Chitosan-Rapamycin Carbon Dots Alleviate Glaucomatous Retinal Injury by Inducing Autophagy to Promote M2 Microglial Polarization.

Introduction: Glaucoma is a prevalent cause of irreversible vision impairment, characterized by progressive retinal ganglion cells (RGCs) loss, with no currently available effective treatment. Rapamycin (RAPA), an autophagy inducer, has been reported to treat glaucoma in rodent models by promoting RGC survival, but its limited water solubility, systemic toxicity, and pre-treatment requirements hinder its potential clinical applications. Methods: Chitosan (CS)-RAPA carbon dot (CRCD) was synthesized via hydrothermal carbonization of CS and RAPA and characterized by transmission electron microscopy, Fourier transform infrared spectra, and proton nuclear magnetic resonance. In vitro assays on human umbilical cord vein endothelial and rat retinal cell line examined its biocompatibility and anti-oxidative capabilities, while lipopolysaccharide-stimulated murine microglia (BV2) assays measured its effects on microglial polarization. In vivo, using a mouse retinal ischemia/reperfusion (I/R) model by acute intraocular pressure elevation, the effects of CRCD on visual function, RGC apoptosis, oxidative stress, and M2 microglial polarization were examined. Results: CRCD exhibited good water solubility and anti-oxidative capabilities, in the form of free radical scavenging. In vitro, CRCD was bio-compatible and lowered oxidative stress, which was also found in vivo in the retinal I/R model. Additionally, both in vitro with lipopolysaccharide-stimulated BV2 cells and in vivo with the I/R model, CRCD was able to promote M2 microglial polarization by activating autophagy, which, in turn, down-regulated pro-inflammatory cytokines, such as IL-1ß and TNF-α, as well as up-regulated anti-inflammatory cytokines, such as IL-4 and TGF-ß. All these anti-oxidative and anti-inflammatory effects ultimately aided in preserving RGCs, and subsequently, improved visual function. Discussion: CRCD could serve as a potential novel treatment strategy for glaucoma, via incorporating RAPA into CDs, in turn not only mitigating its toxic side effects but also enhancing its therapeutic efficacy.

Rapamycin functionalized carbon Dots: Target-oriented synthesis and suppression of vascular cell senescence.

Suppression of vascular cell senescence is of great significance in preventing cardiovascular diseases such as hypertension and atherosclerosis. The oxidative stress damage caused by reactive oxygen species (ROS) can lead to cellular senescence. Rapamycin (Rapa) is well known to suppress cell senescence via mammalian target of rapamycin (mTOR) pathway. However, poor water solubility and lack of ROS scavenging ability limit the further development of Rapa. To improve the solubility of Rapa and endow with ROS scavenging ability, Rapa functionalized carbon dots (Rapa-CDs) are target-oriented synthesized via free radical polymerization combination with hydrothermal carbonization. Rapa-CDs improve the solubility of Rapa and show ROS scavenging abilities. The solubility of Rapa-CDs with 9.41 g is improved 3.6 × 104 times higher than that of Rapa (2.6 × 10-4 g). The half maximal inhibitory concentration (IC50) of Rapa-CDs toward hydroxyl radical (•OH) and 2,2-Diphenyl-1-picrylhydrazyl free radical (DPPH•) are 0.18 and 0.17 mg/mL, respectively. Rapa-CDs show anti-oxidative stress effect in HEVECs (Human Umbilical Vein Endothelial Cells) via reducing ROS levels by 87 %. Rapa-CDs alleviate HUVECs senescence by suppressing mTOR overactivation, attenuate the expression of P53, P21 and P16. The study demonstrates the target-oriented synthesis of drugs functionalized CDs with anti-senescence via dual-pathway of anti-oxidative stress and mTOR.

A ferroptosis-related LncRNAs signature for predicting prognoses and screening potential therapeutic drugs in patients with lung adenocarcinoma: A retrospective study.

