[Impact of Social Capital on Residents' Choice of Medical Institutions: A Study Based on Classification Tree Model and Logistic Regression].

Objective: To explore the influence of social capital on the local residents' choice of medical institutions and to provide a reference basis for promoting diagnosis and treatment services available at different tiers. Methods: A classification tree model was established using the exhaustive chi-square automatic interaction detection (Exhaustive CHAID) method to screen for factors influencing the residents' choice of medical institutions, and a logistic regression model was used to quantitatively analyze the interaction effect of the influencing factors. Results: The classification tree model showed that there were four layers and eight terminal nodes, identifying a total of six influencing factors, including individual social capital, self-reported physical health, education, community social capital, chronic disease prevalence, and self-reported mental health. Logistic regression analysis showed that education (odds ratio [OR]=0.660, 95% confidence interval [CI]: 0.502-0.869), community social capital (OR=0.746, 95% CI: 0.589-0.943), and individual social capital (OR=0.405, 95% CI: 0.287-0.572) (P<0.001) had an impact on residents' choice of medical institution. There was an interaction between individual social capital and self-reported physical health on residents' choice of medical institution (OR=1.872, 95% CI: 1.180-2.969, P<0.05). Conclusion: Interventions in terms of social capital factors should be considered in order to promote the rational use of medical resources.

The impact of social capital and mental health on medication adherence among older people living with HIV (PLWH).

BACKGROUND: The number of older people living with HIV (PLWH) is increasing. Although there are many studies affecting medication adherence, research on the impact of social capital and mental health on medication adherence in this particular population is limited. METHOD: Data were collected from an ongoing observational prospective cohort study, starting from November 2018, among older PLWH in Sichuan province, China. Five hundred twenty-one participants were interviewed. Social capital consists of the individual and family (IF) scale, and the community and society (CS) scale. The presence of probable depression and probable anxiety were assessed using the CES-D-10 and GAD-7 scales. Adherence was defined as taking ≥80% of prescribed HIV medication in 4 days prior to the interview. Two sets of Firth' penalized regression analyses were used to estimate the association between social capital, mental health, and medication adherence. RESULTS: The prevalence of non-adherence was 18.2% (95/521) among older PLWH in this study. After adjusting for significant factors, the CS social capital (OR: 0.92, 95%CI:0.85-0.99, p < 0.05) and probable anxiety (OR:1.73, 95%CI:1.07-2.80, p < 0.05) were associated with non-adherence. CONCLUSION: This study highlighted that the effects of social capital and mental health on older PLWH's adherence, which implied that the need to develop interventions to concern for mental health and enhance CS social capital to help the older PLWH better manage HIV medication adherence.

Insights into spatiotemporal variations of the water quality in Taihu Lake Basin, China.

Taihu Lake Basin is highly developed but suffers from perennial water shortages due to pollution. Most studies have been limited to examining the water quality in specific areas, but few have investigated the entire basin. This study was based on official water quality data obtained from 565 sites in the monitoring network, thereby covering the entire basin. The water quality spatiotemporal variations were explored by statistical analysis, and the precise spatial distribution of the main pollutants was analyzed by heat maps. Only 29.09% of the water quality assessment results showed "drinkable," whereas 28.63% showed "moderate" and "severe" pollution. The "severe" proportion had a significant declining trend (R2 = 0.933) and was affected by the variations of nitrogen that was related to rainfall and anthropogenic activities. The water quality spatial variation was most likely related to anthropogenic influence and land use. The water quality in the developed and densely populated urban areas was poor, especially in downtown Shanghai. NH3-N, TN, TP, BOD5, COD, CODMn, and DO were the main pollutants that affected the water quality. NH3-N and TN were major reduction targets. NH3-N was the main pollutant that deteriorated the water quality in most densely populated urban areas. Many lakes and reservoirs were highly polluted with TN. Controlling domestic sewage may be effective to improve the water quality. This study makes up for the limited research on the water quality spatiotemporal variations in the entire Taihu Lake Basin and provides beneficial information and suggestions for decision-making regarding the water management.

Mycobacterium tuberculosis Mce3E suppresses host innate immune responses by targeting ERK1/2 signaling.

