Potentially inappropriate medications among older patients with Parkinson's disease: a cross-sectional analysis of a national health insurance database in China.

BACKGROUND: With the rapid aging trend of China's population, the issue of drug rational use in older adults has become more and more prominent. Parkinson's disease (PD) is the one of the most common age-related neurodegenerative disorders. Pharmaceutical treatment plays a cardinal role in alleviating motor and non-motor symptoms to improve the quality of life of patients with PD. Patients with PD have complex medical needs yet little is known about the use of potentially inappropriate medications (PIM) among them in China. We quantify the prevalence of PIM use and identify its predictors among older persons with PD in China. METHODS: We conducted a cross-sectional analysis using a national representative database of all medical insurance beneficiaries across China, extracting records of ambulatory visits of older adults with PD between 2015 and 2017. Beneficiaries aged 65 and above were eligible for inclusion. The prevalence of patients exposed to overall PIMs and PIMs related to motor and cognitive impairment was calculated based on Beers Criteria 2015 version. Potential predictors of PIM concerning patients' characteristics were estimated using multivariate logistic regression. RESULTS: A total of 14,452 older adults with PD were included. In total, 8,356 (57.8%) patients received at least one PIM; 2,464 (17.1%) patients received at least one motor-impairing PIM and 6,201 (42.9%) patients received at least one cognition-impairing PIM. The prevalence of overall PIM use was higher in patients of older age group (54.7% [65-74] vs. 59.5% [75-84; OR, 1.22; 95% CI, 1.14-1.31] vs.65.5% [≥ 85; OR, 1.58; 95% CI, 1.38-1.80) and females (61.4% [female] vs. 55.0% [males; OR, 0.77; 95% CI, 0.72-0.82). CONCLUSIONS: Prescribing PIMs for older adults with PD was common in China, especially for females and older age groups, yet younger patients were more inclined to be prescribed with motor or cognition-impaired PIMs. Our findings represent a clear target awaiting multidimensional efforts to promote the rational prescribing of medications for this vulnerable population.

Spatial-temporal evolution and correlation analysis between habitat quality and landscape patterns based on land use change in Shaanxi Province, China.

Regional habitat quality is an important reflection of ecosystem services and ecosystem health. Exploring the characteristics of habitat quality changes and revealing the vulnerability of regional ecosystems caused could provide reference for the improvement of ecological service functions and the protection of regional ecological environment. Based on remote sensing data of Shaanxi Province from 2000 to 2015, InVEST model and grid analysis were used to analyze the evolution characteristics of habitat quality and landscape pattern, and spatial autocorrelation was also used to analyze the spatial correlation and temporal evolution characteristics. The results showed: (1) Arable land, grassland, and forest land were the main landscape types in Shaanxi province, accounting for more than 94% of the total area, and the arable land and unused land showed a decreasing trend, while the grassland and forest land showed an increasing trend, and the proportion of construction land continued to increase with the rapid economic development from 2000 to 2015; (2) The spatial distribution characteristics of habitat quality was similar to land use cover change, which was "high in the southern and central forest areas, low in the northern sandy land and central urban agglomeration", and habitat quality value showed a steady increase, indicating that the habitat quality was getting better; (3) The landscape pattern index values of Guanzhong Plain urban agglomeration changed significantly, which tended to be fragmented, and the landscape types were more diverse and uniform; (4) There were obvious spatial correlation between habitat quality and landscape pattern, and the spatial differentiation of clustering was obvious, and the clustering effect of habitat quality and landscape pattern characteristics would weaken with the increase in urbanization degree. The analysis of the spatial association between habitat quality and landscape pattern could provide scientific support for ecological protection and landscape planning.

Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019.

