Fish collagen sponge with human umbilical cord mesenchymal stem cells for diabetic wound repair in rats.

Stem cell therapy offers a novel approach to treating difbetic foot ulcers. Fish skin decellularized matrix, a type I collagen, provides a promising carrier for stem cells, creating a supportive microenvironment that enhances cell survival and therapeutic potential. This study aims to investigate the effects and mechanisms of human umbilical cord mesenchymal stem cells (HUCMSCs) loaded onto a fish collagen sponge for wound healing in diabetic rats. The study evaluates stem cell-loading efficiency with fish collagen sponge in vitro, assesses material distribution on diabetic rat wounds, and establishes a wound model. Rats are divided into the Self-healing group, Fish collagen sponge group, and Sponge loaded with HUCMSCs group. Therapeutic effects are evaluated through various analyses, including histopathology and reverse transcription polymerase chain reaction for collagen-related gene expression levels. Compared to the self-healing group, both the fish collagen group and the composite group show faster wound repair and improved healing outcomes. The composite group exhibits superior wound healing quality, with fish collagen contributing to enhanced tissue regeneration through collagen regulation at the wound site. Loading HUCMSCs onto a fish collagen sponge shows promise for treating diabetic wounds by addressing nutrient deficiency and cell supply issues, offering potential benefits for patients undergoing treatment.

Prognostic significance of positive lymph node regression grade to neoadjuvant chemoradiation for esophageal squamous cell carcinoma.

BACKGROUND AND PURPOSE: To assess the relationship between metastatic lymph node (LN) responder status and recurrence-free survival (RFS) in patients undergoing neoadjuvant chemoradiotherapy (NCRT). MATERIALS AND METHODS: We retrospectively reviewed 304 patients with local advanced esophageal squamous cell carcinoma received NCRT followed by esophagectomy. For 112 patients with positive node, according to the proportion of residual viable tumor cells area within the whole tumor beds of all metastatic LNs, we classified LN-tumor regression grade (LN-TRG) into four categories: grade 1, 0%; 2, <10%; 3, 10%-50%; 4, >50%. Patients with grade 1-2 LN-TRG of were considered LN responders, and those with grades 3-4, as LN nonresponders. Univariate and multivariate analyses of RFS were estimated by a Cox regression model, Kaplan-Meier curve, and log-rank test. RESULTS: The median follow-up time of a total of 112 patients was 29.6 months. Fifty-two (46.4%) patients have experienced recurrence. In Cox univariate analysis, differentiation, AJCC stage LN responder status, nerve invasion, and lymphovascular invasion significantly correlated with RFS. Multivariate analysis for RFS revealed that LN responder status and AJCC stage (p < 0.05) were independent prognostic factor. The 3-year RFS rates for patients with LN-TRG of 1-4 grades were 72.7%, 76.5%, 37.4%, and 28.5%, respectively, and the median RFS times were not reach, 43.56, 28.09, and 22.77, respectively. CONCLUSIONS: LN responder status is an independent prognostic factor for RFS in esophageal cancer patients who received NCRT.

Understanding the secondary outcomes of international travel measures during the covid-19 pandemic: a scoping review of social impact evidence.

