Evaluation of status quo and determinants of catastrophic health expenditure among empty-nest elderly in China: evidence from the China health and retirement longitudinal survey (CHARLS).

OBJECTIVE: The aging society and the empty nest of the elderly have become issues that cannot be ignored by the Chinese government. Not only does the physical function of the empty-nest elderly (ENE) decline, and the incidence and prevalence of chronic diseases increase significantly, but they are also more likely to have loneliness, low life satisfaction, mental health problems, and even a much greater possibility of suffering from depression than the nonempty-nest elderly, besides the possibility of catastrophic health expenditure (CHE) which is also greatly increased. This paper aims to evaluate the status quo of dilemma and determinants of a vast sample of subjects based on the national level. SUBJECTS AND METHODS: Data were obtained from the latest 2018's data of the China Health and Retirement Longitudinal Study (CHARLS). Under the guidance of Andersen's model of health services utilization, this study clarified the overall and different demographic characteristics and prevalence of CHE among ENE and further built the Logit and Tobit model to explore the determinants of CHE occurrence and its intensity. RESULTS: A total of 7,602 ENE were included in the analysis, and the overall incidence of CHE among them was 21.20%. Poor self-reported health status (OR=2.03, 95% CI: 1.71-2.35), suffering from three or more chronic diseases simultaneously (OR=1.79, 95% CI: 1.42-2.15), low life satisfaction (OR=1.44, 95% CI: 1.20-1.68) and advanced age played the leading role in accounting for its high risk, and its intensity increased 0.0311 (SE=0.005), 0.0234 (SE=0.007), and 0.0178 (SE=0.005), respectively. In contrast, the leading drop in the probability of CHE among ENE was those whose monthly income was over 20,000 CNY (OR=0.46, 95% CI: 0.38-0.55), whose intensity declined 0.0399 (SE=0.005), whose monthly income was between 2,000 and 20,000 CNY (OR=0.78, 95% CI: 0.66-0.90) and whose intensity declined 0.021 (SE=0.005), and who were married during the survey period (OR=0.82, 95% CI: 0.70-0.94). Simultaneously, rural ENE showed more vulnerability and higher risk of CHE when confronted with these factors compared with the urban ones. CONCLUSIONS: More attention should be paid for ENE in China. The priority, including the relevant health insurance or social security measurements, should be further strengthened.

Systematic evaluation of influencing factors for Chinese rural doctors' job satisfaction and turnover intention: based on the two-factor theory.

OBJECTIVE: In China, rural doctors (RDs) perform crucial health care missions. However, they have received less attention than their colleagues in urban public hospitals. In this specific group, a severe challenge occurs in sync with a high turnover rate and deficient job satisfaction. MATERIALS AND METHODS: This study aims to systematically summarize and evaluate the influencing factors of job satisfaction and turnover intention among Chinese rural doctors. Seven databases, including PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI), were systematically retrieved, and several experts were consulted to acquire holistic publications in this domain. RESULTS: A total of 20 full-text papers and 22,721 samples were included. In addition, 53 influencing factors were evaluated, of which 38 factors may play a significant role. Based on Herzberg's two-factor theory, together with China's cultural tradition and national conditions, we classified these influencing factors into sociodemographic characteristic factors (n=13), incentive factors (n=18), and health care factors (n=22). Meanwhile, we discussed and analyzed the influencing factors of turnover intention and job satisfaction in detail and put forward corresponding measures and suggestions for the government. CONCLUSIONS: We are confident that this research provides a holistic perspective to systematically evaluate the factors influencing the job satisfaction and intention to leave of Chinese rural doctors. Importantly, we hypothesize that the illumination of cases among Chinese rural physicians applies to other countries or regions, which has significant implications for the reformation of the medical system by governments or decision-makers worldwide.

[Autophagy promotes recurrence of nasopharyngeal carcinoma via inducing the formation of dormant polyploid giant cancer cells].