Crucial to the pathogenesis of the tuberculosis (TB)-causing pathogen Mycobacterium tuberculosis is its ability to subvert host immune defenses to promote its intracellular survival. The mammalian cell entry protein 3E (Mce3E), located in the region of difference 15 of the M. tuberculosis genome and absent in Mycobacterium bovis bacillus Calmette-Guérin, has an essential role in facilitating the internalization of mammalian cells by mycobacteria. However, relatively little is known about the role of Mce3E in modulation of host innate immune responses. In this study, we demonstrate that Mce3E inhibits the activation of the ERK1/2 signaling pathway, leading to the suppression of Tnf and Il6 expression, and the promotion of mycobacterial survival within macrophages. Mce3E interacts and colocalizes with ERK1/2 at the endoplasmic reticulum in a DEF motif (an ERK-docking motif)-dependent manner, relocates ERK1/2 from cytoplasm to the endoplasmic reticulum, and finally reduces the association of ERK1/2 with MEK1 and blocks the nuclear translocation of phospho-ERK1/2. A DEF motif mutant form of Mce3E (F294A) loses its ability to suppress Tnf and Il6 expression and to promote intracellular survival of mycobacteria. Inhibition of the ERK1/2 pathway in macrophages using U0126, a specific inhibitor of the ERK pathway, also leads to the suppressed Tnf and Il6 expression and the enhanced intracellular survival of mycobacteria. Taken together, these results suggest that M. tuberculosis Mce3E exploits the ERK1/2 signaling pathway to suppress host innate immune responses, providing a potential Mce3E-ERK1/2 interface-based drug target against M. tuberculosis.

Comparing the effects of aquatic-based exercise and land-based exercise on balance in older adults: a systematic review and meta-analysis.

BACKGROUND: Balance plays a crucial role in the daily activities of older adults. Aquatic-based exercises (AE) are widely conducted as an alternative to land-based exercises (LE). Previous studies have compared AE and LE as effective ways to improve balance and have yielded inconsistent results. Therefore, this review aimed to compare the effects of AE and LE on balance function in older adults. METHODS: Electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched. Randomized controlled trials published from January 2003 to June 2023 were included following predetermined criteria. Data extraction was carried out by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software. The fixed-effect model or random-effect model was chosen based on the results of the heterogeneity test. Meta-analysis for the effect sizes of balance outcomes was calculated as standardized mean difference (SMD) with 95% confidence intervals (CI). The quality of the included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. This review was registered at PROSPERO CRD42023429557. RESULTS: A total of 29 studies involving 1486 older adults (with an average age of 66.2 years) were included. Meta-analysis results indicated that AE could improve balance ability based on two tests: the Berg balance scale (BBS: SMD = 1.13, 95% CI 0.25 to 2.00, p = 0.01, I2 = 94%) and the 30-s chair stand test (30 CST: SMD = 2.02, 95% CI 0.50 to 3.54, p = 0.009, I2 = 96%). However, there were no significant differences between the AE group and the LE group in terms of the 6-min walking test (6 MWT: SMD = 0.13, 95% CI -0.16 to 0.43, p = 0.38, I2 = 62%) and time up to go test (TUGT: SMD = 0.44, 95% CI -0.44 to 0.91, p = 0.07, I2 = 85%). Older adults with different health conditions have different gains in different balance measurements after AE intervention and LE intervention. CONCLUSIONS: Although this was influenced by participant health status, transfer effects, sample size, and other factors, AE offers better benefits than LE for improving balance function in older adults.

XTQA: Span-Level Explanations for Textbook Question Answering.

Textbook question answering (TQA) is the task of correctly answering diagram or nondiagram (ND) questions given large multimodal contexts consisting of abundant essays and diagrams. In real-world scenarios, an explainable TQA system plays a key role in deepening humans' understanding of learned knowledge. However, there is no work to investigate how to provide explanations currently. To address this issue, we devise a novel architecture toward span-level eXplanations for TQA (XTQA). In this article, spans are the combinations of sentences within a paragraph. The key idea is to consider the entire textual context of a lesson as candidate evidence and then use our proposed coarse-to-fine grained explanation extracting (EE) algorithm to narrow down the evidence scope and extract the span-level explanations with varying lengths for answering different questions. The EE algorithm can also be integrated into other TQA methods to make them explainable and improve the TQA performance. Experimental results show that XTQA obtains the best overall explanation result mean intersection over union (mIoU) of 52.38% on the first 300 questions of CK12-QA test splits, demonstrating the explainability of our method (ND: 150 and diagram: 150). The results also show that XTQA achieves the best TQA performance of 36.46% and 36.95% on the aforementioned splits. We have released our code in https://github.com/dr-majie/opentqa.