BACKGROUND: Assessment of the effective use of international travel measures during the COVID-19 pandemic has focused on public health goals, namely limiting virus introduction and onward transmission. However, risk-based approaches includes the weighing of public health goals against potential social, economic and other secondary impacts. Advancing risk-based approaches thus requires fuller understanding of available evidence on such impacts. METHODS: We conducted a scoping review of existing studies of the social impacts of international travel measures during the COVID-19 pandemic. Applying a standardized typology of travel measures, and five categories of social impact, we searched 9 databases across multiple disciplines spanning public health and the social sciences. We identified 26 studies for inclusion and reviewed their scope, methods, type of travel measure, and social impacts analysed. RESULTS: The studies cover a diverse range of national settings with a strong focus on high-income countries. A broad range of populations are studied, hindered in their outbound or inbound travel. Most studies focus on 2020 when travel restrictions were widely introduced, but limited attention is given to the broader effects of their prolonged use. Studies primarily used qualitative or mixed methods, with adaptations to comply with public health measures. Most studies focused on travel restrictions, as one type of travel measure, often combined with domestic public health measures, making it difficult to determine their specific social impacts. All five categories of social impacts were observed although there was a strong emphasis on negative social impacts including family separation, decreased work opportunities, reduced quality of life, and inability to meet cultural needs. A small number of countries identified positive social impacts such as restored work-life balance and an increase in perceptions of safety and security. CONCLUSIONS: While international travel measures were among the most controversial interventions applied during the COVID-19 pandemic, given their prolonged use and widespread impacts on individuals and populations, there remains limited study of their secondary impacts. If risk-based approaches are to be advanced, involving informed choices between public health and other policy goals, there is a need to better understand such impacts, including their differential impacts across diverse populations and settings.

Can precancerous stem cells be risk markers for malignant transformation in the oral mucosa?

Accurate assessment of the carcinogenic potential of oral mucosal diseases can significantly reduce the prevalence of oral cancer. We speculate that precancerous stem cells (pCSCs) arise during the evolution of carcinomas based on long-term experimental findings, published literature, and the cancer stem cell (CSC) theory, wherein pCSCs exist in precancerous lesions and have characteristics of both CSCs and normal stem cells. This apparently contradictory feature may be the foundation of the reversible transformation of precancerous lesions. Predicting malignant transformation in potentially malignant oral illnesses would allow for focused treatment, prognosis, and secondary prevention. Currently available clinical assays for chromosomal instability and DNA aneuploidy have several deficiencies. We hope that our study will increase attention to pCSC research and lead to the development of novel strategies for the prevention and treatment of oral cancer by identifying pCSC markers.

Prevention of skin damages related to personal protective equipment among healthcare workers: Summary of best-evidence practiced strategies.

AIM: To conduct a quality evaluation of the literature for the prevention of skin damage caused by personal protective equipment among healthcare workers and to summarise the best-evidence practice strategies to prevent it. DESIGN: Review. METHODS: Two researchers retrieved the literature from Web of Science, Public Medicine, etc., from the establishment of the database until 24 June 2022. Appraisal of Guidelines, Research and Evaluation II was used to assess the methodological quality of the guidelines. Expert consensus was assessed by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. By tracking the original study, the quality of practice recommendations and best-practice evidence information sheets were evaluated by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pre-grading and recommending level system. RESULTS: A total of 5476 studies were retrieved after duplications were eliminated. After the quality evaluation, 10 qualified studies were finally included. All consisted of two guidelines, one best practice information sheet, five practice recommendations, and one expert consensus. The evaluation results of the guidelines were both B-level recommendations. The consistency strength of expert consensus was moderate (Cohen's kappa coefficient = .571). Thirty best-evidence practised strategies were compiled for four elements, including cleaning, moisturising, prophylactic dressings and others. CONCLUSION: Our study evaluated the quality of the included studies and summarised the preventive measures of PPE-related skin lesions according to the recommendation level. The main preventive measures were divided into 4 parts and 30 items. However, the associated literature was rare, and the quality was slightly low. More high-quality research is needed to focus on healthcare workers' health and not just skin in the future.

Retinal development and the expression profiles of opsin genes during larval development in Takifugu rubripes.

