A scoping review of factors associated with self-management in young adults with stroke.

PURPOSE: To synthesize the available evidence on factors associated with self-management behavior in young stroke patients. METHODS: The methodological guidelines for scoping reviews developed by the Joanna Briggs Institute and the PRISMA-scR-checklist for scoping reviews were used. A total of 5586 studies were identified through bibliographic searches of the scientific databases Medline (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO, limited to the period 2000-2023. Studies were independently assessed for inclusion and exclusion criteria by two reviewers. Quantitative observational data and qualitative studies were extracted, mapped, and summarized to provide a descriptive summary of trends and considerations for future research. RESULTS: Nine papers were finally selected to answer the research question. Young patients' self-management was mainly influenced by demographic factors (age, gender, income, education, and stroke knowledge), disease-related factors (functionality and independence, duration of stroke diagnosis, cognitive function, and poststroke fatigue), and psychosocial factors (hardiness, spiritual self-care, self-efficacy, and social support). CONCLUSION: Further research is needed to determine the trajectory of poststroke self-management over time and its potential predictors, which should lead to the development of specific stroke rehabilitation and stroke self-management support programs for young people (considering factors that influence return to work in young stroke patients' self-management). PRACTICE IMPLICATIONS: Healthcare providers can design more efficient interventions to improve the quality of life of young stroke patients after discharge. Gaining an in-depth understanding of the factors that influence self-management can help achieve this.

An integrated neuroimaging-omics approach for the gut-brain communication pathways in Alzheimer's disease.

A key role of the gut microbiota in the pathogenesis of neurodegenerative diseases, such as Alzheimer's disease (AD), has been identified over the past decades. Increasing clinical and preclinical evidence implicates that there is bidirectional communication between the gut microbiota and the central nervous system (CNS), which is also known as the microbiota-gut-brain axis. Nevertheless, current knowledge on the interplay between gut microbiota and the brain remains largely unclear. One of the primary mediating factors by which the gut microbiota interacts with the host is peripheral metabolites, including blood or gut-derived metabolites. However, mechanistic knowledge about the effect of the microbiome and metabolome signaling on the brain is limited. Neuroimaging techniques, such as multi-modal magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET), have the potential to directly elucidate brain structural and functional changes corresponding with alterations of the gut microbiota and peripheral metabolites in vivo. Employing a combination of gut microbiota, metabolome, and advanced neuroimaging techniques provides a future perspective in illustrating the microbiota-gut-brain pathway and further unveiling potential therapeutic targets for AD treatments.

Genomic analysis of almost 8,000 Salmonella genomes reveals drivers and landscape of antimicrobial resistance in China.

IMPORTANCE: We established the largest Salmonella genome database from China and presented the landscape and spatiotemporal dynamics of antimicrobial resistance genes. We also found that economic, climatic, and social factors can drive the rise of antimicrobial resistance. The Chinese local Salmonella genome database version 2 was released as an open-access database (https://nmdc.cn/clsgdbv2) and thus can assist surveillance studies across the globe. This database will help inform interventions for AMR, food safety, and public health.

Alterations in Peripheral Metabolites as Key Actors in Alzheimer's Disease.

Growing evidence supports that Alzheimer's disease (AD) could be regarded as a metabolic disease, accompanying central and peripheral metabolic disturbance. Nowadays, exploring novel and potentially alternative hallmarks for AD is needed. Peripheral metabolites based on blood and gut may provide new biochemical insights about disease mechanisms. These metabolites can influence brain energy homeostasis, maintain gut mucosal integrity, and regulate the host immune system, which may further play a key role in modulating the cognitive function and behavior of AD. Recently, metabolomics has been used to identify key AD-related metabolic changes and define metabolic changes during AD disease trajectory. This review aims to summarize the key blood- and microbial-derived metabolites that are altered in AD and identify the potential metabolic biomarkers of AD, which will provide future targets for precision therapeutic modulation.

Novel chromosomes and genomes provide new insights into evolution and adaptation of the whole genome duplicated yeast-like fungus TN3-1 isolated from natural honey.