BACKGROUND: Lung adenocarcinoma (LUAD) has a high mortality rate. Ferroptosis is linked to tumor initiation and progression. AIMS: This study aims to develop prognostic models of ferroptosis-related lncRNAs, evaluate the correlation between differentially expressed genes and tumor microenvironment, and identify prospective drugs for managing LUAD. METHODS AND RESULTS: In this study, transcriptomic and clinical data were downloaded from the TCGA database, and ferroptosis-related genes were obtained from the FerrDb database. Through correlation analysis, Cox analysis, and the LASSO algorithm for constructing a prognostic model, we found that ferroptosis-related lncRNA-based gene signatures (FLncSig) had a strong prognostic predicting ability in the LUAD patients. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichments reconfirmed that ferroptosis is related to receptor-ligand activity, enzyme inhibitor activity, and the IL-17 signaling pathway. Next, tumor mutation burden (TMB), tumor immune dysfunction and exclusion (TIDE) algorithms, and pRRophetic were used to predict immunotherapy response and chemotherapy sensitivity. The IMvigor210 cohort was also used to validate the prognostic model. In the tumor microenvironment, Type_II_IFN_Response and HLA were found to be a group of low-risk pathways, while MHC_class_I was a group of high-risk pathways. Patients in the high-risk subgroup had lower TIDE scores. Exclusion, MDSC, CAF, and TAMM2 were significantly and positively correlated with risk scores. In addition, we found 15 potential therapeutic drugs for LUAD. Finally, differential analysis of stemness index based on mRNA expression (mRNAsi) indicated that mRNAsi was correlated with gender, primary tumor (T), distant metastasis (M), and the tumor, node, and metastasis (TNM) stage in LUAD patients. CONCLUSIONS: In conclusion, the prognostic model based on FLncSig can alleviate the difficulty in predicting the prognosis and immunotherapy of LUAD patients. The identified FLncSig and the screened drugs exhibit potential for clinical application and provide references for the treatment of LUAD.

Three new Furano-lactones from the endophytic fungus Aspergillus nidulans.

Three new furano-lactones, asperilactones A-C (1-3), and two known compounds silvaticol (4) and violaceic acid (5) were isolated from an ethanol extract of Aspergillus nidulans, a fungus isolated from the Annelida Whitmania pigra Whitman (Haemopidae). Their structures were elucidated by a combination of spectroscopy, ECD calculations, comparing optical rotation values, and single-crystal X-ray diffraction analyses. Asperilactone A (1) represented the first example of furano-lactone with an unusual 2-thia-6-oxabicyclo[3.3.0]octane ring system. Asperilactones A and B showed weak toxicity against the HL-60 and RKO.

A Comparative Study on the Mechanism of Delayed-Type Hypersensitivity Mediated by the Recombinant Mycobacterium tuberculosis Fusion Protein ESAT6-CFP10 and Purified Protein Derivative.

While purified protein derivative (PPD) is commonly used as skin diagnostic reagent for tuberculosis (TB) infection, it cannot distinguish effectively Bacillus Calmette-Guérin (BCG) vaccination from Mycobacterium tuberculosis (MTB) complex and nontuberculous mycobacteria infection. The new skin reagent ESAT6-CFP10 (EC) has favorable sensitivity and specificity, which can overcome limitations associated with PPD. At present, EC skin test reactions are mainly characterized by erythema, while PPD mainly causes induration. We conducted a comparative study on the potential differences between EC-induced erythema and PPD-induced induration using a guinea pig model. The size of EC-dependent erythema was similar to that of PPD-induced induration, and an inflammatory response characterized by the infiltration of monocytes, macrophages and lymphocytes, as well as tissue damage, appeared at the injection site. The lymphocytes included CD4+ T and CD8+ T cells, which released IFN-γ as the main cytokine. Both EC erythema and PPD induration could lead to increased levels of acute-phase proteins, and the differential pathways were similar, thus indicating that the main induced immune pathways were similar. The above results indicated that erythema produced by EC could generate the main delayed-type hypersensitivity (DTH) response characteristic of PPD induration, thereby suggesting that erythema might also have a certain diagnostic significance and provide a possible theoretical basis for its use as a diagnostic indicator for detecting MTB infection.

