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Recently, ready-to-eat vegetable salads have gained popularity worldwide. However, the microbial safety of ready-to-eat salads is a health concern, primarily due to Salmonella enteritidis contamination during the growing, harvesting, processing, and handling of produce. This study aimed to develop a bacteriophage-based strategy to control S. enteritidis growth in mixed-ingredient salads. A lytic Salmonella-specific phage SapYZU01 was isolated from a soil sample from a suburban vegetable field in Yangzhou, China. SapYZU01 exhibited characteristics such as a short latent period, a large burst size, and a lytic effect against 13 S. enteritidis strains isolated from various sources (human, pork, deli, chicken, and chicken meat). The SapYZU01 genome did not contain virulence or antibiotic resistance genes. SapYZU01 significantly decreased the viability of S. enteritidis cells in iceberg lettuce, chicken meat, and mixed-ingredient (lettuce+chicken) salads at 37 and 25 °C. Furthermore, bacterial counts in the salad decreased significantly (by 4.0 log colony-forming units (CFU)/g) at 25 °C upon treatment of contaminated lettuce with SapYZU01 at an MOI of 100 prior to salad preparation. Bacterial counts were decreased by 3.8 log CFU/g at 25 °C in (lettuce+chicken) salads treated with SapYZU01 at an MOI of 100 after the salad preparation. In contrast, treating cooked chicken meat with SapYZU01 at an MOI of 100 before mixing it with contaminated lettuce decreased the bacterial count of the salad by 1.2 log CFU/g at 25 °C. These findings indicate the potential application of SapYZU01 as a natural biocontrol agent against S. enteritidis in mixed-ingredient salads. Furthermore, the application of lytic bacteriophage SapYZU01 in mix-ingredient salads should considered the bacteriophage treatment method in addition to the bacteriophage concentration.

ObjectivesTo evaluate the extent to which marriage influences cancer-specific survival (CSS) by influencing the insurance status among patients with common solid cancers and the feasibility of reducing the survival gap caused by marriage by increasing private insurance coverage for unmarried patients.SettingA retrospective cohort study with patients retrieved from the Surveillance, Epidemiology and End Results programme.ParticipantsPatients with nine common solid cancers diagnosed between 2007 and 2016 were included. Patients were excluded if their marital status, insurance status, socioeconomical status, stage or cause of death was unavailable, if survival time was less than 1 month, or if they were younger than 18 years at the time of diagnosis.Primary and secondary outcome measuresThe primary outcome was CSS, which was compared between married and unmarried individuals. Mediation analyses were conducted to determine the contribution of insurance status to the association between marriage and CSS.ResultsMarried patients had better CSS than those unmarried (time ratio 1.778; 95% CI 1.758 to 1.797). Private health insurance was a key factor mediating the association between marital status and CSS (proportion mediated (PM), 17%; 95% CI 17% to 17.1%). The PM ranges from 10.7% in prostate cancer to 20% in kidney cancer. The contribution of private insurance to the association between marital status and CSS was greater among women than among men (PM 18.5% vs 16.7%). The mediating effect of private insurance was the greatest for the comparison between married and separated individuals (PM 25.6%; 95% CI 25.3% to 25.8%) and smallest for the comparison between married and widowed individuals (PM 11.0%; 95% CI 10.9% to 11.1%).Conclusions17% of the marital disparities in CSS are mediated by private insurance coverage. Increasing private insurance coverage for unmarried patients may reduce the survival gap related to marital status and sex. However, it is unclear whether better publicly funded insurance would have the same effect.

Background High-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country’s mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China. Methods This study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis. Results Workforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (β = − 0.88), self-experience (β = − 0.59) and professional supervision (β = − 1.26) significantly influenced psychotherapy capacity (P Conclusions Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