The light-sensitive capacity of fish larvae is determined by the structure of the retina and the opsins expressed in the retinal and nonretinal photoreceptors. In this study, the retinal structure and expression of opsin genes during the early developmental stage of Takifugu rubripes larvae were investigated. Histological examination showed that at 1 days after hatching (dah), seven layers were observed in the retina of T. rubripes larva, including the pigment epithelial layer [retinal pigment epithelium layer (RPE)], photoreceptor layer (PRos/is), outer nuclear layer (ONL), outer plexiform layer (OPL), inner nuclear layer (INL), inner plexiform layer (IPL) and ganglion cell layer (GCL). At 2 dah, optic fibre layer (OFL) can be observed, and all eight layers were visible in the retina. By measuring the thickness of each layer, opposing developmental trends were found in the thickness of ONL, OPL, INL, IPL, GCL and OFL. The nuclear density of ONL, INL and GCL and the ratios of ONL/INL, ONL/GCL and INL/GCL were also measured and the ratio of ONL/GCL ranged from 1.9 at 2 dah to 3.4 at 8 dah and no significant difference was observed between the different developmental stages (P > 0.05). No significant difference was observed for the INL/GCL ratio between the different developmental stages, which ranged from 1.2 at 2 dah to 2.0 at 18 dah (P > 0.05). The results of quantitative real-time polymerase chain reaction (PCR) showed that the expression of RH1, LWS, RH2-1, RH2-2, SWS2, rod opsin, opsin3 and opsin5 could be detected from 1 dah. These results suggest that the well-developed retina and early expression of the opsins of T. rubripes during the period of transition from endogenous to mixed feeding might be critical for vision-based survival skills during the early life stages after hatching.

The changes and causes of asthenopia after ICL implantation.

OBJECTIVE: To detect the presence of asthenopia after implantation of Implantable Collamer Lens (ICL). METHOD: Design: prospective observational case series. Patients with myopia and/or astigmatism who underwent ICL surgeries and completed 3-month follow-up were enrolled. Asthenopia scores, amplitude of accommodation (AA), positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), the ratio of accommodative convergence and accommodation (AC/A), Schirmer test, noninvasive breakup time (NBUT), and HOA were examined before surgeries and at 1 week, 1 month and 3 months postoperatively then statistically analyzed. RESULTS: Symptoms of asthenopia were significantly decreased at 1 week after ICL surgeries than those before surgeries, but increased gradually as time went by, eventually recovered at 3 months postoperatively. AA, AF, AC/A decreased 1 week postoperatively, returned to the baseline at 1 month and were improved at 3 months after surgeries. NBUT at 1 week, 1 month and 3 months after surgeries were significantly decreased and was the lowest at 1 week postoperatively. PRA, NRA, Schiermer values and HOA had no significant change. Correlation analysis showed that the lower AF and NBUT after ICL surgeries, the more severe the asthenopia symptoms. CONCLUSION: The symptoms of asthenopia aggravated transiently after ICL implantation surgeries, but improved gradually with time. AF and NBUT were important factors affecting the changes of asthenopia.

CNTF induces Clcf1 in astrocytes to promote the differentiation of oligodendrocyte precursor cells.

NSCs play an essential role in the regeneration process of the central nervous system. However, due to the influence of the harsh pathological microenvironment, the viability of neural stem cells is limited, and the therapeutic effect needs improvement. Previous studies have found that stem cells overexpressing ciliary neurotrophic factor (CNTF) have apparent therapeutic effects on remyelination, but the specific mechanism of action still needs to be further explored. We found that astrocytes, the most numerous groups in the CNS, exhibited a pathological role in the experimental autoimmune encephalomyelitis model, but after stimulation with CNTF-NSCs, a phenotypic switch occurred and induced the neurotrophic factor cardiotrophin-like cytokine 1 (Clcf1) production. Mechanistically, Clcf1 can significantly promote the differentiation of oligodendrocyte precursor cells (OPCs), and the advanced effect can attenuate by the Clcf1 antibody. Therefore, this study was conducted to investigate the pathway by which CNTF-NSCs exert their therapeutic effects by affecting astrocytes. It is expected to identify a potential therapeutic factor, Clcf1, for the treatment of demyelinating diseases.

Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study.