Photothermal Carbon Dots Chelated Hydroxyapatite Filler: High Photothermal Conversion Efficiency and Enhancing Adhesion of Hydrogel.

The synthesis of photothermal carbon/hydroxyapatite composites poses challenges due to the binding modes and relatively low photothermal conversion efficiency. To address these challenges, the calcium ions chelated by photothermal carbon dots (PTC-CDs) served as the calcium source for the synthesis of photothermal carbon dots chelated hydroxyapatite (PTC-HA) filler via the coprecipitation method. The coordination constant K and chelation sites of PTC-HA were 7.20 × 102 and 1.61, respectively. Compared to PTC-CDs, the coordination constant K and chelation sites of PTC-HA decreased by 88 and 35% due to chelating to hydroxyapatite, respectively. PTC-HA possesses fluorescence and photothermal performance with a 62.4% photothermal conversion efficiency. The incorporation of PTC-HA filler significantly enhances as high as 76% the adhesion performance of the adhesive hydrogel. PTC-HA with high photothermal conversion efficiency and enhancing adhesion performance holds promise for applications in high photothermal conversion efficiency, offering tissue adhesive properties and fluorescence capabilities to the hydrogel.

Comparison of the Immune Responses to Different Formulations of BC02-Adjuvanted HPV Types 16 and 18 Bivalent Vaccines in Mice.

To achieve maximum efficacy, vaccines, such as subunit, recombinant, and conjugate vaccines, necessitate the incorporation of immunostimulators/adjuvants. Adjuvants play a vital role in bolstering and extending the strength of the immune response while also influencing its type. As antigen and adjuvant formulations become more intricate, it becomes imperative to establish a well-characterized and robust formulation to ensure consistent and reproducible outcomes in preclinical and clinical studies. In the present study, an HPV bivalent vaccine was developed using a BC02 adjuvant in conjunction with HPV 16 and 18 L1 VLP antigens produced from an E. coli expression system. The study involved evaluating the adjuvant formulation and in vivo immunogenicity in mice. Remarkably, a medium-dose of BCG-CpG-DNA combined with a low-dose of aluminum hydroxide substantially enhanced the immunogenicity of HPV16 and 18 VLPs, resulting in improved cellular and humoral immune responses.

Application of Adjustable Skin Stretchers in Repairing Wound-Related Defects.

Objective: To explore the application value of adjustable skin stretchers for repairing skin wound defects. Methods: Twenty patients with skin defects were included in this study. The largest defect was measured to be 45.4 cm × 13.3 cm (length × width) and the smallest one was 4.4 cm × 3.2 cm (length × width). All patients were subjected to adjustable skin stretchers and the short- and long-term clinical efficacy was evaluated. Results: The wounds of all enrolled patients were healed completely except for one patient with a dorsal foot infection (the patient requested to return to the local county hospital for further treatment), with a total satisfaction of 100%. Postoperative 3-month follow-up showed scar formation, a little local hyperpigmentation, normal skin elasticity, and intact organs of involved cases, thus signifying the significant impact of adjacent joint activities. Conclusion: Adjustable skin stretchers can accurately control the tension on wound margins, breaking the limitation of previous stretchers to provide objective quantitative indicators for clinical application. These stretchers are characterized by high use-value and are worth promoting.

EGTA-Derived Carbon Dots with Bone-Targeting Ability: Target-Oriented Synthesis and Calcium Affinity.

