Size-Dependent Cytotoxicity, Adhesion, and Endocytosis of Micro-/Nano-hydroxyapatite Crystals in HK-2 Cells.

Nano-hydroxyapatite (nano-HAP) is often used as a crystal nest to induce calcium oxalate (CaOx) kidney stone formation, but the mechanism of interaction between HAP crystals of different properties and renal tubular epithelial cells remains unclear. In this study, the adhesion and endocytosis of HAP crystals with sizes of 40 nm, 70 nm, 1 µm, and 2 µm (HAP-40 nm, HAP-70 nm, HAP-1 µm, and HAP-2 µm, respectively) to human renal proximal tubular epithelial cells (HK-2) were comparatively studied. The results showed that HAP crystals of all sizes promoted the expression of osteopontin and hyaluronic acid on the cell surface, destroyed the integrity of the lysosomes, and induced the apoptosis and necrosis of cells. Nano-HAP crystals had a higher specific surface area, a smaller contact angle, a higher surface energy, and a lower Zeta potential than those of micro-HAP. Therefore, the abilities of HK-2 cells to adhere to and endocytose nano-HAP crystals were greater than their abilities to do the same for micro-HAP crystals. The order of the endocytosed crystals was as follows: HAP-40 nm > HAP-70 nm > HAP-1 µm > HAP-2 µm. The endocytosed HAP crystals entered the lysosomes. The more crystal endocytosis and adhesion there is, the more toxic it is to HK-2 cells. The results of this study showed that nanosized HAP crystals greatly promoted the formation of kidney stones than micrometer-sized HAP crystals.

Prevalence and clinical characteristics of advanced portal vein thrombosis in cirrhotic patients with gastroesophageal variceal hemorrhage.

OBJECTIVES: Portal venous thrombosis (PVT) in cirrhotic patients is usually asymptomatic and diagnosed incidentally. In this study we aimed to investigate the prevalence and characteristics of advanced PVT in cirrhotic patients with a recent episode of gastroesophageal variceal hemorrhage (GVH). METHODS: Cirrhotic patients with recent GVH at one month before their admission for further treatment to prevent rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurements, contrast-enhanced computed tomography (CT) scan of the portal vein system, and endoscopy were performed. PVT was diagnosed by CT examination and classified as none, mild and advanced. RESULTS: Of the 356 patients enrolled, 80 (22.5%) had advanced PVT. Elevated levels of white blood cells (WBC) and serum D-dimer were observed in advanced PVT patients compared with those with no or mild PVT. Moreover, HVPG was lower in patients with advanced PVT, with fewer patients having HVPG exceeding 12 mmHg, while grade III esophageal varices and varices with red signs were more prevalent. Multivariate analysis showed that WBC count (odds ratio [OR] 1.401, 95% confidence interval [CI] 1.171-1.676, P < 0.001), D-dimer level (OR 1.228, 95% CI 1.117-1.361, P < 0.001), HVPG (OR 0.942, 95% CI 0.900-0.987, P = 0.011), and grade III esophageal varices (OR 4.243, 95% CI 1.420-12.684, P = 0.010) were associated with advanced PVT. CONCLUSIONS: Advanced PVT, which is associated with a more severe hypercoagulable and inflammatory status, causes severe prehepatic portal hypertension in cirrhotic patients with GVH.

Risk factors associated with failure of endoscopic combined treatment to prevent varices rebleeding in patients with liver cirrhosis.