Aureobasidium melanogenum TN3-1 strain and A. melanogenum P16 strain were isolated from the natural honey and the mangrove ecosystem, respectively. The former can produce much higher pullulan from high concentration of glucose than the latter. In order to know what happened to their genomes, the PacBio sequencing and Hi-C technologies were used to create the first high-quality chromosome-level reference genome assembly of A. melanogenum TN3-1 (51.61 Mb) and A. melanogenum P16 (25.82 Mb) with the contig N50 of 2.19 Mb and 2.26 Mb, respectively. Based on the Hi-C results, a total of 93.33% contigs in the TN3-1 strain and 92.31% contigs in the P16 strain were anchored onto 24 and 12 haploid chromosomes, respectively. The genomes of the TN3-1 strain had two subgenomes A and B. Synteny analysis showed that the genomic contents of the two subgenomes were asymmetric with many structural variations. Intriguingly, the TN3-1 strain was revealed as a recent hybrid/fusion between the ancestor of A. melanogenum CBS105.22/CBS110374 and the ancestor of another unidentified strain of A. melanogenum similar to P16 strain. We estimated that the two ancient progenitors diverged around 18.38 Mya and merged around 10.66-9.98 Mya. It was found that in the TN3-1 strain, telomeres of each chromosome contained high level of long interspersed nuclear elements (LINEs), but had low level of the telomerase encoding gene. Meanwhile, there were high level of transposable elements (TEs) inserted in the chromosomes of the TN3-1 strain. In addition, the positively selected genes of the TN3-1 strain were mainly enriched in the metabolic processes related to harsh environmental adaptability. Most of the stress-related genes were found to be related to the adjacent LTRs, and the glucose derepression was caused by the mutation of the Glc7-2 in the Snf-Mig1 system. All of these could contribute to its genetic instability, genome evolution, high stress resistance, and high pullulan production from glucose.

KEGG_Extractor: An Effective Extraction Tool for KEGG Orthologs.

The KEGG Orthology (KO) database is a widely used molecular function reference database which can be used to conduct functional annotation of most microorganisms. At present, there are many KEGG tools based on the KO entries for annotating functional orthologs. However, determining how to efficiently extract and sort the annotation results of KEGG still hinders the subsequent genome analysis. There is a lack of effective measures used to quickly extract and classify the gene sequences and species information of the KEGG annotations. Here, we present a supporting tool: KEGG_Extractor for species-specific genes extraction and classification, which can output the results through an iterative keyword matching algorithm. It can not only extract and classify the amino acid sequences, but also the nucleotide sequences, and it has proved to be fast and efficient for microbial analysis. Analysis of the ancient Wood Ljungdahl (WL) pathway through the KEGG_Extractor reveals that ~226 archaeal strains contained the WL pathway-related genes. Most of them were Methanococcus maripaludis, Methanosarcina mazei and members of the Methanobacterium, Thermococcus and Methanosarcina genus. Using the KEGG_Extractor, the ARWL database was constructed, which had a high accuracy and complement. This tool helps to link genes with the KEGG pathway and promote the reconstruction of molecular networks. Availability and implementation: KEGG_Extractor is freely available from the GitHub.

Psychrophilic Yeasts: Insights into Their Adaptability to Extremely Cold Environments.