BackgroundThe Montessori Method underpinned by the principle of person-centered care has been widely adopted to design activities for people with dementia. However, the methodological quality of the existing evidence is fair. The objectives of this study are to examine the feasibility and effects of a culturally adapted group-based Montessori Method for Dementia program in Chinese community on engagement and affect in community-dwelling people with dementia.MethodsThis was a two-arm randomized controlled trial. People who were aged 60 years or over and with mild to moderate dementia were recruited and randomly assigned to the intervention group to receive Montessori-based activities or the comparison group to receive conventional group activities over eight weeks. The attendance rates were recorded for evaluating the feasibility. The Menorah Park Engagement Scale and the Apparent Affect Rating Scale were used to assess the engagement and affect during the activities based on observations. Generalized Estimating Equation model was used to examine the intervention effect on the outcomes across the sessions.ResultsA total of 108 people with dementia were recruited. The average attendance rate of the intervention group (81.5%) was higher than that of the comparison group (76.3%). There was a significant time-by-group intervention effect on constructive engagement in the first 10 minutes of the sessions (Wald χ2 = 15.21–19.93,ps = 0.006–0.033), as well as on pleasure (Wald χ2 = 25.37–25.73,ps≤ 0.001) and interest (Wald χ2 = 19.14–21.11, ps = 0.004–0.008) in the first and the middle 10 minutes of the sessions, adjusted for cognitive functioning.ConclusionsThis study provide evidence that Montessori-based group activities adapted to the local cultural context could effectively engage community-dwelling Chinese older people with mild to moderate dementia in social interactions and meaningful activities and significantly increase their positive affect.Trial registrationClinicalTrials.gov, NCT04352387. Registered 20 April 2020. Retrospectively registered.

Ferulic acid ethyl ester (FAEE) is abundant inThis study investigated whether FAEE can attenuate osteoclastogenesis and relieve ovariectomy-induced osteoporosis via attenuating mitogen-activated protein kinase (MAPK).We stimulated RAW 264.7 cells with receptor activator of NF-κB ligand (RANKL) followed by FAEE. The roles of FAEE in osteoclast production and osteogenic resorption of mature osteoclasts were evaluated by tartrate resistant acid phosphatase (TRAP) staining, expression of osteoclast-specific genes, proteins and MAPK. Ovariectomized (OVX) female Sprague-Dawley rats were administered FAEE (20 mg/kg/day) for 12 weeks to explore its potentialFAEE suppressed RANKL-induced osteoclast formation (96 ± 0.88 vs. 15 ± 1.68) by suppressing the expression of osteoclast-specific genes, proteins and MAPK signalling pathway related proteins (p-ERK/ERK, p-JNK/JNK and p-P38/P38)These findings suggested that FAEE could be used to ameliorate osteoporosis by the MAPK signalling pathway, suggesting that FAEE could be a potential therapeutic candidate for osteoporosis.

Background Abnormal proliferation of vascular smooth muscle cells (VSMCs) contributes to vascular remodeling diseases. Recently, it has been discovered that tRNA-derived small RNAs (tsRNAs), a new type of noncoding RNAs, are related to the proliferation and migration of VSMCs. tsRNAs regulate target gene expression through miRNA-like functions. This study aims to explore the potential of tsRNAs in human aortic smooth muscle cell (HASMC) proliferation. Methods High-throughput sequencing was performed to analyze the tsRNA expression profile of proliferative and quiescent HASMCs. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to validate the sequence results and subcellular distribution of AS-tDR-001370, AS-tDR-000067, AS-tDR-009512, and AS-tDR-000076. Based on the microRNA-like functions of tsRNAs, we predicted target promoters and mRNAs and constructed tsRNA–promoter and tsRNA–mRNA interaction networks. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to reveal the function of target genes. EdU incorporation assay, Western blot, and dual-luciferase reporter gene assay were utilized to detect the effects of tsRNAs on HASMC proliferation. Results Compared with quiescent HASMCs, there were 1838 differentially expressed tsRNAs in proliferative HASMCs, including 887 with increased expression (fold change > 2, p p Conclusions During HASMC proliferation, the expression levels of many tsRNAs are altered. AS-tDR-000067 and AS-tDR-000076 act as new factors promoting VSMC proliferation.