BACKGROUND: The occurrence of hypomagnesemia in patients with primary hyperparathyroidism (PHPT) has been noted previously; however, the association of hypomagnesemia and severity of primary hyperparathyroidism remains unknown. The present study aimed to evaluate the association of hypomagnesemia with biochemical and clinical manifestations in patients with PHPT. METHODS: This was a retrospective study conducted at a tertiary hospital. We obtained data from 307 patients with PHPT from January 2010 through August 2020. Data on demographics, history, laboratory findings, bone densitometry findings, and clinical presentation and complications were collected and were compared in normal magnesium group vs hypomagnesemia group. RESULTS: Among the 307 patients with PHPT included in our study, 77 patients (33/102 [32.4%] males and 44/205 [21.5%] females) had hypomagnesemia. Mean hemoglobin levels in the hypomagnesemia group were significantly lower than those in the normal magnesium group in both males and females. In contrast, patients with hypomagnesemia had a higher mean serum calcium and parathyroid hormone than individuals with normal magnesium. The typical symptoms of PHPT, such as nephrolithiasis, bone pain/fractures, polyuria, or polydipsia, were more common in the hypomagnesemia group. In addition, patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis. Even after adjusting for potential confounders, including age, sex, body mass index, estimated glomerular filtration rate, and parathyroid hormone levels, these associations remained essentially unchanged. CONCLUSION: Biochemical and clinical evidence indicates that patients with PHPT with hypomagnesemia have more severe hyperparathyroidism than those without hypomagnesemia. In addition, PHPT patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis.

Effect of Cardinium Infection on the Probing Behavior of Bemisia tabaci (Hemiptera: Aleyrodidae) MED.

Facultative endosymbionts can affect the growth, physiology, and behavior of their arthropod hosts. There are several endosymbionts in the invasive whitefly Bemisia tabaci Mediterranean (MED, Q biotype) that influence host fitness by altering stylet probing behavior. We investigated the probing behavior of B. tabaci MED infected with the facultative endosymbiont Candidatus Cardinium hertigii (Cardinium (Sphingobacteriales: Flexibacteraceae)). We generated genetically similar Cardinium-infected (C*+) and uninfected (C-) clonal sublines and analyzed the probing behavior of newly emerged adult on cotton (Malvales: Malvaceae), Gossypium hirsutum L., using electropenetrography (EPG). The C- subline demonstrated a longer duration of E2 (2.81-fold) and more events of E2 (2.22-fold) than the C*+ subline, indicating a greater level of sustained ingestion of plant phloem. These findings provide insight into the fitness costs (fitness of a particular genotype is lower than the average fitness of the population) of the Cardinium-infected B. tabaci.

Assessing farmers' intention towards conservation agriculture by using the Extended Theory of Planned Behavior.

Conservation agriculture is considered as an agro-ecological approach to the sustainable and resource-saving crop production system. Previous studies on the adoption of agricultural innovation often consider socio-economic characteristics and overlook underlying psychological factors influencing farmers' behavioral intention. This study adopted three socio-psychological constructs, Attitude, Subjective Norm (SN), and Perceived Behavioral Control (PBC), which originated from the Theory of Planned Behavior (TPB), and proposed two new constructs, Knowledge (K) and Perceived Climatic Threats of Conventional Farming (PCTCV). Using the Extended Theory of Planned Behavior Model (ETPBM), this study analyzed factors affecting the intention of farmers to continue Conservation Agriculture (CA) for the following year (2020) in three districts located in the northern part of Bangladesh. This research found evidence from the hierarchical regression analysis that variables of ETPBM could explain 7% more variation (change in R2) in intention than variables of TPB, while the socio-economic characteristics of farmers can explain only 0.5% more than the variables of ETPBM. Structural Equation Modelling (SEM) was used to determine and examine the extended theory and indicated that farmers' knowledge (K) had the highest total impact, while attitude had the highest direct impact on intention. The results indicated that factors including Attitude, SN, PBC, Knowledge (K), and PCTCV are positively significant when attempting to understand farmers' intentions to adopt CA. This study presented evidence about the effectiveness of ETPBM when assessing the farmers' intentions towards conservation farming. Based on these findings, we concluded that the combination of extension services for upgrading the level of knowledge concerning the importance of CA could significantly affect farmers' attitudes on intention towards the application of CA.