BACKGROUND: The aim of this study is to investigate risk factors associated with gastroesophageal variceal rebleeding after endoscopic combined treatment. RESEARCH DESIGN AND METHODS: Patients who had liver cirrhosis and underwent endoscopic treatment to prevent variceal rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurement and CT examination of portal vein system were performed before endoscopic treatment. Endoscopic obturation for gastric varices and ligation for esophageal varices were performed simultaneously at the first treatment. RESULTS: One hundred and sixty-five patients were enrolled, and after the first endoscopic treatment, recurrent hemorrhage occurred in 39 patients (23.6%) during 1-year follow-up. Compared to the non-rebleeding group, HVPG was significantly higher (18 mmHg vs.14 mmHg, P = 0.024) and more patients had HVPG exceeding 18 mmHg (51.3% vs.31.0%, P = 0.021) in the rebleeding group. No significant difference was found in other clinical and laboratory data between two groups (P > 0.05 for all). By a logistic regression analysis, high HVPG was the only risk factor associated with failure of endoscopic combined therapy (OR = 1.071, 95%CI, 1.005-1.141, P = 0.035). CONCLUSIONS: The poor efficacy of endoscopic treatment to prevent variceal rebleeding was associated with high HVPG. Therefore, other therapeutic options should be considered for the rebleeding patients with high HVPG.

Incidence and risk factor analysis for swelling after apical microsurgery.

BACKGROUND: Swelling after apical microsurgery is a postoperative reaction and may reduce quality of life during healing. AIM: To evaluate periapical swelling after apical microsurgery and determine potential risk factors. METHODS: Ninety-eight apical microsurgery patients were selected for this study. Before surgery, bone shadow volume and density of pathological tissue were measured by cone beam computed tomography. The other variables (age, gender, operative teeth number, fistula, preoperative swelling, drug use and preoperative root canal treatments) were assessed during examination. Swelling degree was confirmed by questionnaires for patients on postoperative days 1, 7, 14 and 21. Statistical analyses were performed to identify predictors for swelling. RESULTS: Majority of patients reported moderate (45.9%) or severe (34.7%) swelling on day 1, and moderate (44.9%) or mild (45.9%) on postoperative day 7. Ninety-nine percent of patients had no or mild swelling on postoperative day 14. The average swelling level peaked on day 1 postoperatively and gradually decreased. Of statistical significance, age, bone shadow volume and density of pathological tissue acted as predictors of swelling (P < 0.05). However, there was no significant difference in gender, tooth number, fistula, preoperative swelling, drug use, or preoperative root canal treatments (P > 0.05). CONCLUSION: Younger patients with larger shadow volume and density were significantly more likely to develop swelling after apical microsurgery.

Status and correlates of sleep quality in schizophrenia inpatients / 中华健康管理学杂志

Objective:To explore the status and correlates of sleep quality in hospitalized patients with schizophrenia.Methods:A total number of 269 schizophrenia inpatients were recruited from 7 hospitals including Peking University Sixth Hospital, Zhumadian Second People′s Hospital and Liaocheng Fourth People′s Hospital from August 2019 to March 2021. The Brief Psychiatric Rating Scale (BPRS), the Pittsburgh Sleep Quality Index (PSQI), the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the suicide module of Mini-International Neuropsychiatric Interview were evaluated. Poor sleep quality was determined by the score of more than 5 according to PSQI, all patients were divided into groups of poor and normal sleep quality. The general demographic data and clinical characteristics of two groups were compared, and the correlates of sleep quality were obtained by Spearman correlations and multiple logistic regression.Results:The prevalence of poor sleep quality in schizophrenia inpatients was up to 44.6% (120/269). Compared with normal sleep quality group, inpatients with poor sleep quality had higher rates of alcohol consumption history, use of benzodiazepines (BZDs) and current suicide risk, and BPRS total score, factor scores (thinking disorders, anxious-depression, hostile-suspiciousness and activation), PHQ-9 and GAD-7 scores were also higher (all P<0.05). Spearman correlation analyses showed that PSQI total score were significantly positively correlated with BPRS total score ( r=0.323), PHQ-9 score ( r=0.553), GAD-7 score ( r=0.456) and current suicide risk level ( r=0.320) (all P<0.001). Multiple logistic regression showed that history of alcohol consumption ( OR=2.897, 95% CI: 1.002-8.372), use of BZDs ( OR=3.181, 95% CI: 1.548-6.534), thinking disorders ( OR=1.563, 95% CI: 1.015-2.406), comorbidity with depression ( OR=4.968, 95% CI: 1.869-13.202), and current suicide risk ( OR=2.496, 95% CI: 1.360-4.581) were independently correlated with poor sleep quality (all P<0.05). Conclusion:Poor sleep quality is common in hospitalized patients with schizophrenia, and history of alcohol consumption, use of BZDs, thinking disorders, comorbidity with depression and current suicide risk are independent correlates of poor sleep quality.