The bone-targeting mechanism of clinic bisphosphonate-type drugs, such as alendronate, risedronate, and ibandronate, relies on chelated calcium ions on the surface of the bone mineralized matrix for the treatment of osteoporosis. EGTA with aminocarboxyl chelating ligands can specifically chelate calcium ions. Inspired by the bone-targeting mechanism of bisphosphonates, we hypothesize that EGTA-derived carbon dots (EGTA-CDs) hold bone-targeting ability. For the target-oriented synthesis of EGTA-CDs and to endow CDs with bone targeting, we designed calcium ion chelating agents as precursors, including aminocarboxyl chelating agents (EGTA and EDTA) and bisphosphonate agents (ALN and HEDP) for the target-oriented synthesis of aminocarboxyl-derived CDs (EGTA-CDs and EDTA-CDs) and bisphosphonate-derived CDs (ALN-CDs and HEDP-CDs) with high synthetic yield. The synthetic yield of EGTA-CDs reached 87.6%. Aminocarboxyl-derived CDs and bisphosphonate-derived CDs retain the chelation ability of calcium ions and can specifically bind calcium ions. The chemical environment bone-targeting value coordination constant K and chelation sites of EGTA-CDs were 6.48 × 104 M-1 and 4.12, respectively. A novel method was established to demonstrate the bone-targeting capability of chelate-functionalized carbon dots using fluorescence quenching in a simulated bone trauma microenvironment. EGTA-CDs exhibit superior bone-targeting ability compared with other aminocarboxyl-derived CDs and bisphosphonate-derived CDs. EGTA-CDs display exceptional specificity toward calcium ions and better bone affinity than ALN-CDs, suggesting their potential as novel bone-targeting drugs. EGTA-CDs with strong calcium ion chelating ability have calcium ion affinity in simulated body fluid and bone-targeting ability in a simulated bone trauma microenvironment. These findings offer new avenues for the development of advanced bone-targeting strategies.

Life table study of Spodoptera frugiperda at different wheat stages and the effect of larval population density on wheat yield.

BACKGROUND: Spodoptera frugiperda is an invasive, widespread agricultural pest in China. However, there have been no reports assessing feeding damage on wheat caused by S. frugiperda. To clarify the fitness and potential damage of S. frugiperda to wheat, this study analyzed the population parameters of S. frugiperda fed on wheat in a laboratory and simulated the potential damage in field conditions. RESULTS: The population parameters of S. frugiperda were compared using life tables on wheat at the seedling and adult plant stages. The adult female longevity of S. frugiperda varied from 12.29 days on seedling plants to 16.60 days on adult plants. Egg production was significantly higher when fed on wheat at the seedling stage (646.34 eggs) than when fed on adult plants (495.86 eggs). On wheat at the seedling and adult plant stages, the mean generation times were 35.42 and 38.34 days, respectively, and the intrinsic rates of increase were 0.15 and 0.14, respectively. Spodoptera frugiperda completed development and increased its population in wheat at both plant growth stages. In the field, the effect of different larval densities on the 1000-kernel weight of wheat was significantly different. An action threshold of 40 larvae per m2 was estimated, and the higher population densities caused a yield loss of 17.7%. CONCLUSION: Spodoptera frugiperda can complete its life cycle on wheat at different stages. Wheat can serve as an alternative host for S. frugiperda. If S. frugiperda reaches 320 larvae per m2 density during wheat growth, it will cause yield loss exceeding 17%. © 2023 Society of Chemical Industry.

Nigrospora musae Causing Taxus chinensis var. mairei stem blight in Sichuan, China.