Psychrophilic yeasts are distributed widely on Earth and have developed adaptation strategies to overcome the effect of low temperatures. They can adapt to low temperatures better than bacteriophyta. However, to date, their whole-genome sequences have been limited to the analysis of single strains of psychrophilic yeasts, which cannot be used to reveal their possible psychrophilic mechanisms to adapt to low temperatures accurately and comprehensively. This study aimed to compare different sources of psychrophilic yeasts at the genomic level and investigate their cold-adaptability mechanisms in a comprehensive manner. Nine genomes of known psychrophilic yeasts and three representative genomes of mesophilic yeasts were collected and annotated. Comparative genomic analysis was performed to compare the differences in their signaling pathways, metabolic regulations, evolution, and psychrophilic genes. The results showed that fatty acid desaturase coding genes are universal and diverse in psychophilic yeasts, and different numbers of these genes exist (delta 6, delta 9, delta 12, and delta 15) in the genomes of various psychrophilic yeasts. Therefore, they can synthesize polyunsaturated fatty acids (PUFAs) in a variety of ways and may be able to enhance the fluidity of cell membranes at low temperatures by synthesizing C18:3 or C18:4 PUFAs, thereby ensuring their ability to adapt to low-temperature environments. However, mesophilic yeasts have lost most of these genes. In this study, psychrophilic yeasts could adapt to low temperatures primarily by synthesizing PUFAs and diverse antifreeze proteins. A comparison of more psychrophilic yeasts' genomes will be useful for the study of their psychrophilic mechanisms, given the presence of additional potential psychrophilic-related genes in the genomes of psychrophilic yeasts. This study provides a reference for the study of the psychrophilic mechanisms of psychrophilic yeasts.

Transcription Factors in Aureobasidium spp.: Classification, Regulation and a Newly Built Database.

Transcription factors (TFs) can regulate the synthesis of secondary metabolites through different metabolic pathways in Aureobasidium spp. In this study, a set of 16 superfamilies, 45 PFAM families of TFs with the DNA-binding domains, seven zinc finger families and eight categories of the C2H2 TFs have been identified in Aureobasidium spp. Among all the identified TFs, four superfamilies and six PFAM families are the fungal-specific types in this lineage. The Zn2Cys6 and fungal-specific domain regulators are found to be overwhelmingly predominated, while the C2H2 zinc finger class comprises a smaller regulator class. Since there are currently no databases that allow for easy exploration of the TFs in Aureobasidium spp., based on over 50 references and 2405 homologous TFs, the first TFs pipeline-the Aureobasidium Transcription Factor Database (ATFDB)-has been developed to accelerate the identification of metabolic regulation in various Aureobasidium species. It would be useful to investigate the mechanisms behind the wide adaptability and metabolite diversity of Aureobasidium spp.

The Application of the Omaha System in Community Rehabilitation Nursing for Patients With Stroke and Previous Falls.

Objective: This study aimed to explore the use of the Omaha System in rehabilitation and nursing methods and the effects on patients within the community who had experienced stroke and previous falls. Methods: This study enrolled 42 patients who had experienced stroke and previous falls and had returned to the community after being discharged from the Department of Neurology and Rehabilitation of the Affiliated Hospital of Nanchang University from January to July 2018. The patients were randomly divided into two groups: an experimental group (n = 21) and a control group (n = 21). Patients in the control group received routine community rehabilitation care, and patients in the experimental group received community rehabilitation care on the basis of the Omaha System. Intervention lasted for 1 year. The Omaha outcome score, the ability to perform activities of daily living (ADL) (measured via the Modified Barthel Index [MBI]), and the incidence of falls for each group were compared before and after the intervention. Results: After 1 year of intervention, the Omaha outcome score and MBI of both groups were higher than before; the Omaha outcome score and MBI of the experimental group were higher than those of the control group; the differences were statistically significant (P < 0.05). No fall occurred in either of the two groups. Conclusion: The Omaha System can comprehensively evaluate the health problems of patients, guide nursing intervention, and quantitatively evaluate the effect of nursing intervention; it is therefore worthy of promotion.

Liamocins biosynthesis, its regulation in Aureobasidium spp., and their bioactivities.