[Research Progress in Biomimetic Synthesis of Nano-Hydroxyapatite in Bone Tissue Engineering].

Nano hydroxyapatite (nHAp), a main component of the inorganic composition of human bones and teeth, is widely used in bone tissue engineering, bone defect repair and replacement, for example, for its biocompatibility, bioactivity, bioaffinity and the ability to induce bone regeneration. Nano hydroxyapatite contains calcium and phosphorus, elements that can be replaced through the normal metabolic channels of the human body. Therefore, after implantation, it can be partially or completely absorbed and replaced by human tissues and can effectively assist bone regeneration, which makes it an ideal material for bone repair. However, traditional nHAp material is brittle and hard to be degraded in human body. In addition, nHAp has poor stability due to its high surface energy and tendency for agglomeration, which causes rapid attenuation of its mechanical strength and limits its clinical application. At present, the mechanical properties and biocompatibility of nHAp can be effectively improved by loading the related growth factors, proteins, peptides and other bioactive molecules, so as to better meet the biological requirements of bone repair materials. However, the traditional physicochemical modification methods are complicated and may interfere with the bioactivity of nHAp. It is simple to biomimetically synthesize nanomaterials by direct utilization of the molecular recognition and self-assemble capabilities of biomolecules or living microorganisms. Furthermore, the properties of the synthesized nanomaterials are stable, and the method has been extensively studied in recent years. Due to the unique crystaline structure and physicochemical properties of nHAp, results of a large number of studies have shown that its affinity with biological molecules can be used to produce bioactive nHAp by biomimetic synthesis methods. Biomimetically synthesized nHAp is expected to become the mainstream bone tissue engineering scaffold material. Analyzing and summarizing the biomimetic synthetic process and the characteristics of different nHAp materials will facilitate further development of bone defect repair materials with better mechanical and biological properties. Herein we reviewed methods of biomimetic synthesis of nHAp based on different biomolecular templates. Furthermore, we also discussed applications of biomimetic synthesized nHAp in bone tissue engineering, which can used as reference information for further research and development of new-generation bone repair biomaterials.

Size-Dependent Cytotoxicity of Hydroxyapatite Crystals on Renal Epithelial Cells.

BACKGROUND: Hydroxyapatite (HAP) is a common component of most idiopathic calcium oxalate (CaOx) stones and is often used as a nidus to induce the formation of CaOx kidney stones. METHODS: This work comparatively studies the cytotoxicity of four kinds of HAP crystals with different sizes (40 nm to 2 µm), namely, HAP-40 nm, HAP-70 nm, HAP-1 µm, and HAP-2 µm, on human renal proximal tubular epithelial cells (HK-2). RESULTS: HAP crystals reduce the viability and membrane integrity of HK-2 cells in a concentration-dependent manner and consequently cause cytoskeleton damage, cell swelling, increased intracellular reactive oxygen species level, decreased mitochondrial membrane potential, increased intracellular calcium concentration, blocked cell cycle and stagnation in G0/G1 phase, and increased cell necrosis rate. HAP toxicity to HK-2 cells increases with a decrease in crystal size. CONCLUSION: Cell damage caused by HAP crystals increases the risk of kidney stone formation.

Effects of Reynolds Number and Distribution on Passive Flow Control in Owl-Inspired Leading-Edge Serrations.

