.

Cryptic diversity and phylogeography of the Rhabdophis nuchalis group (Squamata: Colubridae).

Previous studies, have found that the rapid uplift of the Tibetan plateau accelerated the diversification of species. However, there are few relevant biogeographic data for the Colubridae in this region. We conducted a comprehensive study of the Rhabdophis nuchalis Group, which presently contains four nominal species, R. nuchalis, R. pentasupralabialis, R. leonardi, and R. chiwen. Building upon previous studies with specimens we have recently examined, greater interspecific and intraspecific diversity has been revealed. Here we address three questions: (1) Do the intraspecific differences represent only geographic variation within lineages, or are there cryptic species? (2) What are the interspecific relationships among members of the R. nuchalis Group? (3) What has been the biogeographic history of this species group? To resolve these questions we used four mitochondrial gene sequences and one nuclear sequence to investigate the molecular phylogenetic and geographic relationships among populations. Our molecular analysis reveals cryptic species diversity within the R. nuchalis Group, and seven clades were identified in the analysis. Ancestral area estimation suggests that the R. nuchalis Group originated in the Hengduan Mountains approximately 6.24 Mya and expanded its range northward to the Qinling-Daba Mountains. The Sichuan Basin appears to have been a barrier to migration. Species divergence seems to have been related to the rapid uplift of the Qinghai-Tibet Plateau.

Chronic Conditions, Persistent Pain, and Psychological Distress Among the Rural Older Adults: A Path Analysis in Shandong, China.

Psychological distress were found to be associated with chronic conditions and persistent pain. However, few studies explored the underlying pathways between them. This study aimed to analyze the path of chronic conditions and persistent pain on psychological distress through sleep quality and self-rated health. A total of 2,748 rural older people in Shandong, China were included in this study. Path analysis was performed by using Mplus 8.3 to examine the associations between chronic conditions, persistent pain, sleep quality, self-rated health, and psychological distress after adjusting for age, gender, education, and household income. The prevalence of psychological distress among the older adults in this study was 47.49%. Chronic conditions and persistent pain were indirectly associated with psychological distress through six mediating pathways: (1) the path from chronic conditions to psychological distress through sleep quality (ß = 0.041, 95%CI: 0.015-0.067) and self-rated health (ß = 0.064, 95%CI: 0.038-0.091), respectively, and a chain mediation existed (ß = 0.007, 95% CI: 0.000-0.014); (2) the path of persistent pain and psychological distress through sleep quality (ß = 0.058, 95% CI: 0.014-0.102) and self-rated health (ß = 0.048, 95% CI: 0.000-0.096), respectively, also the chain mediation found (ß = 0.009, 95% CI: 0.005-0.014). Psychological distress was associated with chronic conditions and persistent pain through decreased sleep quality and self-rated health among Chinese rural older people. Multi-pronged targeted intervention should be taken for older adults with chronic conditions and persistent pain.

Do older people with cardiovascular-metabolic multimorbidity prefer to sign contracts for family doctor services? Evidence from a cross-sectional study in rural Shandong, China.

BACKGROUND: Family doctor policy is an important part of deepening healthcare reform in China. The study aimed to explore the association between cardiovascular-metabolic multimorbidity and the status of signing a contract for family doctor services among the older people in rural Shandong, China. METHODS: A cross-sectional study was conducted in 3 cities of Shandong province, China. A total of 1395 rural residents over 60 years of age were included in this study using a multistage stratified random sampling method. Covariates included demographic and socioeconomic characteristics, health-related characteristics, health service utilization, and awareness of family doctor contract services. The univariate and multivariate regression logistic analysis was used to analyze the data. RESULTS: There were 28.2% of the rural older people contracted for the family doctor contract services. The contract rate of seniors with cardiovascular-metabolic multimorbidity was statistically higher than those without cardiovascular-metabolic multimorbidity (OR = 1.67, 95%CI, 1.21-2.32) after controlling for confounding factors. In addition, occupation, physical activities, self-rated health status, distance from the village clinic, the awareness of family doctor contract services were found to be associated with the signing behavior among the rural older adults. CONCLUSION: This study demonstrated that the rural older people with cardiovascular-metabolic multimorbidity had a higher family doctor contract rate than those without cardiovascular-metabolic multimorbidity, and there was a gap between the current signing rate and the policy goal. To increase the rate of signing for family doctor contract services, the government should take joint efforts to expand the publicity and coverage, and give priority to meeting the healthcare demands of rural older adults with cardiovascular-metabolic multimorbidity.

Willingness of patients with chronic disease in rural China to contract with family doctors: implication for targeting characteristics.

BACKGROUND: Rural residents with chronic conditions have a stronger need for health services, which should make using family doctor contract services a priority. This study aimed to evaluate the rate of willingness among rural residents with chronic conditions to contract with family doctors and examine its determinants. METHODS: A cross-sectional study was conducted from May, 2018 to June, 2018 in Shandong Province in China. A total of 769 rural unsigned residents with chronic conditions were included in the analysis. Using the Andersen model as the theoretical framework, logistic regression models were chosen to analyse the factors associated with willingness to contract with family doctors. RESULTS: This study found that the rate of willingness to contract with family doctors among chronic patients in rural Shandong was 46.7%. A higher willingness was observed in those living a further distance from the village clinic (more than 600 m: OR = 1.85, 95%CI =1.17-2.93), having received publicity for family doctor contract services (OR = 1.71, 95% CI = 1.06-2.76), reporting need for utilizing a chronic disease management program (OR = 3.36, 95% CI = 2.20-5.23), and reporting need for higher medical insurance reimbursement (OR = 1.91, 95% CI = 1.28-2.83). CONCLUSIONS: The prevalence of contract willingness was relatively low among unsigned rural residents with chronic conditions in rural Shandong, China. The need factors were powerful factors affecting their willingness to contract with family doctors. The government should therefore strengthen targeted publicity and education to rural residents with chronic conditions and provide targeted healthcare services, such as chronic disease management programs and medical services with higher reimbursement rates, to promote their willingness to contract with family doctors.

Corrigendum: Longitudinal Associations of Stroke With Cognitive Impairment Among Older Adults in the United States: A Population-Based Study.

[This corrects the article DOI: 10.3389/fpubh.2021.637042.].