Objective: To explore the effect of dormant polyploid giant cancer cells (PGCC) on nasopharyngeal carcinoma (NPC) recurrence and to clarify the role of inhibition of autophagy in inhibiting NPC-PGCC formation and preventing NPC recurrence. Methods: NPC cells-derived PGCC (NPC-PGCC) were induced by paclitaxel (PTX), and the morphology, polyploid characteristics and cell activity of PGCC were identified by light microscopy, immunofluorescence and Live/Dead cell double staining assays. RNA-seq was used to analyze the differentially expressed genes between NPC-PGCC and diploid nasopharyngeal carcinoma cells CNE2. Functional enrichment and pathway annotation analysis of differentially expressed genes were performed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG). The level of autophagy in NPC-PGCC cells was assessed by Western Blot and transmission electron microscopy analysis. The role of autophagy in the formation of NPC-PGCC and the effect of NPC-PGCC on the recurrence of nasopharyngeal carcinoma were studied using a highly clinically relevant mouse nasopharyngeal carcinoma recurrence model. Statistical analysis was performed using GraphPad Prism 6 and P-values<0.05 were considered statistically significant. Results: NPC-PGCC induced by paclitaxel had the characteristics of burst-like division after dormancy. GO enrichment and KEGG pathway analyses identified the significant biological processes and pathways mainly concentrated in autophagy and related pathways involving the differentially expressed genes between NPC-PGCC and diploid nasopharyngeal carcinoma cells CNE2. The autophagy level was significantly enhanced in NPC-PGCC cells. In a highly clinically relevant mouse nasopharyngeal carcinoma recurrence model, the number of PGCC in the primary tumor of the nude mice treated with cisplatin were higher than those of the other groups. In nude mice pretreated with autophagy inhibitor and then co-treatment with autophagy inhibitor and cisplatin, the number of PGCC in primary tumors was less and the recurrence rate was significantly lower than in other groups. Conclusions: The mechanism of dormant polyploid giant cancer cells formation is related to autophagy. Inhibition of autophagy can inhibit the formation of PGCC and thus prevent the recurrence of nasopharyngeal carcinoma.

[Research of SIRT1 on promoting the proliferation, migration and lipid metabolism of nasopharyngeal carcinoma].

Objective: To analyze the differential expression of silent information regulator transcript-1 (SIRT1) in tissues and cells of nasopharyngeal carcinoma (NPC), to explore the effects of SIRT1 on the proliferation and migration of NPC cells, as well as the effects on and mechanisms of lipid metabolism in NPC cells. Methods: Experimental subjects: In this study, tissue specimens were obtained from patients who visited the Department of Otolaryngology and performed nasopharyngeal tissue biopsy in the Affiliated Hospital of Nantong University from 2019 to 2020. Among them, 6 cases were male, 6 cases were female, age range: 27-72 years old, including 7 cases of NPC diagnosed by pathology and 5 cases of normal nasopharyngeal mucosa. Experimental methods and outcome measures: Western Blot and quantitative real time polymerase chain reaction (qRT-PCR) were used to detect the protein and mRNA levels of SIRT1. CNE2 cell line was selected for subsequent experiments. Cell viability and migratory ability were evaluated by CCK8, wound healing and Transwell assays respectively. Animal xenograft tumor model was used to explore the role of SIRT1 inhibitor Ex527 on tumor growth in nude mice. Oil red and Bodipy were used to stain intracellular lipids. For the mechanical investigation, the interactions between SIRT1 and hypoxia inducible factor-1α (HIF-1α) were analyzed by immunoprecipitation (IP) and chromatin immunoprecipitation (ChIP). Finally, statistical analysis was performed by SPSS 26.0 software, P<0.05 was considered statistically significant. Results: The levels of SIRT1 protein (1.005±0.168) and mRNA (5.829±2.395) in NPC tissues were higher than those in normal nasopharyngeal mucosa (0.181±0.042,1.995±1.605). Differences were statistically significant (t values were 6.438 and 2.759, both P<0.05). The mRNA and protein levels of CNE1, CNE2, 5-8F and 6-10B cell lines were also higher than those in normal nasopharynx epithelial cell line NP69. Besides, overexpression of SIRT1 correlated with the proliferation and migration of NPC cells. The tumorigenesis ability of nude mice in the Ex527 group was lower than that in the control group. The low SIRT1 expression reduced the protein level of the key enzymes of liposynthesis in NPC cells, improved the expression of lipolysis enzymes, while HIF-1α overexpression promoted lipid synthesis enzymes in NPC cells. SIRT1 inhibited HIF-1α transcription by enhancing deacetylation levels. The binding ability of HIF-1α to SIRT1 promoter regions decreased when NPC cells were hypoxic. Conclusions: SIRT1 promotes the proliferation, migration and lipid metabolism of nasopharyngeal carcinoma cells, which might be expected to provide new theoretical basis for prognosis judgment and gene therapy.

[The clinical features of patients with allergic rhinitis of Nantong city in China].

Objective:To comprehensively analyze the clinical features of patients with AR by a retrospective study. Method:A total number of 8 102 patients diagnosed with AR were enrolled in Nantong area, and detailed clinical data were documented in all cases. Skin prick tests with standardized aeroallergens were conducted in these patients; The samples were divided into two groups(children and adults group) and the clinical features between two groups were analysed. Result:Children in schoolage were the majority of AR patients in children group. There were 4 581 cases(56.54%) with ocular symptoms, 3 977 cases(49.09%)with lower respiratory tract symptoms. Nasal congestion (97.37%) was the most common symptoms in patients with AR,while eye itching(32.68%) was the most common ocular symptoms in patients with AR, followed by the dacryorrhea(23.57%);and cough(44.72%) was the most common lower respiratory tract symptoms. Dermatophagoides pteronyssinus and dermatophagoides farinae had the highest positivity among all allergens, and the shrimp was the main food allergen. Conclusion:We analyzed the clinical features of patients with AR, that would provide a more scientific basis for prevention,clinical diagnosis, treatment and epidemiological studies for AR.