As a sophisticated micro device for noise reduction, the owl-inspired leading-edge (LE) serrations have been confirmed capable of achieving passive control of laminar-turbulent transition while normally paying a cost of lowering the aerodynamic performance in low Reynolds number (Re∼O[103]) regime. In order to explore potential applications of the owl-inspired serrated airfoils or blades in developing low noise wind turbines or multi-copters normally operating at higher Res, we conducted a large-eddy simulation (LES)-based study of Re effects on the aerodynamic performance of 2D clean and serrated models. Our results show that the LE serrations keep working effectively in mitigating turbulent fluctuations over a broad range of Re (O[103] ∼ O[105]), capable of achieving marked improvement in lift-to-drag ratio with increasing Res. As the aeroacoustic fields are in close association with the propagation of the turbulence sources, it is observed that the tradeoff between passive mitigation of turbulent fluctuations (hence aeroacoustic noise suppression) and aerodynamic performance can be noticeably mitigated at large angles of attack (AoAs) and at high Res. This indicates that the LE serrations present an alternative passive flow control mechanism at high Res through a straightforward local excitation of the flow transition while capable of mitigating the turbulent intensity passively. We further developed a 3D LES model of clean and partially serrated rectangular wings to investigate the effects of the LE serrations' distribution on aerodynamic features, on the basis of the observation that longer serrations are often distributed intensively in the mid-span of real owl's feathers. We find that the mid-span distributed LE serrations can facilitate the break-up of LE vortices and the turbulent transition passively and effectively while achieving a low level of turbulence kinetic energy over the upper suction surface of the wing.

Surgical left atrial appendage occlusion in patients with atrial fibrillation undergoing mechanical heart valve replacement.

BACKGROUND: Surgical left atrial appendage occlusion (SLAAO) may be associated with a lower risk of thromboembolism in patients with atrial fibrillation undergoing cardiac surgery. However, evidence regarding the effectiveness of SLAAO in patients undergoing mechanical heart valve replacement (MHVR) is lacking. Therefore, we aimed to evaluate the association between SLAAO and the cardiovascular outcomes in patients with atrial fibrillation undergoing MHVR. METHODS: We retrospectively analyzed data for 497 patients with atrial fibrillation; 27.6% of the patients underwent SLAAO, and the remainder of the patients did not (No-SLAAO group). The primary outcome was a composite of ischemic stroke, systemic embolism, and all-cause mortality. Cumulative event-free survival rates were estimated using Kaplan-Meier curves, and we performed multivariate Cox analyses to evaluate the association between SLAAO and outcomes. We used one-to-one propensity score matching to balance patients' baseline characteristics, and analyzed 120 matching pairs. RESULTS: Five patients died within 30 days postoperatively, and there were no significant differences between the two groups regarding in-hospital complications (all P > 0.05). After a median follow-up of 14 months, 14 primary events occurred. Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome (log-rank P = 0.830), hemorrhagic events (log-rank P = 0.870), and the secondary outcome (log-rank P = 0.730), between the two groups. Multivariable Cox proportional hazards regression analysis showed no association between SLAAO and any outcome (all P > 0.05). After propensity score matching, cardiopulmonary bypass time and aortic cross-clamp time, and the postoperative length of stay were significantly longer in the SLAAO group (all P < 0.05); results were similar to the unadjusted analyses. CONCLUSIONS: Concomitant SLAAO and MHVR was associated with longer length of stay, and cardiopulmonary bypass time and aortic cross-clamp time, but was not associated with additional protective effects against thromboembolic events and mortality during the 14-month follow-up.

Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness.

BACKGROUND: Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD). METHODS: In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization. RESULTS: A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n = 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group. CONCLUSIONS: Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD. CLINICAL TRIAL REGISTRATION: Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.

Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China.

BACKGROUND: The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients. METHODS: We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission. RESULTS: From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45-0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52-1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51-1.23; P = 0.308). CONCLUSIONS: In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making. CLINICAL TRIAL REGISTRATION: NCT02880605. https://www.clinicaltrials.gov.

