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Objective: Patient education materials (PEMs) are commonly used for patient education. This study assessed readability, format quality, accuracy, understandability and actionability of printed asthma PEMs available in primary care in Singapore. Methods: Primary care in Singapore is provided by island-wide polyclinics and private general practices. We invited the three polyclinic healthcare groups and private general practices via the Primary Care Research Network to submit asthma-related PEMs. Readability was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch–Kincaid (FK) score. Format quality was assessed using “Clear-print and large-print golden rules” from UK Association for Accessible Formats (UKAAF). Understandability and actionability were evaluated using Patient Education Materials Assessment Tool – Printed. Three pulmonologists assessed content accuracy. Results: Thirty leaflets were assessed. SMOG and FK estimated 93% (mean 9.3, range 5–14, SD 1.8) and 47% (mean 6.8, range 2.4–9.9, SD 2.0) exceeded the recommended sixth-grade reading level, respectively. About a third (37%) were fully concordant with UKAAF guidelines, with poor format quality contributed by small font size, poor text emphasis methods, and not using left-aligned text. Leaflets generally scored well in both understandability (mean 84%) and actionability (mean 72%). Thirteen leaflets were inaccurate, 92% of which contained at least one inaccuracy judged to have potentially harmful consequences to patients, including wrong emergency advice. Conclusion: While understandability and actionability are adequate, current asthma PEMs are limited by inappropriately high reading levels, poor format quality and inaccuracies. Healthcare professionals need to assess patients’ reading abilities and ensure PEMs are accurate and suitable for their patients. Ministry of Health (MOH) National Medical Research Council (NMRC) Accepted version This research is supported by the Singapore Ministry of Health’s National Medical Research Council under the Centre Grant Programme (Ref No: NMRC/CG/C019/2017).

Background Aminosulpiride is a benzamide used to treat acute or chronic schizophrenia Some researchers believe that early improvement of depression symptoms in patients has a certain predictive effect on the recovery of symptoms after drug treatment for schizophrenia. This study is aimed to explore whether the improvement of depression symptoms is a predictive factor for the amelioration of the schizophrenia symptoms by amisulpride treatment. Methods A total of 383 patients with schizophrenia admitted to 15 hospitals in Fujian and Zhejiang from July 1, 2018 to March 31, 2019 were included in the study. The patients were treated with amisulpride tablets with a dose strategy of 200-1,200 mg/d for 8 weeks. The Positive and Negative Affect Scale (PANAS) was used as the criteria to evaluate the treatment effect, including criterion A and criterion B. After the course of treatment, the improvement of depression symptoms was compared between the remission group and the non-remission group. Logistic regression analysis was used to investigate predictors of symptom relief in schizophrenia patients treated with amisulpride. Results Of the 383 subjects with schizophrenia, 303 completed the 8-week treatment with amisulpride, and 244 (80.53%) achieved remission of symptoms after the treatment, satisfying criterion A. In 258 patients (85.15%), the symptoms were relieved and satisfied criterion B, while there was no significant difference between the number of patients who met criterion A and those who met criterion B (P>0.05). Both the remission group and the non-remission group had obvious improvement in depression symptoms. Furthermore, the remission group showed a more significant improvement in depression symptoms after the treatment. Logistic regression analysis revealed that the improvement of depression symptoms cannot be used as a predictor of symptomatic relief with amisulpride in the treatment of schizophrenia according to criterion A (B=-0.01, P=0.07). While under the criterion B, the patient's age could be used as a predictive factor of symptom remission from amisulpride in the treatment of schizophrenia (B=-0.08, P=0.03). Conclusions Amisulpride is effective in the treatment of schizophrenia and improving depression symptoms. The improvement of depression symptoms has no significant predictive effect on the remission of schizophrenia symptoms.

Background LINC00426 is a newly identified long non-coding RNA (lncRNA) with unacknowledged biological roles. Here we set out to characterize the expression status of LINC00426 in osteosarcoma and understand its mechanistic involvement in incidence of doxorubicin (Dox) resistance. Methods The relative expression of LINC00426 and miR-4319 was determined by real-time PCR. Cell viability and proliferation in response to LINC00426 silencing or miR-4319 over-expression was measured with CCK-8 kit and colony formation assay, respectively. The direct association between LINC00426 and miR-4319 was analyzed by pulldown assay with biotin-labelled probes. Results LINC00426 was significantly up-regulated in Dox-resistant osteosarcoma (OS) both in vitro and in vivo, which intimately associated with unfavorable prognosis. SiRNA-mediated knockdown of LINC00426 remarkably compromised cell viability and proliferation in Dox-resistant OS cells, which accompanied with decrease of IC50 and activation of caspase-3. We further predicted and validated the regulatory effects of miR-4319 on LINC00426 expression. Simultaneously, we provided evidences in support of direct binding between LINC00426 and miR-4319 by pulldown assay. Reciprocally negative regulation was observed between LINC00426 and miR-4319 each other. Conclusion Ectopic introduction of miR-4319 significantly surmounted the Dox resistance in OS cells, while miR-4319 inhibition in LINC00426-deficient cells greatly restore this phenotype. We uncovered the important contribution of LINC00426/miR-4319 to Dox resistance in osteosarcoma. Reviewers This article was reviewed by Bo Liang and Sinan Zhu.