Background: The appropriateness of antibiotic use for acute respiratory infections (ARIs) in Chinese primary healthcare facilities (PHFs) remained uncertain. We aimed to evaluate to what degree antibiotic prescribing for ARIs were aligned with guideline recommendations in primary settings across China. Methods: We collected outpatient prescriptions from 262 Chinese PHFs in 27 cities of six provinces between 2017 and 2019. The appropriate antibiotic prescribing was defined as prescribing antibiotic classes that were recommended by Chinese clinical guidelines, if patients were prescribed antibiotics. We evaluated the magnitude of antibiotics prescribed for acute upper respiratory infections (AURIs), acute bronchitis, and community-acquired pneumonia (CAP) and their appropriateness. Findings: Overall, 55.1% (87,684/159,150), 66.8% (30,836/46,153), and 68.5% (4615/6733) of outpatients with AURIs, acute bronchitis, and CAP treated at PHFs in China were prescribed with antibiotics. Of all antibiotic prescriptions, only 20.0% (17,542/87,684), 18.6% (5724/30,836) and 69.6% (3211/4615) used antibiotic classes that were recommended by the guidelines for AURIs, acute bronchitis, and CAP, respectively. Patients residing in the Chinese central region (17.0%, 15.4%, 69.3% for AURIs, acute bronchitis, and CAP, respectively) were less likely to be prescribed with antibiotics that were appropriately selected. Interpretation: Unnecessary antibiotics were widely prescribed for patients with AURIs or acute bronchitis and most patients with ARIs did not receive guideline-recommended antibiotic classes in Chinese PHFs. Interventions to promote evidence-based treatment and the appropriate use of antibiotics are urgently needed at the primary level across China. Funding: This work was supported by the National Natural Science Foundation of China [grant number 72074007, 81973294].

Public awareness of One Health in China.

One Health is recognized as an increasingly important approach to global health. It has the potential to inform interventions and governance approaches to prevent future pandemics. Successfully implementing the One Health approach in policy will require active engagement from the public, which begs the question: how aware is the public of One Health? In this study, we examine the level and distribution of One Health awareness among the general public in China using a survey conducted in Beijing (n = 1820). We distinguish between awareness of the term of "One Health" versus awareness of the core set of ideas - the interconnection between the health of people, animals, and the environment. Our analysis shows that 40% of respondents reported that they have heard of the term, but more than double the number indicated that they recognize the core idea of interconnection between people, animals, and the environment. Specifically, about 83% of the respondents said that they believe people's health is closely connected to animal health and 86% believe people's health is closely connected to plant and environmental health. Multiple regression analysis indicates that women, younger people, and individuals with a higher level of education show higher levels of One Health awareness than their counterparts. Being aware of the term is associated with higher recognition of the core ideas. Policymakers and health practitioners should consider these findings when designing public awareness campaigns and educational initiatives to promote One Health principles.

Benzodiazepine Receptor Agonists Prescribing for Insomnia Among Adults in Primary Health Care Facilities in Beijing, China.

This cross-sectional study examines the benzodiazepine receptor agonists (BZRA) prescribing rate for insomnia among adult patients in primary health care facilities (PHFs) in China.

Inappropriate antibiotic prescribing in primary healthcare facilities in China: a nationwide survey, 2017-2019.

OBJECTIVES: We aimed to generate comprehensive estimates of the appropriateness of outpatient antibiotic prescriptions at primary healthcare facilities (PHFs) in China. METHODS: Between 2017 and 2019, we collected outpatient-visit prescriptions from 269 Chinese PHFs in 31 cities located in 6 provinces. Conditions that resulted in antibiotic use were classified into appropriate, potentially appropriate, and inappropriate using a well-established classification approach. We then assessed the magnitude, appropriateness, and costs of antibiotic prescribing, overall and by antibiotic classification group, diagnostic categories, and patient characteristics. RESULTS: Of all eligible 209 662 antibiotic prescriptions, 147 758 (70.5%) were inappropriate, which accounted for 66.8% (558.0/835.3 thousand US dollars) of costs for antibiotics. Upper respiratory tract infections, acute bronchitis, and non-infectious gastroenteritis were responsible for 68.9% (101 744/147 758) of inappropriately antibiotic prescriptions. High inappropriate antibiotic prescribing rates were observed among children aged 0-5 years (78.5% (21 049/26 799)) and patients living in economically undeveloped areas (77.5% (38 430/49 587)). A total of 256 474 individual antibiotics were prescribed, of which 82.2% (210 885/256 474) were broad-spectrum antibiotics, with second-generation cephalosporins (15.1% (38 705/256 474)) and third-generation cephalosporins (14.6% (37 491/256 474)) being the most commonly prescribed subgroups. DISCUSSION: Our findings highlight the excessive and inappropriate use of antibiotics in Chinese PHFs pending multidimensional efforts.