As a key component of extracellular polymeric substances (EPS), extracellular deoxyribonucleic acid (eDNA) acts as a bridge in maintaining the structural stability of granular sludge. However, its ability of carrying antibiotic resistance genes (ARGs) promotes the gene horizontal transfer, raising a high risk for human health. In this study, a series of batch tests were performed to elucidate the response of anammox granular sludge (AnGS) with different sizes (S-AnGS with diameters lower than 0.9 mm and L-AnGS with diameters of 0.9-2 mm) to the removal of eDNA and corresponding mechanism. The results showed that the highest bioactivity of S-AnGS and L-AnGS was achieved by adding DNase I, and the absolute abundance of hzsA in the systems also increased. The dominant microorganism in each sludge was Candidatus Kuenenia, which maintained a higher relative abundance of 24% in S-AnGS. Settling experiments demonstrated that the permeability of AnGS was positively correlated with the addition of DNase I. The permeability index of granular sludge, Г, rose by 58.54% in S-AnGS and 11.79% in L-AnGS. The absence of eDNA is conducive to the increase in the permeability and porosity of AnGS. Similarity in the functional genes and microbial communities of intracellular and extracellular DNA implied the occurrence of gene transmembrane transfer. The findings enrich our knowledge of eDNA in anammox granules and provide a guidance for the specific control of gene transfer through reducing eDNA.

Deepening the reform of insurance companies and improving commercial insurance protection capabilities become issues important to national strategy. They involve improving China's multi-tiered social security system to analyze the deep-seated reasons impacting the purchasing behavior of commercial health insurance for rural residents in China. Using the DEA-CCR model, this paper evaluates the development of China's insurance industry, inspects the impact of insurance industry development on purchasing behavior of rural commercial health insurance based on the data of tracking survey projects from China's household, and carries out empirical analysis. The research result shows that the development of the insurance industry has obviously promoted the purchase behavior of commercial health insurance for rural residents. This research has significant practical value on protection and promotion of production and life quality of rural residents, which will also provide beneficial reference on the formulation and implementation of future operation strategy in China's commercial health insurance companies.

Cancer is caused primarily by genomic alterations resulting in deregulation of gene regulatory circuits in key growth, apoptosis, or DNA repair pathways. Multiple genes associated with the initiation and development of tumors are also regulated at the level of mRNA decay, through the recruitment of RNA-binding proteins to AU-rich elements (AREs) located in their 3'-untranslated regions. One of these ARE-binding proteins, tristetraprolin (TTP; encoded by Zfp36), is consistently dysregulated in many human malignancies. Herein, using regulated overexpression or conditional ablation in the context of cutaneous chemical carcinogenesis, we show that TTP represents a critical regulator of skin tumorigenesis. We provide evidence that TTP controlled both tumor-associated inflammation and key oncogenic pathways in neoplastic epidermal cells. We identify Areg as a direct target of TTP in keratinocytes and show that EGFR signaling potentially contributed to exacerbated tumor formation. Finally, single-cell RNA-Seq analysis indicated that ZFP36 was downregulated in human malignant keratinocytes. We conclude that TTP expression by epidermal cells played a major role in the control of skin tumorigenesis., info:eu-repo/semantics/published

Antibiotic pollution is becoming increasingly severe due to its extensive use. The potential application of the anaerobic ammonium oxidation (anammox) process in the treatment of wastewater containing antibiotics has attracted much attention. As common antibiotics, spiramycin (SPM) and streptomycin (STM) are widely used to treat human and animal diseases. However, their combined effects on the anammox process remain unknown. Therefore, this study systematically evaluated the response of the anammox process to both antibiotics. The half maximal inhibitory concentrations of SPM and STM were determined. The continuous-flow anammox system could adapt to SPM and STM at low concentrations, while antibiotics at high concentrations exhibited inhibitory effects. When the concentrations reached 5 mg L−1 SPM and 50 mg L−1 STM, the nitrogen removal efficiency dramatically decreased and then rapidly recovered within 8 days. Correspondingly, the abundances of dominant bacteria and genes also changed with antibiotic concentrations. In general, the anammox process showed a stable performance and a high resistance to SPM and STM, suggesting that acclimatization by elevating the concentrations was beneficial for the anammox process to obtain resistance to different antibiotics with high concentrations. This study provides guidance for the stable operation of anammox-based biological treatment of antibiotics containing wastewater.