Effects of non-caloric ultrashort wave on the expression of CoQ10 and C1GALT1C1 in rats with cerebral ischemia reperfusion injury / 中南大学学报(医学版)

OBJECTIVES@#To examine the changes of coenzyme Q10 (CoQ10) and β-galactosyl transferase specific chaperone 1 (C1GALT1C1) in brain of rats with ischemic injury at different time points and to explore the protective mechanism of ultrashort wave (USW) on ischemic brain injury.@*METHODS@#Fifty SD rats were randomly divided into 5 groups (=10 per group): a sham group (control group) and 4 experimental group (ischemia for 2 h). The 4 experimental groups were set as a model 1 d group, a USW 1 d group, a model 3 d group and a USW 3 d group, respectively. Five rats were randomly selected for 2,3,5-triphenyltetrazoliumchloride (TTC) staining in each experimental group, and the remaining 5 rats were subjected to Western blotting and real-time PCR. The percentage of cerebral infarction volume and the relative expression level of CoQ10 and C1GALT1C1 in the brain were examined and compared.@*RESULTS@#The infarct volume percentage after TTC staining was zero in the sham group. With the progress of disease and USW therapy, the infarct volume percentage was decreased in the experimental groups (all <0.05); Western blotting and real-time PCR showed that the relative expression level of CoQ10 in the sham group was the highest, while in the experimental groups, the content of CoQ10 showed a upward trend with the extension of disease and USW therapy, with significant difference (all <0.05). The relative expression level of C1GALT1C1 in the sham group was the lowest, but in the experimental groups, they showed a downward trend with the extension of disease and USW therapy, with significant difference (all <0.05).@*CONCLUSIONS@#Non-caloric USW therapy may upregulate the expression of CoQ10 to suppress the expression of C1GALT1C1 in rats, leading to alleviating cerebral ischemic reperfusion injury.

Effects of physical properties of nano-sized hydroxyapatite crystals on cellular toxicity in renal epithelial cells.

Hydroxyapatite (HAP) is not only a common component of most idiopathic CaOx stones, but also the core of Randall's plaque. HAP is a nest that can induce the formation of Randall's plaques and even kidney stones. We studied the toxic effects and mechanisms of four different types of nano-HAP crystals (H-Sphere, 72.5 nm × 72.5 nm; H-Needle, 37.2 nm × 162.7 nm; H-Rod, 42.3 nm × 115.3 nm; and H-Plate, 145.5 nm × 272.9 nm) on human renal proximal tubular epithelial cells (HK-2). HAP crystals could cause oxidative stress that triggered a series of cell dysfunction problems, resulting in decreased cell viability, loss of cell membrane integrity, cell swelling, and cell necrosis. The toxic effect of HAP was mainly attributed to its entry into cell by endocytosis and its accumulation in the lysosomes, causing the level of intracellular reactive oxygen species (ROS) to rise, the mitochondrial membrane potential (Δψm) to decrease, the lysosomal integrity to be destroyed, and the cell cycle blocked during the G0/G1 phase. The cytotoxicity of the four kinds of HAP crystals was ranked as follows: H-Sphere > H-Needle > H-Rod > H-Plate. The cytotoxicity of each crystal was positively correlated with low absolute zeta potential, conduciveness to internalized morphology, large specific surface area and aspect ratio, and small particle size. These results indicated that nano-HAP could damage HK-2 cells, and the physical properties of HAP crystals play a vital effect in their cytotoxicity.

Aerodynamic robustness in owl-inspired leading-edge serrations: a computational wind-gust model.

Owls are a master to achieve silent flight in gliding and flapping flights under natural turbulent environments owing to their unique wing morphologies. While the leading-edge serrations are recently revealed, as a passive flow control micro-device, to play a crucial role in aerodynamic force production and sound suppression (Rao et al 2017 Bioinspiration Biomim. 12 1-13), the characteristics of wind-gust rejection associated with leading-edge serrations remain unclear. Here we address a large-eddy simulation-based study of aerodynamic robustness in owl-inspired leading-edge serrations, which is conducted with clean and serrated wing models through mimicking wind-gusts under a longitudinal fluctuation in free-stream inflow and a lateral fluctuation in pitch angle over a broad range of angles of attack (AoAs) over 0° ⩽ Φ â©½ 20°. Our results show that the leading-edge serration-based passive flow control mechanisms associated with laminar-turbulent transition work effectively under fluctuated inflow and wing pitch, indicating that the leading-edge serrations are of potential gust fluctuation rejection or robustness in aerodynamic performance. Moreover, it is revealed that the tradeoff between turbulent flow control (i.e. aero-acoustic suppression) and force production in the serrated model holds independently to the wind-gust environments: poor at lower AoAs but capable of achieving equivalent aerodynamic performance at higher AoAs >15° compared to the clean model. Our results reveal that the owl-inspired leading-edge serrations can be a robust micro-device for aero-acoustic control coping with unsteady and complex wind environments in biomimetic rotor designs for various fluid machineries.