Evaluation and analysis of water conservation function of ecosystem in Shaanxi Province in China based on "Grain for Green" Projects.

The evaluation of water conservation function of the ecosystem and the analysis of influencing factors are conducive to the implementation of "Grain for Green" Projects, scientific management of land use types, and the optimization of ecosystem service functions. In this paper, we selected the data of precipitation, soil, evapotranspiration, land use/cover change, and other data to quantitatively evaluate the water conservation function of the ecosystem in Shaanxi Province from 1980 to 2015 and explored the key factors which lead to the spatial differences in water conservation functions. The results showed that (1) from 1980 to 2015, the water production and water conservation of Shaanxi Province's ecosystem based on grid units decreased by 12.81 × 108 m3 and 7.74 × 108 m3, respectively. (2) The use types of cultivated land, forest land, and grassland had a prominent contribution to the water production and water conservation of the ecosystem, while the contribution rate of water area, construction land, and unused land was small. During the research period, "Grain for Green" Projects consumed a lot of water production in a short period of time, which was not conducive to the improvement of water production capacity in Shaanxi Province. However, the conversion of cultivated land to grassland would help improve the water conservation capacity of the ecosystem, increasing the water conservation capacity by 0.77 × 108 m3. (3) The water conservation function of Shaanxi Province was "hot in the south and cold in the north," with obvious regional and spatial heterogeneity from 1980 to 2015. (4) The factors of precipitation, evapotranspiration, slope, common cultivated land area, afforestation area, and water conservation function showed a positive correlation, and the impact was significant, while the overall vegetation coverage index showed a negative correlation with it. Therefore, it is necessary to comprehensively consider the local climatic and environmental conditions to implement ecological protection and restoration policies in terms of enhancing water conservation function of the ecosystem. (5) Targeted measures are proposed for different areas in Shaanxi Province: The Northern Shaanxi area should be regarded as an ecological restoration and management area, focusing on returning farmland to grassland; Central Shaanxi Plain should be considered as an ecological protection zone, and the key task is to effectively protect the ecological land; the Southern Shaanxi area should be regarded as a key water conservation area, and the main function of the forest and grass ecosystem to conserve water is to be exerted.

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis.

Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF. Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes. Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33-0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20-0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44-0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32-0.55) and hospitalization (HR: 0.73, 95% CI: 0.58-0.92). Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

Oxoammonium salts are catalysing efficient and selective halogenation of olefins, alkynes and aromatics.

Electrophilic halogenation reactions have been a reliable approach to accessing organohalides. During the past decades, various catalytic systems have been developed for the activation of haleniums. However, there is still a short of effective catalysts, which could cover various halogenation reactions and broad scope of unsaturated compounds. Herein, TEMPO (2,2,6,6-tetramethylpiperidine nitroxide) and its derivatives are disclosed as active catalysts for electrophilic halogenation of olefins, alkynes, and aromatics. These catalysts are stable, readily available, and reactive enough to activate haleniums including Br+, I+ and even Cl+ reagents. This catalytic system is applicable to various halogenations including haloarylation of olefins or dibromination of alkynes, which were rarely realized in previous Lewis base catalysis or Lewis acid catalysis. The high catalytic ability is attributed to a synergistic activation model of electrophilic halogenating reagents, where the carbonyl group and the halogen atom are both activated by present TEMPO catalysis.

Floral tea polyphenols can improve honey bee memory retention and olfactory sensitivity.