The objective of this study was to investigate the between autophagy activity and local immune response in hypopharyngeal squamous cell carcinoma (HSCC). Herein, we observed the expression of autophagy marker microtubule-associated protein light chain 3B (MAP1LC3B), CD8 cytotoxic T lymphocytes (CTLs), CD39 (regulatory T cells Tregs) and CD163 (tumor-associated macrophages TAMs) in HSCC, and determined the prognostic roles of CD8+/CD39+ and CD8+/CD163+ in patients with HSCC. The expression of light chain 3B (LC3B) and CD8+/CD39+ was found to be significantly lower in HSCC tissues than in adjacent non-tumor mucosa tissue samples; LC3B expression was positively correlated with the infiltration rate of CD8+/CD39+ in HSCC. Further studies revealed that the ratio of CD8+/CD39+ immune cells was negatively correlated with tumor lymph node metastasis and TNM classification, while the ratio of CD8+/CD163+ immune cells was negatively correlated with TNM classification. Moreover, the expression of LC3B was analyzed and the patients were grouped according to their immune infiltration characteristics. The 5-year cumulative survival rates of LC3B+, CD8+/CD39+, and CD8+/CD163+ patients were significantly higher than those of other group patients. Collectively, our studies indicated that the expression of LC3B in HSCC was correlated with the infiltration ratio of immune cells, and a change in autophagy activity may affect the cellular immunity in HSCC. The ratios of tCD8+/CD39+ and tCD8+/CD163+ may serve as prognostic factors for HSCC.

To assess how expansion sphincter pharyngoplasty (ESP) impacts blood pressure (BP) and health-related quality of life (HRQOL) in hypertensive patients with obstructive sleep apnea (OSA). Patients were separated into two groups based upon whether or not they adhered to antihypertensive drug regimens. Patients underwent 24-h ambulatory BP monitoring before and at 6 months post-ESP, while clinical BP measurements and HRQOL questionnaires (SF-36) were conducted over the course of 24 months post-surgery. We enrolled 62 patients, with 25 and 37 in the medicated and non-medicated groups, respectively. Mean 24-h BP differed significantly, with systolic and diastolic BP (SBP and DBP) decreases of 5.3 mmHg and 2.5 mmHg, respectively (P

Four pairs of new spiropyrrolizidine oxindole enantiomers (1a/1b-4a/4b) were isolated from the leaves of Isatis indigotica Fortune. Their structures and absolute configurations were elucidated by a combination of NMR spectroscopic analyses, experimental and calculated electronic circular dichroism (ECD) and the assistance of quantum chemical predictions (QCP) of 13C NMR chemical shifts. Notably, all the isolated spiropyrrolizidine oxindoles are reported as natural products for the first time. The biosynthetic pathway of these unique structures was proposed to be formed by cycloaddition reaction. In addition, all the compounds were evaluated for their inhibitory effects on β-amyloid aggregation by ThT assay, and the optically pure compounds 1a/1b and 2a/2b exhibited better Aβ1-42 aggregation inhibition potency (85.8% and 73.6%, 71.5% and 75.8%, respectively) at a concentration of 20 μM, compared with the positive control curcumin (57.0%). The difference of the inhibitory pattern caused by chirality was also explained by molecular docking studies.

The industrial and agricultural activities based on phosphorous can increase the F content in the surrounding area, causing a widespread adverse effect on the organisms. However, the current information on the superposed health risk posed by the multi-exposure to the F contamination in an area jointly affected by agricultural and industrial activities (DA) is limited. Herein, the F distribution in multi-environmental media and the exposure risk to humans by ingestion, inhalation, and dermal contact pathways are studied in an DA. The content of soil water-soluble fluorine (WF) was higher in the DA than in the area individually affected by agricultural activities (SA). This indicated a superposed contribution of the industrial and agricultural activities to increase the F toxicity in the soil. The correlation of the soil pH and the organic matter content with the soil WF concentration in DA suggested an inter-relationship between the soil physicochemical properties and the toxicity of F in the soil by industrial and agricultural activities. Irrigation water was not a major anthropogenic source of the cropland soil F. The large variation in F concentration in the crops (101.8–195.6%) might have originated from the discrepancies in the soil F content and air F concentration. The air F pollution (0.6–1.6 μg dm−2 d−1) in the area particularly influenced by intensive industrial activities should be important. The exposure of residents to F was mainly from the ingestion of F-enriched crops. The higher exposure of adults to F than that of children could be attributed to more industrial and agricultural outdoor activities, larger exposure area of the skin, and more daily ingestion of F-enriched food by adults. Overall, present insights into the distribution of and the multi-exposure to F may be beneficial for decreasing the adverse F effects on the residents in DAs worldwide.