Quality Measurement and Improvement Study of Surgical Coronary Revascularization: Medication Adherence (MISSION-2).

BACKGROUND: Secondary preventive therapies play a key role in the prevention of adverse outcomes after coronary artery bypass grafting (CABG). However, medication adherence after CABG is often poor, and conventional interventions for improving adherence have limited success. With increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve adherence. Carefully designed trials are needed to provide reliable evidence for the use of these applications in patients after CABG. METHODS: The Measurement and Improvement Studies of Surgical Coronary Revascularization: Medication Adherence (MISSION-2) study is a multicenter randomized controlled trial, aiming to randomize 1000 CABG patients to the intervention or control groups in a 1:1 ratio. We developed the multifaceted, patient-centered, smartphone-based Heart Health Application to encourage medication adherence in the intervention group through a health self-management program initiated during hospital admission for CABG. The application integrated daily scheduled reminders to take the discharge medications, cardiac educational materials, a dynamic dashboard to review cardiovascular risk factors and secondary prevention targets, and weekly questionnaires with interactive feedback. The primary outcome was secondary preventive medication adherence measured by the Chinese version of the 8-item Morisky Medication Adherence Scale at 6 months after randomization. Secondary outcomes included all-cause death, cardiovascular rehospitalization, and a composite of death, myocardial infarction, stroke, and repeat revascularization. DISCUSSION: Findings will not only provide evidence regarding the feasibility and effectiveness of the described intervention for improving adherence to CABG secondary preventive therapies but also explore a model for outpatient health self-management that could be translated to various chronic diseases and widely disseminated across resource-limited settings. TRIAL REGISTRATION: https://clinicaltrials.gov (NCT02432469).

Owl-inspired leading-edge serrations play a crucial role in aerodynamic force production and sound suppression.

Owls are widely known for silent flight, achieving remarkably low noise gliding and flapping flights owing to their unique wing morphologies, which are normally characterized by leading-edge serrations, trailing-edge fringes and velvet-like surfaces. How these morphological features affect aerodynamic force production and sound suppression or noise reduction, however, is still not well known. Here we address an integrated study of owl-inspired single feather wing models with and without leading-edge serrations by combining large-eddy simulations (LES) with particle-image velocimetry (PIV) and force measurements in a low-speed wind tunnel. With velocity and pressure spectra analysis, we demonstrate that leading-edge serrations can passively control the laminar-turbulent transition over the upper wing surface, i.e. the suction surface at all angles of attack (0° < AoA < 20°), and hence play a crucial role in aerodynamic force and sound production. We find that there exists a tradeoff between force production and sound suppression: serrated leading-edges reduce aerodynamic performance at lower AoAs < 15° compared to clean leading-edges but are capable of achieving both noise reduction and aerodynamic performance at higher AoAs > 15° where owl wings often reach in flight. Our results indicate that the owl-inspired leading-edge serrations may be a useful device for aero-acoustic control in biomimetic rotor designs for wind turbines, aircrafts, multi-rotor drones as well as other fluid machinery.