Liamocins synthesized by Aureobasidium spp. are glycolipids composed of a single mannitol or arabitol headgroup linked to either three, four or even six 3,5-dihydroxydecanoic ester tail-groups. The highest titer of liamocin achieved was over 40.0 g/L. The substrates for liamocins synthesis include glucose, sucrose, xylose, mannitol, and others. The Pks1 is responsible for the biosynthesis of the tail-group 3,5-dihydroxydecanoic acid, both mannitol dehydrogenase (MDH) and mannitol 1-phosphate 5-dehydrogenase (MPDH) catalyze the mannitol biosynthesis and the arabitol biosynthesis is controlled by arabitol dehydrogenase (ArDH). The ester bond formation between 3,5-dihydroxydecanoic acid and mannitol or arabitol is catalyzed by the esterase (Est1). Liamocin biosynthesis is regulated by the specific transcriptional activator (Gal1), global transcriptional activator (Msn2), various signaling pathways, acetyl-CoA flux while Pks1 activity is controlled by PPTase activity. The synthesized liamocins have high bioactivity against the pathogenic bacteria Streptococcus spp. and some kinds of cancer cells while Massoia lactone released liamocins which exhibited obvious antifungal and anticancer activities. Therefore, liamocins and Massoia lactone have many applications in various sectors of biotechnology.

Clinicians' Perspectives About the Feasibility and Effectiveness of Using Telemedicine in First Aid: A Qualitative Study.

OBJECTIVE: This study investigated clinicians' perspectives on the feasibility and effectiveness of using telemedicine in the context of providing first aid. It is crucial to identify and explore clinicians' attitudes and awareness of tele-first-aid in China to keep pace with ongoing global trends. DESIGN: This was a qualitative study. Data gathered from in-depth interviews with 22 clinicians were coded into themes and analyzed. PARTICIPANTS: Participants included hospital-based clinicians: four clinical specialists, eight emergency nurses, four emergency doctors, three general practitioners, and three clinical administrators. SETTING: The study was conducted in university-affiliated hospitals. RESULTS: All clinicians who were invited to participate believed that the use of telemedicine in first aid was promising and effective. Participants stated that relevant technology should be designed to synergize the chain of existing platforms in the industry and that it should be determined who has the authority to utilize such technology and how it should be used to achieve the sought-after benefits. The use of such technology refreshes the role of clinicians and their relationship with patients. Additionally, participants believed that the government could play an important role especially in the reform of medical systems. CONCLUSION: Telemedicine can facilitate the provision of conventional first aid and systematically exploit existing resources due to its feasibility and effectiveness. The social benefits of using tele-first-aid in clinical and community applications, especially when used in coordination with existing resources, make its adoption an inevitable trend in the field.

Molecular evolution and regulation of DHN melanin-related gene clusters are closely related to adaptation of different melanin-producing fungi.

Many genes responsible for melanin biosynthesis in fungi were physically linked together. The PKS gene clusters in most of the melanin-producing fungi were regulated by the Cmr1. It was found that a close rearrangement of the PKS gene clusters had evolved in most of the melanin-producing fungi and various functions of melanin in them were beneficial to their adaptation to the changing environments. The melanin-producing fungi had undergone at least five large-scale differentiations, making their PKS gene clusters be quickly evolved and the fungi be adapted to different harsh environments. The recent gene losses and expansion were remarkably frequent in the PKS gene clusters, leading to their rapid evolution and adaptation of their hosts to different environments. The PKS gene and the CMR1 gene in them were subject to a strong co-evolution, but the horizontal gene transfer events might have occurred in the genome-duplicated species, Aspergillus and Penicillium.

Polymalate (PMA) biosynthesis and its molecular regulation in Aureobasidium spp.

It has been well documented that different strains of Aureobasidium spp. can synthesize and secrete over 30.0 g/L of polymalate (PMA) and the produced PMA has many potential applications in biomaterial, medical and food industries. The substrates for PMA biosynthesis include glucose, xylose, fructose, sucrose and glucose or fructose or xylose or sucrose-containing natural materials from industrial and agricultural wastes. Malate, the only monomer for PMA biosynthesis mainly comes from TCA cycle, cytosolic reduction TCA pathway and the glyoxylate cycle. The PMA synthetase (a NRPS) containing A like domain, T domain and C like domain is responsible for polymerization of malate into PMA molecules by formation of ester bonds between malates. PMA biosynthesis is regulated by the transcriptional activator Crz1 from Ca2+ signaling pathway, the GATA-type transcription factor Gat1 from nitrogen catabolite repression and the GATA-type transcription factor NsdD.