Animal-pollinated plants face a common problem, how their defensive anti-herbivore compounds may impair or alter pollinator behavior. Evolution has tailored multiple solutions, which largely involve pollinator tolerance or manipulation, to the benefit of the plant, not the removal of these compounds from pollen or nectar. The tea plant, Camilla sinensis, is famous for the caffeine and tea polyphenols (TP) that it produces in its leaves. However, these compounds are also found in its nectar, which honey bees readily collect. We examined the effects of these compounds on bee foraging choices, learning, memory, and olfactory sensitivity. Foragers preferred a sucrose feeder with 100 µg or 10 µg TP/ml over a control feeder. Caffeine, but not TP, weakly increased honey bee learning. Both caffeine and TP significantly increased memory retention, even when tested 7 d after the last learning trial. In addition, TP generally elevated EAG responsiveness to alarm pheromone odors. These results demonstrate that other secondary plant compounds, not only caffeine, can attract pollinators and influence their learning and memory.

Spatial patterns and interspecific associations among trees at different stand development stages in the natural secondary forests on the Loess Plateau, China.

Quercus wutaishansea populations on the Loess Plateau are currently becoming more dominant in natural secondary forests, whereas Pinus tabulaeformis is declining. In the present paper, the diameter class (instead of age) was used to classify the different growth stages as juvenile, subadult, or adult, and the univariate function g(r) was used to analyze the dynamic changes in spatial patterns and interspecific associations in three 1-ha tree permanent plots on the Loess Plateau, NW China. Our results suggested that the niche breadth changed with the development stage. The diameter distribution curve was consistent with the inverted "J" type, indicating that natural regeneration was common in all three plots. There was a close relationship between the spatial pattern and scale, which showed significant aggregation at small distances, and became more random as distance increased, but in the Pinus + Quercus mixed forests, the whole species were aggregated at distances up to 50 m. The degree of spatial clumping decreased from juvenile to subadult and from subadult to adult. The spatial pattern also differed at different growth stages, likely due to strong intraspecific competition. Associations among different growth stages were positively correlated at small scales. Our study is important to the understanding of the development of the Q. wutaishansea forests; thus, the spatial dynamic change features should be received greater attention when planning forest management and developing restoration strategies on the Loess Plateau.

Hornets possess long-lasting olfactory memories.

The ability of animals to learn and remember is an important adaptation for coping with environmental changes. The fitness benefits provided by these cognitive skills, in conjunction with social behaviours, contribute to the success of social insects. How these abilities are shared among the different castes and the long-term persistence of memory are now being elucidated in diverse systems, work that should shed light on general principles underlying cognitive evolution. Here, we provide the first evidence of olfactory learning and long-term olfactory memory in all three castes of an Asian hornet, Vespa velutina Using the first proboscis extension reflex assay developed for hornets or wasps, we found that all hornet castes could learn and remember odours associated with a food reward. Moreover, long-lasting memory was retained without significant decay in gynes (virgin queens) and drones even up to 30 days (workers did not survive for 30 days). Drones learned and remembered simple odorant molecules and gyne sex pheromone with equal facility. These results increase our understanding of the outstanding cognitive abilities of social insects and suggest the likely importance of long-lasting memory in different castes of the same species.

Chimeric antigen receptor-engineered T-cell therapy for liver cancer.

BACKGROUND: Chimeric antigen receptor-engineered T-cell (CAR-T) therapy is a newly developed immunotherapy used in the treatment of cancers. Because CAR-T therapy has shown great success in treating CD19-positive hematological malignancies, its application has been explored in the treatment of solid tumors, such as liver cancer. In this review, we discuss the immune characteristics of liver cancer, the obstacles encountered during the application of CAR-T therapy, and preclinical and clinical progress in the use of CAR-T therapy in patients with liver cancer. DATA SOURCES: The data on CAR-T therapy related to liver cancers were collected by searching PubMed and the Web of Science databases prior to December 2017 with the keywords "chimeric antigen receptor", "CAR-T", "liver cancer", "hepatocellular carcinoma", and "solid tumor". Additional articles were identified by manual search of references found in the primary articles. The data for clinical trials were collected by searching ClinicalTrials.gov. RESULTS: The liver has a tolerogenic nature in the intrahepatic milieu and its tumor microenvironment significantly affects tumor progression. The obstacles that reduce the efficacy of CAR-T therapy in solid tumors include a lack of specific tumor antigens, limited trafficking and penetration of CAR-T cells to tumor sites, and an immunosuppressive tumor microenvironment. To overcome these obstacles, several strategies have emerged. In addition, several strategies have been developed to manage the side effects of CAR-T, including enhancing the selectivity of CARs and controlling CAR-T activity. To date, no clinical trials of CAR-T therapy against HCC have been completed. However, preclinical studies in vitro and in vivo have shown potent antitumor efficacy. Glypican-3, mucin-1, epithelial cell adhesion molecule, carcinoembryonic antigen, and other targets are currently being studied. CONCLUSIONS: The application of CAR-T therapy for liver cancer is just beginning to be explored and more research is needed. However, we are optimistic that CAR-T therapy will offer a new approach for the treatment of liver cancers in the future.