Effects of Bacillus lincheniformis feeding frequency on the growth, digestion and immunity of Haliotis discus hannai.

To study the effects of Bacillus lincheniformis feeding frequency on the survival and growth of Haliotis discus hannai abalone, we measured the expression levels of nonspecific immune genes and monitored the anti-Vibrio parahaemolyticus immune reaction. H. discus hannai (shell length: 32.75 ± 2.63 mm, body weight: 4.91 ± 0.34 g) was selected to perform a 70 d laboratory culture experiment including a 14 d V. parahaemolyticus artificial infection experiment. The control group (C) was fed normal commercial feed every day. The M1 experimental group was given experimental feed and basal feed on alternating days until the end of the experiment. The M2 experimental group was given experimental feed for 4 d and basal feed for 3 d, and this cycle was repeated every 7 d until the end of the experiment. The M3 experimental group was given experimental feed for 2 d and basal feed for 5 d, and this cycle was repeated every 7 d until the end of the experiment. The M4 group was continuously given experimental feed for the duration of the experiment. The concentration of added B. lincheniformis in each experimental group was 105 cfu/g (according to the quantity of viable bacteria). The specific growth rate (as measured by body weight) and the feed conversion efficiency of the abalone in M1 and M2 were significantly higher than those in M4 and C (P < 0.05). The cellulose and lipase activities of abalone in M1, M2 or M4 were significantly higher than those in M3 or C (P < 0.05). The acid phosphatase, superoxide dismutase, total haemocyte counts, O2- levels generated by respiratory bursts, and the expression levels of Mn-SOD, TPx, GSTs and GSTm in abalone in the M2 group were significantly higher than those in any other feeding frequency group (P < 0.05). At the end of the V. parahaemolyticus infection, the cumulative mortality of the abalone in M2 was significantly lower than that in any other group (P < 0.05). Consequently, given the growth advantages and the enhancement of immune function, the feeding plan in which B. lincheniformis was applied for 4 d per week, and basal feed was then applied for 3 d, did not lead to a high level of immune reaction, immune fatigue or waste of resources, but increased the growth rate of individuals and their resistance to V. parahaemolyticus infection.

Biochar mitigates the N2O emissions from acidic soil by increasing the nosZ and nirK gene abundance and soil pH.

Nitrous oxide (N2O) is a pervasive greenhouse gas, and soil management practices greatly affect its release into the atmosphere. Soil pH management (particularly increasing the pH) using biochar can seriously affect soil N2O emissions. The current incubation experiment was conducted to explore the response of N2O emissions from acidic soils using various doses of biochar. Soil with a pH of 5.48 was treated with rice straw biochar at different doses (0%, 1% and 2%) and incubated with 60% water-filled pore spaces (WFPS). The experiment was conducted in a completely randomized design (CRD) with three replications. The soil N2O emissions, pH, NH4+-N, NO3--N, microbial biomass carbon (MBC), and nosZ and nirK gene abundance were determined at various intervals throughout the study. The biochar application (2%) increased the soil pH (from 5.48 to 6.11), triggered the transformation of nitrogen, and augmented the abundance of nosZ and nirK genes. Higher magnitudes of cumulative soil N2O emissions (48.60 µg kg-1) were noted in the control (no biochar) compared to 1% (28.10 µg kg-1) and 2% (14.50 µg kg-1) biochar application. The 2% biochar application more effectively decreased the soil N2O emissions, mainly because of the increased nosZ and nirK gene abundance at higher soil pH levels. The findings suggest that the amelioration of acidic soil with rice straw biochar can considerably control soil N2O emissions by elevating the soil pH and the abundance of nosZ and nirK genes.

[Research progress on processing history evolution, chemical components and pharmacological effects of Polygonati Rhizoma].

