Social determinants of health impact mortality from HCC and cholangiocarcinoma: a population-based cohort study.

BACKGROUND AND AIMS: The social determinants of health can pose barriers to accessing cancer screening and treatment and have been associated with cancer mortality. However, it is not clear whether area deprivation is independently associated with mortality in HCC and cholangiocarcinoma when controlling for individual-level social determinants of health. APPROACH AND RESULTS: The cohort included individuals over 18 years old diagnosed with HCC (N=3460) or cholangiocarcinoma (N=781) and reported to the Indiana State Cancer Registry from 2009 to 2017. Area disadvantage was measured using the social deprivation index (SDI). SDI was obtained by linking addresses to the American Community Survey. Individual social determinants of health included race, ethnicity, sex, marital status, and insurance type. The primary outcome was mortality while controlling for SDI and individual social determinants of health by means of Cox proportional hazard modeling. In HCC, living in a neighborhood in the fourth quartile of census-track SDI (most deprived) was associated with higher mortality (HR: 1.14, 95% CI, 1.003-1.30, p=0.04) than living in a first quartile SDI neighborhood. Being uninsured (HR: 1.64, 95% CI, 1.30-2.07, p<0.0001) and never being married (HR: 1.31, 95% CI, 1.15-1.48, p<0.0001) were also associated with mortality in HCC. In cholangiocarcinoma, SDI was not associated with mortality. CONCLUSIONS: Social deprivation was independently associated with mortality in HCC but not cholangiocarcinoma. Further research is needed to better understand how to intervene on both area and individual social determinants of health and develop interventions to address these disparities.

Calculation of the contribution of water to calcium intake in low- and middle-income countries.

Dietary calcium intake is low in many countries, particularly in low- and middle-income countries (LMICs). Water is often overlooked as a source of dietary calcium despite it being universally consumed and providing good calcium bioavailability. Our objective was to assess water distribution systems in LMICs and to develop a formula to simulate the contribution of different water sources to calcium availability. We calculated the contribution of drinking water considering different calcium concentration levels to estimate total calcium availability. We consider a country's households' access to drinking water sources and the distribution of the country's population by age and gender. Calcium availability could be increased by an average of 49 mg of calcium per person per day in the 62 countries assessed if calcium in drinking water was considered. In 22 (31%) of the countries studied, 80% of households are supplied by water sources that could increase calcium availability. Improving calcium concentration in water could be considered as a strategy in LMICs to slightly improve calcium availability.

Identification of a Na+-Binding Site near the Oxygen-Evolving Complex of Spinach Photosystem II.

The oxygen-evolving complex (OEC) of photosystem II (PSII) is an oxomanganese cluster composed of four redox-active Mn ions and one redox-inactive Ca2+ ion, with two nearby bound Cl- ions. Sodium is a common counterion of both chloride and hydroxide anions, and a sodium-specific binding site has not been identified near the OEC. Here, we find that the oxygen-evolution activity of spinach PSII increases with Na+ concentration, particularly at high pH. A Na+-specific binding site next to the OEC, becomes available after deprotonation of the D1-H337 amino acid residue, is suggested by the analysis of two recently published PSII cryo-electron microscopy maps in combination with quantum mechanical calculations and multiconformation continuum electrostatics simulations.

Insights into Proton-Transfer Pathways during Water Oxidation in Photosystem II.

Water oxidation by photosystem II (PSII) involves the release of O2, electrons, and protons at the oxygen-evolving complex (OEC). These processes are facilitated by a hydrogen-bonded network of amino acid residues and waters surrounding the OEC. It is crucial to probe the proton-transfer pathways from the OEC as proton release helps to maintain the charge balance required for efficient water oxidation. In this study, we generate point mutations in the cyanobacterium Synechocystis sp. PCC 6803 at secondary-shell amino acid residues surrounding the OEC: D2-K317, D1-S169, CP43-R357, D1-D61, and D1-N181. We employ direct experimental methods to study the O2 evolution rate under varying pH ranging from 3-8. The pH dependence follows a bell-shaped curve in both wild-type and mutated PSII from which we can derive the effective acidic pKa. The effective acidic pKa provides insights into the protonation states of the amino acid residues participating in the proton-transfer process during the rate-determining step of water oxidation. The presence of an additional effective pKa in D1-S169A PSII and D2-K317A PSII indicates the possibility of multiple proton-transfer pathways during the rate-determining step of water oxidation. We also studied the O2 evolution rate in H2O and D2O with varying pL (L = H or D) to identify the amino acid residues participating in the proton-transfer process. We find that replacing the positively charged lysine with a neutral alanine in D2-K317A PSII and aspartate with alanine in D1-D61A PSII significantly enhances the kinetic solvent isotope effect (KSIE), indicating that proton transfer becomes rate-limiting at the optimal pH in these mutated PSII. However, the KSIE remains unchanged for D1-N181A, D1-S169A, and CP43-R357K PSII. Thus, perturbing the channel defined by the D1-D61 and D2-K317 residues strongly hampers the proton-transfer mechanism, and in turn, the water oxidation reaction of PSII. Hence, our study provides a direct experimental probe to identify that the D1-D61 and D2-K317 residues participate in the proton-transfer process. These results, thereby, provide us a deeper understanding of the proton-transfer processes in the water oxidation mechanism.