Three pairs of bufadienolide l/d-lactate epimers (1-6) were isolated from the eggs of the toad Bufo bufo gargarizans. The structures were elucidated by using spectroscopic methods, X-ray diffraction analysis and a modified Mosher's method. Compounds 1-6 represent the first occurrence of lactate-conjugated bufadienolides in nature, and illustrate the existence of an enzyme-controlled epimerization from l- to d-lactate in amphibians. The biosynthetic pathways, in which two key enzymes might be involved (i.e., lactate racemase and acyltransferase), were proposed. In addition, the biological assays revealed that compounds 1-4 are potent cytotoxic agents against human gastric cancer cells BGC-823 and human lung cancer cells A549 with IC50 values in a range of 8.0 to 80.0 nM.

Background Epidermal growth factor receptor (EGFR) mutations, including a known exon 19 deletion (19 del) and exon 21 L858R point mutation (L858R mutation), are strong predictors of the response to EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment in lung adenocarcinoma. However, whether patients carrying EGFR 19 del and L858R mutations exhibit different responsiveness to EGFR-TKIs and what are the potential mechanism for this difference remain controversial. This study aimed to investigate the clinical outcomes of EGFR-TKI treatment in patients with EGFR 19 del and L858R mutations and explore the genetic heterogeneity of tumors with the two mutation subtypes. Methods Of 1127 patients with advanced lung adenocarcinoma harboring EGFR 19 del or L858R mutations, 532 received EGFR-TKI treatment and were included in this study. EGFR 19 del and L858R mutations were detected by using denaturing high-performance liquid chromatography (DHPLC). T790M mutation, which is a common resistant mutation on exon 20 of EGFR, was detected by amplification refractory mutation system (ARMS). Next-generation sequencing (NGS) was used to explore the genetic heterogeneity of tumors with EGFR 19 del and L858R mutations. Results Of the 532 patients, 319 (60.0%) had EGFR 19 del, and 213 (40.0%) had L858R mutations. The patients with EGFR 19 del presented a significantly higher overall response rate (ORR) for EGFR-TKI treatment (55.2% vs. 43.7%, P = 0.017) and had a longer progression-free survival (PFS) after first-line EGFR-TKI treatment (14.4 vs. 11.4 months, P = 0.034) compared with those with L858R mutations. However, no statistically significant difference in overall survival (OS) was observed between the two groups of patients. T790M mutation status was analyzed in 88 patients before EGFR-TKI treatment and 134 after EGFR-TKI treatment, and there was no significant difference in the co-existence of T790M mutation with EGFR 19 del and L858R mutations before EGFR-TKI treatment (5.6% vs. 8.8%, P = 0.554) or after treatment (24.4% vs. 35.4%, P = 0.176). In addition, 24 patients with EGFR 19 del and 19 with L858R mutations were analyzed by NGS, and no significant difference in the presence of multiple somatic mutations was observed between the two genotypes. Conclusions Patients with EGFR 19 del exhibit longer PFS and higher ORR compared with those with L858R mutations. Whether the heterogeneity of tumors with EGFR 19 del and L858R mutations contribute to a therapeutic response difference needs further investigation.

Aim This study aimed to investigate and monitor the mental health status of pregnant women during the COVID-19 pandemic. Materials and methods The meta-analysis was used to study the literatures on the psychology of pregnant women in four databases until Sep 27, 2020. Results A total of 19 articles were included in the final meta-analysis. The overall prevalence of anxiety was 42 % (95 %CI 26 %–57 %) with substantial heterogeneity (I2 = 99.6 %). The overall prevalence of depression was 25 % (95 %CI 20 %–31 %) with substantial heterogeneity (I2 = 97.9 %). Age, family economic status, social support, and physical activity seem to correlate with the mental health status of pregnant women. Conclusion The prevalence of anxiety and depression among pregnant women increased significantly during the COVID-19 epidemic. Pregnant women are more concerned about others than themselves during COVID-19, and younger pregnant women seem to be more prone to anxiety, while social support and physical activity can reduce the likelihood of anxiety and depression. It is necessary to take some psychological intervention measures for pregnant women to help them go through this special period safely and smoothly.