Pullulan biosynthesis and its regulation in Aureobasidium spp.

It has been well known that different strains of Aureobasidium spp. can yield a large amount of pullulan. Although pullulan has wide applications in various sectors of biotechnology, its biosynthesis and regulation were not resolved. Lately, the molecular mechanisms of pullulan biosynthesis and regulation have been elucidated and their genes and encoding proteins have been identified using the genome-wide mutant analysis. It is found that a multidomain AmAgs2 is the key enzyme for pullulan biosynthesis and the alternative primers are required for its biosynthesis. Pullulan biosynthesis is regulated by glucose repression and signaling pathways. Elucidation of such a biosynthetic pathway and regulation is of significance in biotechnology. Therefore, the present review article mainly summaries the recent research proceedings in this field, hoping to promote further endeavors on enhanced pullulan production and improved chemical properties of pullulan via molecular modifications of the producers by using synthetic biology approaches.

An Empirical Study on the Factors Affecting Elderly Users' Continuance Intention of Shared Nurses.

OBJECTIVE: Based on the technical acceptance model, expectation confirmation model, and perceived risk theory, this study aims to analyze the factors and their effects on shared nurse users' continuance intention in the process of e-health consumption. METHODS: This research established a measurement tool that fits the topic of this study and a model of shared nurse continuance. From January to May 2020, 373 valid samples from elderly individuals living in urban areas of Jiangxi Province, China, were collected by convenience sampling in order to analyze through empirical research their continuance intentions of selecting shared nurses. The theoretical models and research hypotheses were verified by structural equation modeling with AMOS 25 software. RESULTS: The measurement model indicated that the theoretical constructs have adequate reliability and validity, while the structured equation model is illustrated as having a high model fit for empirical data. The hypothesis test results showed that expectation confirmation positively affects perceived ease of use; both of them have positive effects on perceived usefulness and satisfaction. Perceived usefulness and satisfaction play an intermediary role in expectation confirmation and continuance intention. Perceived ease of use and perceived usefulness positively affect continuance intention. Perceived risk negatively affects perceived usefulness and continuance intention. CONCLUSION: This study expanded the application of the technology acceptance model, expectation confirmation model, and perceived risk model in e-health by investigating the factors that influence elderly users' continued intention to use shared nurses. Based on these empirical findings, we derived implications for the design and operation of the shared nurse platform, and suggestions on relevant management departments and incentive structures for using e-health. The results of this study provide important implications for further research and practice of mobile health care.

Efficacy and safety of tripterygium glycosides in the treatment of hyperthyroidism: A systemic review and meta-analysis.

BACKGROUND: Hyperthyroidism is a condition in which the thyroid gland is overreactive and produces excess amounts of thyroid hormone. Tripterygium glycosides, traditional Chinese medicine has been widely used in the treatment of rheumatoid arthritis, nephrotic syndrome, hyperthyroidism and other diseases due to its anti-inflammatory and immunosuppressive effects. Evidence-based research is becoming popular especially with the application of Chinese traditional medicine. This paper systematically reviews and evaluates existing clinical data on the efficacy and safety of Tripterygium glycosides in the treatment of hyperthyroidism. MATERIALS AND METHODS: PubMed, Cochrane library and EMBase, Chinese biomedical literature database (CBM), Chinese journal full-text database (CNKI), Wan fang digital periodical full-text database and China Science and Technology Journal Database (VIP) were searched based on the defined inclusion and exclusion criteria. Data extraction, research quality assessment and meta-analysis were conducted with RevMan5.3 software. Trial sequential analysis (TSA) was used to evaluate information size and treatment benefits. RESULTS: Seventeen randomized controlled clinical trials with 1536 participants were included in the systematic review. In the meta-analysis, there were two subgroups: Tripterygium glycosides combined with thiamazole and prednisone group; Tripterygium glycosides combined with thiamazole group. The study results revealed that the degree of exophthalmos, FT3, FT4, BGP, and AKP decreased while TSH, SOD, GSH-PX increased after the addition of Tripterygium glycosides. This study results suggested that Tripterygium glycosides combined with western medicine are an effective therapy for hyperthyroidism. CONCLUSION: This study indicates that Tripterygium glycosides enhances the effect of thiamazole and prednisone in the treatment of hyperthyroidism and without increasing the risk of adverse events.