First demonstration of olfactory learning and long-term memory in honey bee queens.

As the primary source of colony reproduction, social insect queens play a vital role. However, the cognitive abilities of queens are not well understood, although queen learning and memory are essential in multiple species such as honey bees, in which virgin queens must leave the nest and then successfully learn to navigate back over repeated nuptial flights. Honey bee queen learning has never been previously demonstrated. We therefore tested olfactory learning in queens and workers and examined the role of DNA methylation, which plays a key role in long-term memory formation. We provide the first evidence that honey bee queens have excellent learning and memory. The proportion of honey bee queens that exhibited learning was 5-fold higher than that of workers at every tested age and, for memory, 4-fold higher than that of workers at a very young age. DNA methylation may play a key role in this queen memory because queens exhibiting remote memory had a more consistent elevation in Dnmt3 gene expression as compared with workers. Both castes also showed excellent remote memory (7 day memory), which was reduced by 14-20% by the DNA methylation inhibitor zebularine. Given that queens live approximately 10-fold longer than workers, these results suggest that queens can serve as an excellent long-term reservoir of colony memory.

Niches and Interspecific Associations of Dominant Populations in Three Changed Stages of Natural Secondary Forests on Loess Plateau, P.R. China.

Ecological niches remain central to explaining community structure, and niche-based studies have helped us to better understand species interactions, distributions, coexistence and associated mechanisms. Quercus wutaishansea populations on Loess Plateau are currently expanding their dominance in natural secondary forest types. In the present paper, we focused on the dynamic changes of niches and interspecific association among different changed stages. The overall interspecies association of the three communities exhibited positive association for Variance Ratio (VR) >1; the value of χ2 significance test further revealed that the overall association had reached the level of significant association. Among the total of 45 species pairs composed of 10 dominant species, in the Pinus tabulaeformis forest, the ratio of positive and negative associations was below 1, which 19 pairs showing positive association, 25 pairs showing negative association, and 1 pair showing no association; in contrast, in another forests, the ratios of positive and negative associations were above 1. The timing and consequences of these associations may illuminate how interaction mechanisms such as competition and alleopathy, structure changes. Then differences of species features in niches and associations should receive greater attention when planning forest management and developing restoration strategies.

Inhibiting DNA methylation alters olfactory extinction but not acquisition learning in Apis cerana and Apis mellifera.

DNA methylation plays a key role in invertebrate acquisition and extinction memory. Honey bees have excellent olfactory learning, but the role of DNA methylation in memory formation has, to date, only been studied in Apis mellifera. We inhibited DNA methylation by inhibiting DNA methyltransferase (DNMT) with zebularine (zeb) and studied the resulting effects upon olfactory acquisition and extinction memory in two honey bee species, Apis cerana and A. mellifera. We used the proboscis extension reflex (PER) assay to measure memory. We provide the first demonstration that DNA methylation is also important in the olfactory extinction learning of A. cerana. DNMT did not reduce acquisition learning in either species. However, zeb bidirectionally and differentially altered extinction learning in both species. In particular, zeb provided 1h before acquisition learning improved extinction memory retention in A. mellifera, but reduced extinction memory retention in A. cerana. The reasons for these differences are unclear, but provide a basis for future studies to explore species-specific differences in the effects of methylation on memory formation.