Aims Metformin was found to protect against hyperglycemia-induced injury in osteoblasts, but the cellular mechanisms involved remain unclear. Therefore, the aim of this study was to determine the effect of metformin on hyperglycemia-induced apoptosis and differentiation suppression in osteoblasts and to explore its relationships with the TLR4 signaling pathway. Main methods A mouse osteoblast cell line, MC3T3-E1, and a diabetic rat model were used to survey the protective effects of metformin on hyperglycemia-induced injury. TLR4 expression was altered using small interfering (si)RNA and lentivirus-mediated TLR4 overexpression. LPS was used as a specific TLR4 activator, and CLI-095 was used as a TLR4 inhibitor. Key findings Metformin improved osteoblast differentiation, reduced apoptosis in hyperglycemic osteoblasts, and inhibited TLR4, MyD88 and NF-κB expression in a dose-dependent manner. Down-regulating the expression or inhibiting the activity of TLR4 enhanced these protective effects of metformin on osteoblast differentiation, cell viability and cell apoptosis in hyperglycemic conditions, whereas up-regulating the expression or activating the activity of TLR4 had the opposite effects. Activating NF-κB suppressed the protective effects of metformin, while inhibiting NF-κB activity had the opposite effects. Metformin increased ALP and OCN secretion, enhanced BMP-2 expression, improved bone mineral density (BMD), and decreased TLR4, MyD88 and NF-κB levels in the femur tissues of diabetic rats. Significance Taken together our experimentation support the hypothesis that metformin may alleviate hyperglycemia-induced apoptosis and differentiation suppression in osteoblasts by inhibiting the TLR4/MyD88/NF-κB signaling pathway.

Polyquaternium-6 (PQ6) as the water-soluble polymer was used for complexing the anion forms of tungsten (VI) before ultrafiltration. Tungsten (VI)-PQ6 complex was retained by polysulfone hollow fiber ultrafiltration membrane in the complexation-ultrafiltration process. Effects of various operating parameters such as polymer metal ratio(PMR), pH and chloride ion concentration on permeate flux ( J ) and tungsten rejection coefficient ( R ) were investigated. The integration of four experiments including concentration, decomplexation, diafiltration and reuse of regenerated polymer was carried out. In the process of concentration, J declines slowly and R is about 1 at PMR of 3 and pH of 7. Tungsten concentration in the retentate increases linearly with volume concentration factor. Tungsten is concentrated efficiently with the membrane. The concentrated retentate was used further for the decomplexation. It takes about 6 min to reach the decomplexation equilibrium at chloride ion concentration of 50 mgL −1 . The decomplexation percentage of tungsten (VI)-PQ6 complex reaches 56.1%. In the diafiltration process, tungsten (VI) can be extracted effectively by using 50 mgL −1 chloride ion solution, and the purification of the regenerated PQ6 is acceptably satisfactory. The regenerated PQ6 was used to bind tungsten (VI) at various pH values. The binding capacity of the regenerated PQ6 is close to that of fresh PQ6, and the recovery percentage of binding capacity is higher than 90%.

This study was carried out to evaluate the effect of cigarette smoke (CS) on the activity of oral peroxidase (OPO) after berberine was added to the cigarette filter. Activated carbon fiber (ACF) was chosen to load berberine as a part of the cellulose acetate (CA) filter to obtain the modified B-ACF cigarette filter. Then the effects of CS from the testing cigarettes on the activity of OPO were investigated in vitro by the 2-nitrobenzoic acid assay, and the smoke chemistry was also analyzed, especially the content of hydrogen cyanide (HCN) in the CS. The results indicated that the loss of activity of OPO in B-ACF filter cigarette group decreased by 20% and 25%, compared with those of ACF and CA filter cigarette groups, respectively. The relative residual activity of OPO in B-ACF filter group was increased with the increase of berberine in the filter compared with the CA filter group. It could be observed that the reduction in HCN might be related to the berberine in the cigarette filter, reducing the inhibition of CS on the activity of OPO.

Purpose It is estimated that half of all cancer patients experience catabolic wasting, either from growth of the cancer itself or through its subsequent treatment. In the head & neck, this is often exacerbated by symptoms such as dysphagia which results in poor nutrition even before treatment has started. We audited the nutritional status and the effectiveness of the dietician in the management of head and neck cancer patients undergoing radiotherapy. Material and methods A retrospective study of 31 consecutive head and neck cancer patients treated with radiotherapy (RT) alone, in a single tertiary referral centre from January to June 2011. Using their weights as a surrogate marker for nutritional status, these were compared at diagnosis, after the completion of RT, 3 and 6 months after RT. A loss of more than 15% of the initial body weight was deemed significant. Results 17 Patients saw a dietician and were recommended a dietary regime based on their estimated calorie requirements. Post RT, this group had a similar change of body weight compared to the group that did not see the dietician. 3 Patients in each group decreased their body-weight significantly. At 6 months after RT, 41.1% of patients who saw the dietician regained over 90% of their initial weight compared with 35.7% in the group that did not see the dietician. Conclusion A malnourished patient is less likely to tolerate the full planned dose of RT and more likely to succumb to other illness while under therapy. Our results indicate potential for improvement with higher caloric intake and better monitoring of a patient’s weight. It is important that more patients are encouraged to attend dietician consultations. Seeking an alternative way of funding these extra sessions and the prescribed dietary regimes may help.