A pair of new cycloneolignan enantiomers (1a and 1b) were isolated from the leaves of Isatis indigotica Fortune. Their structures were elucidated by extensive spectroscopic data analysis, including 1D and 2D NMR, HRESIMS, MS/MS analysis, together with theoretical electronic circular dichroism (ECD) calculations. Compounds 1a and 1b were then evaluated for their neuroprotective effects against MPP

To research the diagnostic performance of clinical potential bone turnover indexes in rheumatoid arthritis (RA) complicated with osteoporosis (OP).This study involved 87 RA patients, 48 with OP, and 39 without OP, and 204 non-RA control patients, including those with systemic lupus erythematosus, ankylosing spondylitis, primary Sjogren's syndrome, systemic sclerosis, and healthy patients. The levels of 25-hydroxyvitamin D [25(OH)D], β-crosslaps (β-CROSSL), parathyroid hormone (PTH) were measured by electrochemiluminescence (ECLIA), and the level of bone alkaline phosphatase (BALP) was measured by lectin affinity method.The serum concentration of 25(OH)D in the RA with OP group was significantly lower than the control group (The significantly reduced levels of 25(OH)D and excessive β-CROSSL may indicate a high risk of the secondary osteoporosis in RA patients.

Six undescribed alkaloids, indiforine A-F, together with four known ones, were isolated from the leaves of Isatis indigotica Fortune. Their structures were elucidated on the basis of extensive spectroscopic analyses. The absolute configurations of indiforine A and B were determined by comparison of the experimental and calculated electronic circular dichroism spectra, as well as experimental and calculated optical rotations. The isolated alkaloids were evaluated for their neuroprotective activities against H2O2-induced cell injury in human neuroblastoma SH-SY5Y cells. The results showed that in H2O2-induced SH-SY5Y cell injury models, indiforine A and B exhibited potent neuroprotective activities. Further investigation of the most potent indiforine A by Hoechst 33258 staining and Annexin V/PI analysis demonstrated that it could protect SH-SY5Y cells from oxidative damage through inhibiting cell apoptosis.

Background To improve the understanding of acute fibrinous and organizing pneumonia (AFOP), we present one case of AFOP proven by percutaneous lung biopsy along with clinical features, chest imaging and pathology. Case presentation A 50-year-old man was admitted to our department after he was given empiric therapy for community-acquired pneumonia (CAP). The clinical symptoms of the patient were dry cough, chills, night sweats and high fevers. Chest computed tomography (CT) scan showed a high-density shadow in the right lung lobe, similar to lobular pneumonia. The patient was preliminarily diagnosed with community-acquired pneumonia; however, antibacterial treatment was ineffective. To confirm the diagnosis, we performed bronchoscopy and percutaneous lung biopsy; pathology was consistent with AFOP. After he was treated with glucocorticoids, the patient’s symptoms were relieved, and the shadow seen on imaging dissipated during the follow-up period. Conclusions AFOP is a rare histopathological diagnosis that can be easily misdiagnosed. Clinicians need to consider the possibility of AFOP in the case of invalid antibacterial therapy.

This three-year study, based on the Guangzhou Institute of Respiratory Disease (GRID), chronic obstructive pulmonary disease (COPD) Biobank, was conducted in 36 COPD patients to estimate whether changes in levels of leukocytes, erythrocytes, hemoglobin, and platelets were related to changes in air pollutant concentration. Daily NO2 levels exhibited significant differences between baseline years and the 2010 Asian Game period. We observed significant reductions in leukocyte and neutrophils counts levels, by 15.51% and 23.01%, from pre-Asian Games to during-Asian Games, respectively. In the post-Asian Game period, most pollutants approximated pre-Asian Game period levels, and similar effects were demonstrated in leukocyte and neutrophil counts. For both items, we identified significant increases resulting from elevated NO2 at lag days 0-2/5-6. We concluded that reductions in pollutants during the intervention period were associated with inactivation of hematological events in COPD.