Influencing factors of LDCT recommendation by physicians in Sichuan Province, China.

The study aimed to investigate the influencing factors of physicians in recommending low-dose computed tomography (LDCT) for lung cancer screening to high-risk groups. A total of 1767 participants with good knowledge of LDCT were included in a cross-sectional study. Data about physicians' demographics, perception of barriers on LDCT screening, medical conditions for practicing medicine and the behavior of recommending LDCT were collected by a questionnaire. Physicians who care about the transportation convenience of patients were less likely to recommend LDCT (OR 0.568, 95% CI (0.423 to 0.763), p < 0.05). The physicians who considered LDCT expensive, recommended LDCT less than others (OR 0.308, 95% CI (0.186 to 0.510), p < 0.05). The false positive rate of LDCT can decrease the possibility of physicians' recommending (OR 0.542, 95% CI (0.387 to 0.758), p < 0.05). The physicians in oncology department and health management center were more likely to recommend LDCT (OR 2.282, 95% CI (1.557 to 3.345); OR 2.476, 95% CI (1.618 to 3.791)). The convenience of transportation, the price, and the\ false positive rate may be the main concerns among physicians on recommending LDCT to high-risk groups. The influencing factors of physicians' recommending on LDCT was various. Information technology, government support in price and self-improvement of LDCT should be gathered together to break the barriers on physicians' recommending on LDCT.

Weakly Supervised Learning for Textbook Question Answering.

Textbook Question Answering (TQA) is the task of answering diagram and non-diagram questions given large multi-modal contexts consisting of abundant text and diagrams. Deep text understandings and effective learning of diagram semantics are important for this task due to its specificity. In this paper, we propose a Weakly Supervised learning method for TQA (WSTQ), which regards the incompletely accurate results of essential intermediate procedures for this task as supervision to develop Text Matching (TM) and Relation Detection (RD) tasks and then employs the tasks to motivate itself to learn strong text comprehension and excellent diagram semantics respectively. Specifically, we apply the result of text retrieval to build positive as well as negative text pairs. In order to learn deep text understandings, we first pre-train the text understanding module of WSTQ on TM and then fine-tune it on TQA. We build positive as well as negative relation pairs by checking whether there is any overlap between the items/regions detected from diagrams using object detection. The RD task forces our method to learn the relationships between regions, which are crucial to express the diagram semantics. We train WSTQ on RD and TQA simultaneously, i.e., multitask learning, to obtain effective diagram semantics and then improve the TQA performance. Extensive experiments are carried out on CK12-QA and AI2D to verify the effectiveness of WSTQ. Experimental results show that our method achieves significant accuracy improvements of 5.02% and 4.12% on test splits of the above datasets respectively than the current state-of-the-art baseline. We have released our code on https://github.com/dr-majie/WSTQ.

Freestanding vascular scaffolds engineered by direct 3D printing with Gt-Alg-MMT bioinks.

There is an urgent need for vascular scaffolds as a treatment option for cardiovascular diseases in the clinic. Here, we developed a simple and effective method to fabricate vascular scaffolds by direct 3D printing in air with gelatine (Gt) - alginate (Alg) - montmorillonite (MMT) nanocomposite bioinks. This work includes the optimization of key 3D printing parameters and the characterization of microscopic morphology, physicochemical properties, mechanical properties and preliminary biological properties. Successful 3D printing of linear and branched vascular scaffolds showed that the addition of nano-MMT improved the printability and shape accuracy. Scanning electron microscopy revealed that the inner and outer surfaces of the vascular scaffolds exhibited interconnected microporous structures favourable for nutrient delivery and cell infiltration. Axial and radial tensile tests indicated that the tensile strength and elastic modulus were similar to those of the native artery. The burst pressure of Gt-4%Alg-MMT was also in good accordance with the physiological pressure of natural blood vessels. In addition, a haemolysis test demonstrated that the haemolysis rate of Gt-4%Alg-MMT matched the gold standard of blood vessel substitution. A Live & Dead stain and a CCK-8 test confirmed the safe applicability of Gt-Alg-MMT as a biomaterial. Overall, the 3D-printed vascular scaffolds are promising candidates for in situ vascular tissue regeneration.

Characterization of spatiotemporal patterns of soil water stable isotopes at an agricultural field.