Polygonati Rhizoma(PR), listed as a top-grade medicine, was recorded first in the Mingyi Bielu written by TAO Hongjing. It is a good medicine through the ages to tonify Qi and nourish Yin, strengthen spleen and kidney. PR has a long history of processing and has a variety of processing methods and technologies. Steaming and stewing are the main processing methods. There are many different excipients used in processing PR, such as wine, honey, black beans, and multiple excipients. At present, there are three plant varieties of PR recorded in Chinese Pharmacopoeia, including Polygonatum sibiricum, P. kingianum and P. cyrtonema, collectively called medicinal PR. Medicinal PR has a wide range of chemical components, mainly including polysaccharides, steroidal saponins, flavonoids, phenylpropanoids and alkaloids etc. It also has a wide range of pharmacological effects, such as anti-oxidation, anti-osteoporosis and anti-tumor effects. In this paper, we review the historical evolution, chemical components, pharmacological effects, and the effects of processing on ingredients and pharmacological effects of PR. We also analyze the limitations of the current research on PR, and put forward the prospects on the scientific connotation of processing, quality improvement, process innovation and new product development of PR for further researches.

[Preparation and evaluation of schisandrin B-loaded F127 modified lipid-polymer nanoparticles for inhibition of breast cancer lung metastasis].

In the current study, schisandrin B(SchB)-loaded F127 modified lipid-polymer hybrid nanoparticles(SchB-F-LPNs) were developed to improve the inhibition of breast cancer lung metastasis. Modified nanoprecipitation method was used to prepare SchB-F-LPNs. The nanoparticles were spherical in shape with shell-core structure by TEM observation. SchB-F-LPNs showed a mean particle size of(234.60±6.11) nm with zeta potential of(-5.88±0.49) mV. XRD results indicated that SchB existed in the nanoparticles in an amorphous state. The apparent permeability coefficient through porcine mucus of F-LPNs was 1.43-fold of that of LPNs as shown in the in vitro mucus penetration study. The pharmacokinetics study showed that the C_(max) of SchB was(369.06±146.94) µg·L~(-1),(1 121.34±91.65) µg·L~(-1) and(2 951.91±360.53) µg·L~(-1) respectively in SchB suspensions group, SchB-LPNs group and SchB-F-LPNs group after oral administration in rats. With SchB suspensions as the reference formulation, the relative bioavailability of SchB-F-LPNs was 568.60%. SchB-F-LPNs inhibited the morphological change during transforming growth factor-ß1(TGF-ß1)-induced epithelial-mesenchymal transition. In addition, SchB-F-LPNs significantly decreased the number of metastatic pulmonary nodules in 4 T1 tumor-bearing mice, suggesting that SchB-F-LPNs may inhibit the metastasis of breast cancer. These results reveal the promising potential of SchB-F-LPNs in treatment of breast cancer lung metastasis.

Effects of the probiotic Bacillus amyloliquefaciens on the growth, immunity, and disease resistance of Haliotis discus hannai.

The effects of a diet containing the probiotic Bacillus amyloliquefaciens on the survival and growth of Haliotis discus hannai were evaluated by measuring growth and hematological parameters and the expression levels of nonspecific immune genes. In addition, the abalone's response to Vibrio parahaemolyticus infection was assessed. H. discus hannai (shell length: 29.35 ±â€¯1.81 mm, body weight: 4.28 ±â€¯0.23 g) were exposed to an 8-week culture experiment in indoor aquariums and a 2-week V. parahaemolyticus artificial infection experiment. In each experiment, the control group (C) was fed daily with the basal feed; the experimental groups were fed daily with the experimental feed, prepared by spraying B. amyloliquefaciens onto the basal feed at final concentrations of 103 (group A1), 105 (A2), and 107 (A3) cfu/g. The survival rate, body weight specific growth rate, and food conversion efficiency in A2 and A3 were significantly higher than those in A1 and C (P < 0.05). The total number of blood lymphocytes, the O2- and NO levels produced from respiratory burst, the activities of acid phosphatase, superoxide dismutase, and catalase, and the expression levels of catalase and thiol peroxidase in A2 were not significantly different from those in A3, but these factors were significantly higher in A2 compared to A1 and C (P < 0.05). The total antioxidant capacity and expression levels of glutathione S-transferase in A1, A2 and A3 were significantly higher than those in C (P < 0.05). At day 9 after infection with V. parahaemolyticus, all abalone in C were dead; at the end of the experiment, the cumulative mortality of abalone in A2 was significantly lower than that in any other group (P < 0.05). Thus, the experimental feed containing 105 cfu/g B. amyloliquefaciens not only facilitated the food intake and growth of abalone, but also effectively enhanced their non-specific immunity and resistance to V. parahaemolyticus infection. In this regard, B. amyloliquefaciens may be a useful probiotic strain for abalone aquaculture.