Taxus chinensis var. mairei is the endemic, endangered, and first-class protected tree species in China. This species is considered as an important resource plant because it can produce Taxol which is an effective medicinal compound against various cancers (Zhang et al., 2010). Stem blight was observed in two plant nurseries in Ya'an (102°44'E,30°42'N), Sichuan province in April 2021. The symptoms first appeared as round brown spots on the stem. As the disease progressed, the damaged area gradually expanded into an oval or irregular shape, which was dark brown. About 800 square meters of planting area were investigated and the disease incidence was up to approximately 64.8%. Twenty obviously symptomatic stems which exhibited the same symptoms as above were collected from 5 different trees in the nursery. To isolate the pathogen, the symptom margin was cut into small blocks (5 x 5 mm), and the blocks were surface sterilized in 75% ethanol for 90 s and 3% NaClO solution for 60 s . Finally incubated on Potato Dextrose Agar (PDA) at 28℃ for 5 days. Ten pure cultures were isolated by transferring hyphal and the three strains (HDS06, HDS07 and HDS08) were selected as representative isolates for further study. Initially, colonies on the PDA of three isolates were white and cotton-like, and then gradually turned gray-black from the center. After 21 days, conidia were produced and were smooth-walled, single-celled, black, oblate, or spherical, measuring 9.3 to 13.6 × 10.1 to 14.5 µm in size (n = 50). Conidia were present at the tip of conidiophores on hyaline vesicles. These morphological features were generally consistent with those of N. musae (Wang et al., 2017). To validate the identification, DNA were extracted from the three isolates, followed by the amplification of transcribed spacer region of rDNA (ITS), the translation elongation factor EF-1 (TEF-1), and the Beta-tubulin (TUB2) sequences with the respective primer pairs ITS1/ITS4 (White et al., 1990), EF-728F/EF-986R (Vieira et al., 2014) and Bt2a/Bt2b (O'Donnell et al., 1997) .The sequences were deposited in GenBank with the accession numbers ON965533, OP028064, OP028068, OP060349, OP060353, OP060354, OP060350, OP060351 and OP060352, respectively. Phylogenetic analysis of combined ITS, TUB2, and TEF genes using the Mrbayes inference method showed that the three isolates clustered with Nigrospora musae as a distinct clade (Fig. 2). Combine with morphological characteristics and phylogenetic analysis, three isolates were identified as N. musae. 30 2-year-old healthy potted plants of T. chinensis were used for pathogenicity test. 25 of these plants were inoculated by injecting 10 µL of the conidia suspension (1 × 106 conidia/mL) into stems and then wrap around the seal to moisturize. The remaining 5 plants were injected with the same amount of sterilized distilled water as a control. Finally, all potted plants were placed in a greenhouse at 25°C and 80% relative humidity. After 2 weeks, the inoculated stems developed lesions similar to those observed in the field, whereas controls were asymptomatic. N. musae was re-isolated from the infected stem and identified by both morphological characteristics and DNA sequence analysis. The experiments repeated three times showed similar results. As far as we know, this is the first report of N. musae causing T. chinensis stem blight in the world. The identification of N. musae could provide a certain theoretical basis for field management and further research of T. chinensis.

Liver Metabolic Dysregulation Induced by Polypropylene Nano- and Microplastics in Nile Tilapia Using Internal Extractive Electrospray Ionization Mass Spectrometry.

Understanding the metabolic disorders induced by nano- and microplastics in aquatic organisms at the molecular level could help us understand the potential toxicity of nano- and microplastics more thoroughly and provide a fundamental scientific basis for regulating the usage and management of plastic products. In this research, the effect of polypropylene nanoplastics (PP-NPs) and microplastics (PP-MPs) on metabolites in the tilapia liver was comprehensively investigated by internal extractive electrospray ionization mass spectrometry (iEESI-MS). A partial least-squares discriminant analysis (PLS-DA) and a one-component analysis of variance (ANOVA) were used for selecting 46 differential metabolites, including phospholipids, amino acids, peptides, carbohydrates, alkaloids, purines, pyrimidines, and nucleosides. Pathway enrichment analysis showed significant effects on glycerophospholipid metabolism, arginine and proline metabolism, and aminoacyl-tRNA biosynthesis after tilapia were exposed to PP-N/MPs. Dysregulation of these metabolites is mainly reflected in the possible induction of hepatitis, oxidative stress, and other symptoms. The application of iEESI-MS technology without sample pretreatment to the study of metabolic disorders in aquatic organisms under the interference of nano- and microplastics provides a promising analytical method for environmental toxicology research.