Training of Basic Life Support Among Lay Undergraduates: Development and Implementation of an Evidence-Based Protocol.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is an important method to improve the prognosis of patients with prehospital cardiac arrest (CA). Basic life support (BLS) is the first step in CPR and is usually performed by the first witness. However, the general population has poor BLS skills due to the lack of efficient and practical training strategy. Several training initiatives could be used to improve this situation, and the challenge is to find the most efficient one in detail according to the actual setting. Repeated and effective BLS training increase bystander's confidence and willingness to perform BLS. Evidence-based instructional design is essential to improve the training of lay providers and ultimately improve resuscitation performance and patient outcomes. OBJECTIVE: 1) To develop an evidence-based BLS training protocol for lay undergraduates; 2) to implement the protocol and 3) to evaluate the process of implementation. METHODS: Nine databases were searched to synthesize the best evidence. A protocol was formed by ranking evidence and considering university setting and students' preferences. We implemented this training protocol and evaluated its effects. RESULTS: We achieved the three aims above. A total of 120 lay undergraduates received BLS training and retraining within 3 months. The students and teaching staff were satisfied with the training protocol and effect. The BLS training process was more clearly defined. The role of teaching assistants and the strategies to sustain training quality was proven to be crucial to the project's success. CONCLUSION: The development and implementation of an evidence-based protocol could elevate undergraduates' BLS skill and confidence.

Fungi in mangrove ecosystems and their potential applications.

Mangrove fungi, their ecological role in mangrove ecosystems, their bioproducts, and potential applications are reviewed in this article. Mangrove ecosystems can play an important role in beach protection, accretion promotion, and sheltering coastlines and creeks as barriers against devastating tropical storms and waves, seawater, and air pollution. The ecosystems are characterized by high average and constant temperatures, high salinity, strong winds, and anaerobic muddy soil. The mangrove ecosystems also provide the unique habitats for the colonization of fungi which can produce different kinds of enzymes for industrial uses, recycling of plants and animals in the ecosystems, and the degradation of pollutants. Many mangrove ecosystem-associated fungi also can produce exopolysaccharides, Ca2+-gluconic acid, polymalate, liamocin, polyunsaturated fatty acids, biofuels, xylitol, enzymes, and bioactive substances, which have many potential applications in the bioenergy, food, agricultural, and pharmaceutical industries. Therefore, mangrove ecosystems are rich bioresources for bioindustries and ecology. It is necessary to identify more mangrove fungi and genetically edit them to produce a distinct array of novel chemical entities, enzymes, and bioactive substances.

The differences between fungal α-glucan synthase determining pullulan synthesis and that controlling cell wall α-1,3 glucan synthesis.

The fungal α-glucan synthases (Agss) are multi-domain proteins catalyzing biosynthesis of cell wall α-1,3-glucan which determines cell wall integrity or fungal pathogenicity and pullulan which is a maltotriosyl polymer made of α-1,4 and α-1,6 bound glucose units. The Agss family can be divided into 11 groups, some of which lost the original functions due to accumulation of harmful mutations or gene loss. Schizosaccharomyces pombe kept five kinds of Agss in the genome while Aspergillus spp. and Penicillium spp. lost one or two or three kinds of Agss. All the human, animal and plant pathogens kept only one single kind of Ags or only one active Ags for synthesis of cell wall α-1,3-glucan, a virulence factor. While the genus Aureobasidium spp. contained three kinds of Agss, of which only some of the Ags2 was involved in pullulan biosynthesis. Although many Agss contained Big_5 domain, only the Big_5 domain with conserved amino acids LQS from some strains of A. melanogenum could catalyze pullulan biosynthesis. This whole amino acid sequence and phylogenetic differences may cause non-α-1,3-glucan synthesizing activity of some fungal Agss.