Impact of an intelligent chronic disease management system on patients with type 2 diabetes mellitus in a Beijing community.

BACKGROUND: Rapid demographic and economic changes have made chronic disease the number one health issue in China, contributing to more than 80% of the country's 10.3 million annual deaths and nearly 70% of its total disease burden (Wang et al., Toward a Healthy and Harmonious Life in China: Stemming the Rising Tide of Non-Communicable Diseases, 2011; Yip and Hsiao, Lancet 384: 805-18, 2014). Diabetes is a major contributor to the chronic disease burden and is experienced by nearly 11% of the adult population of China (Yang et al., N Engl J Med 362:1090-101, 2010). In response to the challenges of chronic disease, the Chinese government initiated comprehensive health care reforms nationwide in 2009. A key measure was a hierarchical diagnosis and treatment system for monitoring and reducing chronic diseases and improving the community health service system (Barber et al., Health Policy Plan 29:367-78, 2014). Primary hospitals, such as community health service centers, are the main gatekeepers for management of diabetes and other chronic diseasesin China. In recognition of the need for a more patient-centered approach, the Chinese government has piloted a program incorporating methods of diabetes self-management for chronic care: the Happy Life Club (Browning et al., Front in Public Health 2:181, 2015). This program is modeled on a similar program developed in Australia (Kelly et al., Aust J Prim Health 9:186-9, 2003). The ICDMS is an important tool in the implementation of patient-centered programs targeting chronic health issues, and its success is determined by factors, such as frequent contact between patients and doctors and effective website training for patients. This retrospective study used de-identified data from the Fangzhuang (Beijing) intelligent chronic disease management system (ICDMS) database to evaluate the effect of an intelligent chronic disease management system on selected Beijing community patients who have type 2 diabetes mellitus (T2DM). METHODS: A comparative study before and after ICDMS implementation was performed to evaluate the effect of ICDMS on the rates of follow-up and laboratory examinations, measurement rates of blood glucose and lipids, glycosylated hemoglobin (HbA1c) and blood lipid levels, as well as the corresponding health parameters. Continuous variables and categorical variables were analyzed using paired t-test and McNemar's tests, respectively. RESULTS: A total of 2451 T2DM patients met inclusion/exclusion criteria. Compared with the pre-index period, the laboratory examination, rates of blood glucose and blood lipids increased significantly in the post-index period (p < 0.001). Triglyceride (TC) levels decreased significantly from 5.22 mmol/L to 5.11 mmol/L (p < 0.05), and high density lipoprotein-cholesterol (HDL-C) levels increased significantly from 1.35 mmol/L to 1.48 mmol/L (p < 0.05). The control rate of TC increased from 24.86 to 29.76% (p = 0.079). The control rate of low density lipoprotein-cholesterol (LDL-C) increased from 12.16 to 13.97% (p = 0.421), while the control rate of HDL-C increased significantly from 68.60 to 78.77%. Importantly, Compared with the patients with HbA1C above 7% in the pre-index period, the mean HbA1c decreased significantly from 7.84 to 6.94%((p < 0.001) in the post-index period, and the control rate of HbA1c was 57.43%. CONCLUSIONS: The intelligent chronic disease management system is an effective tool in the management of T2DM and should be promoted by the Community Health Service Center in China as well as in other developing countries.

Dark triad personalities and counterproductive work behaviors among physicians in China.