72-hour real-time forecasting of ambient PM2.5 by hybrid graph deep neural network with aggregated neighborhood spatiotemporal information.

The observation-based air pollution forecasting method has high computational efficiency over traditional numerical models, but a poor ability in long-term (after 6 h) forecasting due to a lack of detailed representation of atmospheric processes associated with the pollution transport. To address such limitation, here we propose a novel real-time air pollution forecasting model that applies a hybrid graph deep neural network (GNN_LSTM) to dynamically capture the spatiotemporal correlations among neighborhood monitoring sites to better represent the physical mechanism of pollutant transport across the space with the graph structure which is established with features (angle, wind speed, and wind direction) of neighborhood sites to quantify their interactions. Such design substantially improves the model performance in 72-hour PM2.5 forecasting over the whole Beijing-Tianjin-Hebei region (overall R2 increases from 0.6 to 0.79), particularly for polluted episodes (PM2.5 concentration > 55 µg/m3) with pronounced regional transport to be captured by GNN_LSTM model. The inclusion of the AOD feature further enhances the model performance in predicting PM2.5 over the sites where the AOD can inform additional aloft PM2.5 pollution features related to regional transport. The importance of neighborhood site (particularly for those in the upwind flow pathway of the target area) features for long-term PM2.5 forecast is demonstrated by the increased performance in predicting PM2.5 in the target city (Beijing) with the inclusion of additional 128 neighborhood sites. Moreover, the newly developed GNN_LSTM model also implies the "source"-receptor relationship, as impacts from distanced sites associated with regional transport grow along with the forecasting time (from 0% to 38% in 72 h) following the wind flow. Such results suggest the great potential of GNN_LSTM in long-term air quality forecasting and air pollution prevention.

Health-related quality of life among ethnic minority residents in remote Western China: a cross-sectional study.

BACKGROUND: Paying attention to the health-related quality of life (HRQOL) of rural residents in poverty-stricken areas is an important part of China's poverty alleviation, but most studies on health-related quality of life have focused on rural residents, elderly individuals, and patients; evidence on the HRQOL of rural minority residents is limited. Thus, this study aimed to assess the HRQOL of rural Uighur residents in remote areas of Xinjiang, China, and determine its influencing factors to provide policy opinions for realizing a healthy China strategy. METHODS: A cross-sectional study was performed on 1019 Uighur residents in rural areas. The EQ-5D and self-administered questionnaires were used to assess HRQOL. We applied Tobit and binary logit regression models to analyse the factors influencing HRQOL among rural Uighur residents. RESULTS: The health utility index of the 1019 residents was - 0.197,1. The highest proportion of respondents reporting any problem was for mobility (57.5%), followed by usual activity (52.8%). Low levels of the five dimensions were related to age, smoking, sleep time, Daily intake of vegetables and fruit per capita. Gender, age, marital status, physical exercise, sleep duration, daily intake of cooking oil per capita, daily intake of fruit per capita, distance to the nearest medical institution, non-infectious chronic diseases (NCDs), self-rated health score, and participation in community activities were correlated with the health utility index of rural Uighur residents. CONCLUSIONS: HRQOL was lower for rural Uyghur residents than for the general population. Improving health behavioural lifestyles and reducing the incidence of poverty (return to poverty) due to illness are effective means of promoting the health in Uyghur residents. The region must fulfil the health poverty alleviation policy and focus on vulnerable groups and low-income residents to improve the health, ability, opportunity, and confidence of this population to live well.

Risk score = LncRNAs associated with doxorubicin metabolism can be used as molecular markers for immune microenvironment and immunotherapy in non-small cell lung cancer.