Spatiotemporal variations in soil water content (SWC) and soil water stable isotopic compositions (SWSIC; 2H/1H (δD) and 18O/16O (δ18O)) provide critical information on elucidating land surface processes across scales. Meanwhile, little is known about the spatiotemporal characteristics of SWSIC and its driving factors. Therefore, it's necessary to improve tracer techniques of SWSIC by interpreting their spatiotemporal variability patterns as well as the correlations with other factors such as texture, soil depth and vegetation. To this end, the spatiotemporal variations in SWC and SWSIC along with their controlling factors were jointly investigated based on seven field campaigns over roughly a two-year period at an agricultural field in North China Plain. Two transects, vegetated and bared, were considered. The results of vegetated transect showed that both SWC and SWSIC exhibited considerable spatiotemporal variabilities at the field scale of ~100 m, with SWSIC displaying more complex patterns. Overall, the spatial variations in SWSIC were larger in wet seasons than in dry seasons, which decreased with increasing soil depth, largely due to less impacts of precipitation inputs and soil evaporation on SWSIC dynamics at deeper depths. The temporal stability analysis (TSA) showed that there existed temporal persistence of the spatial structure of SWSIC, particularly at deeper soil depths. Moreover, the SWSIC data in our study showed that the effect of vegetation on the SWSIC dynamics was noticeable with shading effects, root distribution and water uptake, which caused much lesser degrees of soil evaporation at the vegetated transect. What's more, the representative sites for monitoring spatial average δD values were identified, demonstrating the viability of using the TSA method to estimate the spatial average SWSIC values at field scales. These findings can improve the interpretation of SWSIC data for practical applications.

Identifying the Epileptogenic Zone With the Relative Strength of High-Frequency Oscillation: A Stereoelectroencephalography Study.

BACKGROUND: High-frequency oscillation (HFO) represents a promising biomarker of epileptogenicity. However, the significant interindividual differences among patients limit its application in clinical practice. Here, we applied and evaluated an individualized, frequency-based approach of HFO analysis in stereoelectroencephalography (SEEG) data for localizing the epileptogenic zones (EZs). METHODS: Clinical and SEEG data of 19 patients with drug-resistant focal epilepsy were retrospectively analyzed. The individualized spectral power of all signals recorded by electrode array, i.e., the relative strength of HFO, was computed with a wavelet method for each patient. Subsequently, the clinical value of the relative strength of HFO for identifying the EZ was evaluated. RESULTS: Focal increase in the relative strength of HFO in SEEG recordings were identified in all 19 patients. HFOs identified inside the clinically identified seizure onset zone had more spectral power than those identified outside (p < 0.001), and HFOs in 250-500 Hz band (fast ripples) seemed to be more specific identifying the EZ than in those in 80-250 Hz band (ripples) (p < 0.01). The resection of brain regions generating HFOs resulted in a favorable seizure outcome in 17 patients (17/19; 89.5%), while in the cases of other patients with poor outcomes, the brain regions generating HFOs were not removed completely. CONCLUSION: The relative strength of HFO, especially fast ripples, is a promising effective biomarker for identifying the EZ and can lead to a favorable seizure outcome if used to guide epilepsy surgery.

The ubiquitin system: a critical regulator of innate immunity and pathogen-host interactions.

The ubiquitin system comprises enzymes that are responsible for ubiquitination and deubiquitination, as well as ubiquitin receptors that are capable of recognizing and deciphering the ubiquitin code, which act in coordination to regulate almost all host cellular processes, including host-pathogen interactions. In response to pathogen infection, the host innate immune system launches an array of distinct antimicrobial activities encompassing inflammatory signaling, phagosomal maturation, autophagy and apoptosis, all of which are fine-tuned by the ubiquitin system to eradicate the invading pathogens and to reduce concomitant host damage. By contrast, pathogens have evolved a cohort of exquisite strategies to evade host innate immunity by usurping the ubiquitin system for their own benefits. Here, we present recent advances regarding the ubiquitin system-mediated modulation of host-pathogen interplay, with a specific focus on host innate immune defenses and bacterial pathogen immune evasion.

Vagus nerve stimulation balanced disrupted default-mode network and salience network in a postsurgical epileptic patient.