The goal of this study was to examine the relationship between the dark triad personality (DTP) and organizational and individual counterproductive work behaviors (CWBs), based on the argument that situational variables mediate this relationship. The data were collected at Beijing Children's Hospital, the largest children's hospital in China. Paper and pencil questionnaires were distributed to 200 randomly selected physicians, of whom 168 responded, an 84% response rate. The findings of regression analysis and mediation analysis show a strong relationship between the DTP and CWBs. Of the three traits of the DTP, Machiavellianism was significantly related to both dimensions of CWBs, organizational and interpersonal. The findings also show that the relationship examined here was affected by mediators, particularly organizational commitment and organizational justice, emphasizing the effect of the environment on the behavior of dark personalities. The environment, represented by the mediators, had no effect on narcissists' CWB, and psychological contract breach was the only mediator found to have no mediating effect. The paper concludes with suggestions and recommendations for future research, in particular in different settings.

Early Evaluation of Relative Changes in Tumor Stiffness by Shear Wave Elastography Predicts the Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer.

OBJECTIVES: Neoadjuvant chemotherapy plays an important role in comprehensive therapy for breast cancer, but response prediction is imperfect. Shear wave elastography (SWE) is a novel technique that can quantitatively evaluate tissue stiffness. In this study, we sought to investigate the application value of SWE for early prediction of the response to neoadjuvant chemotherapy in patients with breast cancer. METHODS: We prospectively evaluated tumor stiffness in 62 patients with breast cancer using SWE, which was performed at baseline and after the second cycle of neoadjuvant chemotherapy. After chemotherapy, all of the patients underwent surgery. We investigated the correlations between the relative changes in tumor stiffness (Δ stiffness) after 2 cycles of chemotherapy and the pathologic response to the therapy. RESULTS: Compared with baseline values, tumor stiffness after 2 cycles of neoadjuvant chemotherapy was significantly decreased in responders (P < .001) but not in nonresponders (P = .172). The Δstiffness was significantly higher in responders (-42.194%) than in nonresponders (-23.593%; P = .001). As determined at either the baseline or after the second cycle of chemotherapy, tumor stiffness was significantly lower in responders than in nonresponders (P = .033 and .009, respectively). The Δ stiffness threshold for distinguishing between responders and nonresponders was -36.1% (72.92% sensitivity and 85.71% specificity). Furthermore, correlating Δ stiffness with clinical and pathologic characteristics, we found that estrogen and progesterone receptor expression showed statistically significant correlations with Δ stiffness (estrogen receptor, P = .008; progesterone receptor, P = .023). CONCLUSIONS: Early evaluation of relative changes in tumor stiffness using SWE could effectively predict the response to neoadjuvant chemotherapy in patients with breast cancer and might indicate better therapeutic strategies on a timelier basis.

Objective assessment of health or pre-chronic disease state based on a health test index derived from routinely measured clinical laboratory parameters.

OBJECTIVE: To develop a quantitative system to enable the objective assessment of health or pre-chronic disease state. METHODS: On the basis of measured values and reference ranges, we obtained the organ function index (mean of the cut-off ratios of albumin and creatinine), blood lipid index (mean of the cut-off ratios of triglycerides, cholesterol, high-density lipoproteins and low-density lipoproteins), stress index (mean of the cut-off ratios of neutrophils and glucose), and the health test index (mean of the above three indexes, HTI). Elderly populations, individuals with nonalcoholic fatty liver disease and administrators were included in the groups of observed subjects to verify the organ function index, blood lipid index and stress index. RESULTS: The scores of the three indexes were all statistically higher in the observed group than in the control group (p < 0.05). The mean HTI score was 0.7 ± 0.07 and was normally distributed in the control population. The rates of hypertension, obesity, fatty liver disease and health (undetectable organic diseases) increased with increasing HTI scores in a random population. CONCLUSIONS: The HTI is easily derived from routinely measured clinical laboratory parameters. It can reflect the health status of an individual and may be a useful tool for the quantitative differentiation of health status.