Doxorubicin is the most effective anthracycline chemotherapy drug in the treatment of cancer, and it is an effective single agent in the treatment of non-small cell lung cancer (NSCLC). There is a lack of studies on the differentially expressed doxorubicin metabolism-related lncRNAs in NSCLC. In this study, we extracted related genes from the TCGA database and matched them with lncRNAs. Doxorubicin metabolism-related lncRNA-based gene signatures (DMLncSig) were gradually screened from univariate regression, LASSO regression, and multivariate regression analysis, and the risk score model was constructed. These DMLncSig were subjected to a GO/KEGG analysis. We then used the risk model to construct the TME model and analyze drug sensitivity. The IMvigor 210 immunotherapy model was cited for validation. Eventually, we performed tumor stemness index differences, survival, and clinical correlation analyses.

Schiff base modified starch: A promising biosupport for palladium in Suzuki cross-coupling reactions.

Starch can be used in diverse fields because it is a readily available, non-toxic polysaccharide with adaptable functionality and biodegradability. In this study, taking the aforementioned characteristics into consideration, we designed a modified starch (Starch-SB), which serves as supporting material for palladium stabilization. This new air and moisture-stable robust palladium composite [Starch-SB-Pd(II)] was characterized by FT-IR, XRD, TGA, XPS, SEM, EDX, TEM, CP/MAS 13C NMR, and ICP-MS analytical techniques. The catalytic studies exhibit high activity (up to 99 %) and stability in Suzuki cross-coupling reactions for this starch supported catalytic system under mild conditions (lower reaction temperature and green solvents) because of the cooperative interactions of multifunctional capturing sites on starch (Schiff base, hydroxy and amine groups) with palladium species. The experiments on reusability demonstrate that Starch-SB-Pd(II), which was prepared from functionalized starch, could be readily recycled several cycles through centrifugation. Moreover, we proposed a possibly multifunctional complex structure. This work presents an appealing and intriguing pathway for the utilization of polysaccharide as crucial support in green chemical transformations.

Survey of Residents' Satisfaction with the Environmental Sanitation of Key Public Places Under the Background of National Healthy City - China, 2021.

What is already known about this topic?: Sanitation of public places has been the focus of environmental sanitation construction in China for many years. It is critical to achieving the goal of building national healthy cities and counties. What is added by this report?: The results showed that in all types of areas, residents' satisfaction with the sanitation of railway stations and other places of transportation ranked first, and farmers' markets ranked last. What are the implications for public health practice?: This study provides a suitable reference for government decision-makers to effectively improve the sanitation situation of key public places and to further construct national healthy cities and counties.

Path Analysis of Influencing Factors of Depression in Middle-Aged and Elderly Patients with Diabetes.

Purpose: This study aimed to assess the prevalence of depression in middle-aged and elderly patients with diabetes in China, determine the risk factors of depression in these patients, and explore the internal relationship between influencing factors and depression by constructing a pathway model. Methods: Data were collected from the 2018 China Health and Retirement Longitudinal Study (CHRLS). We included 1743 patients with diabetes who were assessed using the CES-D10, which is used to measure depressive symptoms in Chinese older adults. Based on the theory of psychological stress, data were analyzed using SPSS software version 22.0 and MPLUS 8.0. A correlation analysis was used to explore the relationship between the variables and depression scores. A path model was constructed to explore the interrelationships between variables and verify the relationships between variables and depression in patients with diabetes. Results: The prevalence of depression among patients with diabetes was 42.5%. The path analysis results showed that income, diabetes duration, sleep duration, pain distress, self-rated health, and glycemic control directly affected depression, and self-rated health had the largest effect value. With self-rated health and glycemic control as mediator variables, income, diabetes duration, sleep duration, pain distress, glycemic control, and insulin use had indirect effects on depression by influencing self-rated health. Age, frequency of blood glucose monitoring, and exercise glycemic control awareness indirectly affected depression by affecting glycemic control, self-rated health status, and depression. Conclusion: We found that the path analysis model could construct the interaction between the influencing factors and explore the potential interrelationship between the influencing factors and diabetes-related depression. Patients with diabetes must adhere to regular medication, maintain a healthy lifestyle, and have effective glycemic control. Diabetes depression can be effectively prevented by making psychological knowledge publicly available, providing health education, and establishing corresponding for diabetes.