Background: The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Internet hospitals have not been systematically investigated. Objective: The aim of this study was to describe the characteristics of China’s Internet hospitals, and to assess their health service capacity. Methods: We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as “Internet hospital,” “web hospital,” or “cloud hospital.” All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. Results: We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Conclusions: Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China’s Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done.

Background The past decade has witnessed the increasing adoption of Web 2.0 technologies in medical education. Recently, the notion of digital habitats, Web 2.0 supported learning environments, has also come onto the scene. While there has been initial research on the use of digital habitats for educational purposes, very limited research has examined the adoption of digital habitats by medical students and educators on mobile devices. This paper reports the Stage 1 findings of a two-staged study. The whole study aimed to develop and implement a personal digital habitat, namely digiMe, for medical students and educators at an Australian university. The first stage, however, examined the types of Web 2.0 tools and mobile devices that are being used by potential digiMe users, and reasons for their adoption. Methods In this first stage of research, data were collected through a questionnaire and semi-structured interviews. Questionnaire data collected from 104 participants were analysed using the Predictive Analytics SoftWare (PASW). Frequencies, median and mean values were pursued. Kruskal Wallis tests were then performed to examine variations between views of different participant groups. Notes from the 6 interviews, together with responses to the open-ended section of the questionnaire, were analysed using the constructivist grounded theory approach, to generate key themes relevant to the adoption of Web 2.0 tools and mobile devices. Results The findings reflected the wide use of mobile devices, including both smart phones and computing tablets, by medical students and educators for learning, teaching and professional development purposes. Among the 22 types of Web 2.0 tools investigated, less than half of these tools were frequently used by the participants, this reflects the mismatch between users’ desires and their actual practice. Age and occupation appeared to be the influential factors for their adoption. Easy access to information and improved communication are main purposes. Conclusions This paper highlights the desire of medical students and educators for a more effective use of Web 2.0 technologies and mobile devices, and the observed mismatch between the desire and their actual practice. It also recognises the critical role of medical education institutions in facilitating this practice to respond to the mismatch. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0283-6) contains supplementary material, which is available to authorized users.

This paper aims to identify self-report data for hysterectomy prevalence and to explore its correlated factors among women with physical and mobility disabilities in Taiwan. This paper was part of a larger study, “Survey on Preventive Health Utilizations of People with Physical and Mobility Disability in Taiwan”, which is a cross-sectional survey conducted in 2009. We recruited 502 women aged ≧15 years who were officially registered as having physical and mobility disabilities. The results show that 11.3% of women with physical and mobility disabilities accepted hysterectomy surgery and that hysterectomy prevalence was increasing by age: 7% (45–49 years), 9.7% (50–54 years), 26.3% (55–59 years), 31% (60–64 years) and 17.6% (≧65 years). Multilevel logistic regression analyses revealed that being ≧50 years or older (OR = 4.65, 95% CI = 1.79–12.064), having had cervical cancer (OR = 17.2, 95% CI = 3.5–84.47) and not having a Pap smear test within the last 3 years (OR = 2.79, 95% CI = 1.194–6.561) were more likely to accept a hysterectomy operation than their counterparts. This study suggests that future studies should analyze hospital data and assesses long-term changes to understand an area's hysterectomy profile and correlated factors for these types of vulnerable populations.

The study aims to explore knowledge and attitudes regarding cervical cancer screening and to examine its determinants based on the perspectives of Taiwanese women with physical disabilities living in the community. A cross-sectional survey was employed in the study, and we recruited 498 women aged more than 15 years who were officially registered as having physical disabilities in Taipei County, Taiwan, in March 2009. A mail-out structured questionnaire designed to collect data concerning the participants' demographics, reported use, health experience and perception (understanding and attitudes) of cervical cancer screening among women with physical disabilities. We used a scoring system (range 0-10) to categorize the study subjects' awareness of screening (low vs. high). The results showed that 77.3% of subjects reported a low level of awareness (score[double bond] 7), whereas 22.7% were in the high awareness level group (score7). The logistic regression model revealed that married women (OR = 3.30, 95%CI = 1.25-8.71), those with a higher educational level (OR = 2.88, 95%CI=1.51-5.53), and those with a high familiarity with Pap smear resources (OR = 5.31, 95%CI = 2.82-9.98) had a significantly higher perception level of cervical cancer screening among women with physical disabilities. This study highlights the necessity of increasing the knowledge and awareness of cervical cancer screening and reducing the barriers to cervical cancer screening experienced by women with disabilities.