INTRODUCTION: In recent years, treatment of intractable epilepsy has become more challenging, due to an increase in resistance to antiepileptic drugs, as well as diminished success following resection surgery. Here, we present the case of a 19-year old epileptic patient who received vagus nerve stimulation (VNS) following unsuccessful left parietal-occipital lesion-resection surgery, with results indicating an approximate 50% reduction in seizure frequency and a much longer seizure-free interictal phase. MATERIALS AND METHODS: Using resting-state functional magnetic resonance imaging, we measured the changes in resting-state brain networks between pre-VNS treatment and 6 months post-VNS, from the perspective of regional and global variations, using regional homogeneity and large-scale functional connectives (seeding posterior cingulate cortex and anterior cingulate cortex), respectively. RESULTS: After 6 months of VNS therapy, the resting-state brain networks were slightly reorganized in regional homogeneity, mainly in large-scale functional connectivity, where excessive activation of the salience network was suppressed, while at the same time the suppressed default-mode network was activated. CONCLUSION: With regard to resting-state brain networks, we propose a hypothesis based on this single case study that VNS acts on intractable epilepsy by modulating the balance between salience and default-mode networks through the integral hub of the anterior cingulate cortex.

Comparative study of acoustic radiation force impulse imaging with real-time elastography in differential diagnosis of thyroid nodules.

The aims of this study were to evaluate whether acoustic radiation force impulse (ARFI) imaging of the thyroid gland and thyroid nodules yields reliable results and to compare the values of ARFI imaging with those of real-time elastography (RTE) in the differential diagnosis of thyroid nodules. RTE and ARFI were performed in 30 patients with 58 thyroid nodules. The results were compared with pathologic findings. Receiver operating characteristic curves were drawn to evaluate the diagnostic results. The area under the curve for RTE (0.78) was smaller than that for ARFI (0.94) (p < 0.01). ARFI imaging of thyroid tissue yields more reliable results than RTE.

VP22 and cytosine deaminase fusion gene modified tissue-engineered neural stem cells for glioma therapy.

PURPOSE: The herpes simplex virus type 1 tegument protein VP22 has the remarkable property of intercellular trafficking, thus making it a promising tool for improving gene transfer efficiency. METHODS: To investigate whether the fusion of VP22 to the cytosine deaminase (CD) suicide gene could enhance the therapeutic efficiency of neural stem cells (NSCs) in the treatment for C6 glioma, the lentiviral vectors pHIV-VP(22)-EGFP, pHIV-CD, and pHIV-VP(22)-CD were constructed based on the pHIV-EGFP vector. After packaging, vectors were transduced into rat NSCs. RESULTS: Fluorescence-activated cell sorting analysis revealed that the fusion of VP22-EGFP increased the expression rate of EGFP in NSCs compared with lenti-EGFP transduced cells. Under incubation with the prodrug 5-fluorocytosine (5-FC), the survival rates of C6 cells co-cultured with NSCs/VP(22)-CD (NSCs transduced with lenti-VP(22)-CD) decreased tremendously compared with those of C6 and NSCs/CD. Similar results were also observed in vivo; a significant reduction in tumor volumes in C6 glioma-bearing rats was observed in the NSCs/VP(22)-CD therapy group when compared with other control groups. CONCLUSIONS: Our results reveal that VP22 increases the transduction efficiency of lentivirus into NSCs and enhances the therapeutic efficacy of CD-engineered rat NSCs in the treatment for C6 glioma, demonstrating that VP22 might be a useful tool for the gene therapy of engineered NSCs and providing a potential novel strategy for enhancing the effectiveness of gene therapy in other diseases.

[Establishment of snow disaster remote sensing monitoring and damage estimation systems in Altai pastoral region of Xinjiang].

It is of significance to establish an integrated evaluation system of snow disaster in northern pastoral areas. Based on the NOAA satellite digital images, field observation data, and maps of grassland type and seasonal pastureland, this paper selected the winter and spring pasturelands in Aletai region of Xinjiang as the main area of snow disaster-remote sensing monitoring. With affecting factors of economy and the characteristics of natural resource distribution comprehensively analyzed, and using 3S techniques and field survey information, a fundamental information processing model for integrated evaluation of snow disaster was built up, and snow disaster-spatial evaluation indices and damage level systems were constructed. Natural and social systems and 20 indices were selected in snow disaster evaluation indicator system. Four principal factors, i.e., snow cover area, snow depth on grassland, persistence days of low temperature, and livestock death rate, were used as the grading indices of snow disaster damage level, and the models of snow disaster identification and loss estimatation were set up to quantitatively analyze snow disaster. The results indicated that the system could accurately reflect the details of snow hazard grade and the situation of a disaster in temporal and spatial scales, which would help to carry out the dynamic monitoring and scientific estimatation of big area's snow disaster in pastoral region.