Factors that related to the depressive symptoms among elderly in urban and rural areas of China / 中华流行病学杂志

Objective The aim of this research was to study the prevalence and differences of depressive symptoms and related factors in elderly in both urban and rural areas so as to develop relative strategies on this issue.Methods Ten-question-version of the Center Epidemiologic Studies-Depression scale (CES-D) was applied to score the depressive status.Data used in this research was from the 2013 China Health and Retirement Longitudinal Study (CHARLS).Binary logistic regressions method was applied to examine the influential factors related to depression symptoms.Results In the elderly population,the mean score on depressive symptoms was 8.3 ± 5.9,with a prevalence as 26.8％.The incidence rates on ‘Elderly depression'in urban and rural areas were 16.4％ and 30.0％ respectively.The prevalence of depressive symptoms was relatively low (P＜0.05)with protective factors including:being male,status related to self-rated health,without chronic diseases,active participation in social activities etc.noticed,among elderly in both urban and rural areas.Age and alcohol consumption appeared factors that influencing the depressive symptoms of the elderly in rural areas,while the average income was an influencing factor on the elderly in urban areas.Incidence of depression was relatively low in age ≥75 years group in rural areas.However,elderly in the rural areas with abstinence of alcohol intake showed higher incidence of depressive symptoms (P＜0.05).Incidence of depression was reltively low (P＜0.05) among elderly with high income in the urban areas.Conclusions Incidence of depression appeared high among the elderly and even higher in the rural areas.Strategies would include the following points:to strengthen the construction of urban-rural integration,improving and strengthening the rural pension insurance system,upgrading the urban social assistance for low-income elderly,strengthening the psychological consultation service of primary medical institutions and actively developing the three-tier levels related to the prevention of chronic diseases.

Factors that related to the depressive symptoms among elderly in urban and rural areas of China / 中华流行病学杂志

Objective The aim of this research was to study the prevalence and differences of depressive symptoms and related factors in elderly in both urban and rural areas so as to develop relative strategies on this issue.Methods Ten-question-version of the Center Epidemiologic Studies-Depression scale (CES-D) was applied to score the depressive status.Data used in this research was from the 2013 China Health and Retirement Longitudinal Study (CHARLS).Binary logistic regressions method was applied to examine the influential factors related to depression symptoms.Results In the elderly population,the mean score on depressive symptoms was 8.3 ± 5.9,with a prevalence as 26.8％.The incidence rates on ‘Elderly depression'in urban and rural areas were 16.4％ and 30.0％ respectively.The prevalence of depressive symptoms was relatively low (P＜0.05)with protective factors including:being male,status related to self-rated health,without chronic diseases,active participation in social activities etc.noticed,among elderly in both urban and rural areas.Age and alcohol consumption appeared factors that influencing the depressive symptoms of the elderly in rural areas,while the average income was an influencing factor on the elderly in urban areas.Incidence of depression was relatively low in age ≥75 years group in rural areas.However,elderly in the rural areas with abstinence of alcohol intake showed higher incidence of depressive symptoms (P＜0.05).Incidence of depression was reltively low (P＜0.05) among elderly with high income in the urban areas.Conclusions Incidence of depression appeared high among the elderly and even higher in the rural areas.Strategies would include the following points:to strengthen the construction of urban-rural integration,improving and strengthening the rural pension insurance system,upgrading the urban social assistance for low-income elderly,strengthening the psychological consultation service of primary medical institutions and actively developing the three-tier levels related to the prevention of chronic diseases.

Characteristics and Related Factors of Wechsler Memory Scale-Fourth Edition of Chinese Version for Mental Retardation / 中国康复理论与实践

@#Objective To investigate the memory characteristics and related factors of patients with mental retardation. Methods 73 patients with mental retardation (patient group) and 73 normal subjects (control group) matched with the patient group were respectively tested with Wechsler Memory Scale-Fourth Edition of Chinese Version (WMS-IV). Results The scores of each subtest and composite scores of WMS-IV were significantly lower in the patient group than in the control group (P<0.01). All the composite scores positively correlated with each other in the patient group (r=0.38-0.90, P<0.01) and in the control group (r=0.31-0.94, P<0.01). Age and education level positively correlated with all the composite scores (except the Visual Working Memory Index) in the patient group (P<0.05). Conclusion The patients with mental retardation present an overall decline in memory, especially in the immediate memory. The memory function in patients is related with their ages and education levels.