The present paper aims to explore awareness and acceptability of human papillomavirus (HPV) vaccination and to identify factors influencing HPV acceptability among women with physical disabilities in Taiwan. The study participants were 438 adult women with physical disabilities, aged 18-69 years. The participants were all officially registered as having physical disabilities in Taipei County, Taiwan, in March 2009. The major findings were that 54.5% of the participants had previously heard about the HPV vaccine and that vaccine acceptability was very low (3.2%) if the participants would have had to pay for the vaccine but would increase to 60% if the government were to provide the vaccine for free. We found that those participants who had had a Pap smear test within the past 1 year or 3 years were significantly more likely to be aware of and willing to receive the HPV vaccine than those who had not. To increase the HPV vaccination rate among women with physical disabilities, the study suggests that the current health care system in Taiwan should consider implementing free immunization for this group of women.

Background Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, hyperinsulinemia, and infertility. In PCOS, abnormal regulation of relevant genes is required for follicular development. By binding to the 3' untranslated region (3'URT), microRNAs (miRNAs) are widely involved in posttranscriptional gene regulation. However, few studies have been conducted on circulating miRNA expression in PCOS. This study aims to describe altered expression of circulating miR-21 in PCOS. Methods The expression of serum miRNAs of PCOS patients were explored using the TaqMan Low Density Array followed by individual quantitative reverse transcription polymerase chain reaction assays. The protein level of LATS1 was determined using Western blot. To validate whether miR-21 targeted LATS1, the luciferase assay was applied. Results In comparison with normal subjects, the circulating level of miRNA-21 was significantly enhanced in PCOS patients. In PCOS patients, the expression levels of MST1/2, LATS1/2, TAZ were much lower than the control subjects. Luciferase reporter assay revealed that LATS1 was a downstream target of miR-21. Conclusions In comparison with normal subjects, serum miR-21 is obviously increased in PCOS patients. Through targeting LATS1, miR-21 could prompt PCOS progression and could act as a novel non-invasive biomarker for diagnosis of PCOS.

Stimulated by retinoic acid gene 8 (STRA8) is specifically expressed in mammalian germ cells before their transition from mitosis to meiosis. STRA8 expression is observed only in the postnatal testis. Single nucleotide polymorphisms but no mutations were identified in the coding or proximal promoter region of STRA8 in some gonadal dysgenesis patients. Studies on the teratocarcinoma cells and embryonic stem cells (ESC) transfected with STRA8-EGFP, a fusion construct harboring the promoter and coding region of the enhanced green fluorescence protein, have shown that the STRA8-EGFP positive cells may undergo meiosis, develop into sperm and generate live offspring mice. STRA8-EGFP positive cells derived from the bone marrow are able to differentiate into spermatogenic cells, but arrest in the premeiotic stage, and those from the adult mouse testis, when cultured in ESC culture conditions, may acquire ESC properties, pluripotency and redifferentiation capacity and act as a new stem cell source for tissue regeneration. The presence of oocytes renewed in postnatal mouse ovaries calls in question the absence of STRA8 in postnatal mouse ovaries.

In recent years, people have paid more attention to the spermatogonial stem cells that have the capacity for self renewal and multilineage differentiation and produce daughter cells that can expand and differentiate into spermatozoa under the adjustment of self genes and external signal. This article reviews recent advances in studies of enrichment and original selection of the spermatogonial stem cells. This review also summarizes some control factors in proliferation and transplantation techniques.

Apoptosis is necessary for the development and maturation of Leydig cells. However, increased apoptosis results the decline of testosterone production, which may increase germ cell apoptosis and the possibility of infertility. There are several aspects contributing to Leydig cell apoptosis such as ethane dimethanesulphonate (EDS), glucocorticoid, developmental stage and some hormones including FSH, LH/hCG and testosterone. A number of genes are involved in the regulation of Leydig cells apoptosis. It was reported that SCF/c-kit, Bcl-2 and Bcl-xl inhibited the apoptosis while caspase-3, Fas, Bax and clusterine stimulated it.