Simultaneous separation and confirmation of amphetamine and related drugs in equine plasma by non-aqueous capillary-electrophoresis-tandem mass spectrometry.

A non-aqueous capillary electrophoresis-mass spectrometry (NACE-MS) method was developed for simultaneous separation and identification of 12 amphetamine and related compounds in equine plasma. Analytes were recovered from plasma by liquid-liquid extraction using methyl tertiary butyl ether (MTBE). A bare fused-silica capillary was used for separation of the analytes. Addition of sheath liquid to the capillary effluent allowed the detection of the analytes by positive electrospray ionization mass spectrometry using full scan data acquisition. The limit of detection (LOD) for the target analytes was 10-200 ng/mL and that of confirmation (LOC) was 50-1000 ng/mL in equine plasma. Capillary electrophoresis (CE) and mass spectrometry (MS) parameters were optimized for full CE separation and MS detection of the analytes. Separation buffer comprised 25 mM ammonium formate in acetonitrile/methanol (20: 80, v/v) plus 1 M formic acid. Sheath liquid was isopropanol-water-formic acid (50:50:0.5, v/v/v). Samples were hydrodynamically injected and separated at 25 kV. Analytes were electrokinetically separated and mass spectrometrically identified and confirmed. This simple, fast, inexpensive and reproducible method was successfully applied to post race equine plasma and research samples in screening for amphetamine and related drugs.

Antisense inhibition of xylitol dehydrogenase gene, xdh1 from Trichoderma reesei.

AIMS: To inhibit xylitol dehydrogenase (XDH) in Trichoderma reesei by antisense inhibition strategy and construct novel strains capable of accumulating xylitol. METHODS AND RESULTS: The xdh1 antisense expression plasmid pGTA-xdh was constructed by inserting xdh1 DNA fragment inversely between the gpdA promoter and the trpC terminator from Aspergillus nidulans into a pUC19 plasmid backbone. Trichoderma reesei protoplasts were co-transformated with pGTA-xdh and hygromycin B resistance plasmid pAN7-1. Of 20 transformants screened from the selective medium, one transformant with the highest xylitol accumulation, designated ZY15, showed a distinct reduction (c. 52%) in XDH activity compared with the original strain Rut-C30. The results of Southern hybridization and PCR assay showed that the antisense expression cassette of xdh1 was integrated into the genome of T. reesei. The RT-PCR analysis proved that antisense RNA effectively inhibited XDH expression (c. 65%). Xylitol accumulation (2.37 mg ml(-1)) of ZY15 was five times higher than that (0.46 mg ml(-1)) of the original strain Rut-C30. CONCLUSIONS: Strain ZY15 successfully downregulated XDH production and exhibited xylitol accumulation in xylose liquid medium. SIGNIFICANCE AND IMPACT OF THE STUDY: This study contributed to the budding field of fungal genetics in two points. First, it confirmed that antisense RNA strategy could be used as a means of reducing gene expression in the filamentous fungus T. reesei. Secondly, it verified that the strategy appears most promising for creating novel filamentous fungi strains capable of accumulating intermediary metabolites.

Removal of arsenite from aqueous solutions by anionic clays.

Layered double hydroxides are antitype 2/1 clay minerals that can be synthesized rapidly under laboratory conditions. Due to their high anion exchange capacities, layered double hydroxides have been investigated as potential adsorbents for removal of anionic contaminants from aqueous systems. In this study, uncalcined and calcined layered double hydroxides were prepared and characterized by X-ray diffraction, with the products evaluated for their ability to adsorb As(III) in aqueous solutions. Results indicated that As(III) could be adsorbed on chloride layered double hydroxide and calcined layered double hydroxide, but no adsorption occurred for carbonate layered double hydroxide. The adsorption isotherms of As(III) on chloride layered double hydroxide and calcined layered double hydroxide were typical L and H-type curves, respectively. The adsorption of As(III) on calcined layered double hydroxide was a slow process and reached a quasi-equilibrium after a 20 hr reaction time. The layered double hydroxides had high pH buffering capacities and the As(III) adsorption on calcined layered double hydroxide was a function of pH. Competing anions strongly affected adsorption, with As(III) adsorption increasing in the order: HPO(2-)4 < SO(2-)4 < CO(2-)3 < F- < Cl- < Br- approximately equals I- < NO(-)3. Adsorbed As(III) on calcined layered double hydroxide could be desorbed by different anions, but there was no systematic relationship between As(III) desorption and anion affinities for the calcined layered double hydroxide. Calcination immobilized the As(III) adsorbed on calcined layered double hydroxides. Although layered double hydroxides could be recycled and used as an adsorbent, its adsorption efficiency was reduced with successive treatments.

Co-administration of sertraline and haloperidol.

Along with recent increased interest in the selective serotonin reuptake inhibitors, a number of studies has been undertaken to observe interactions with different drugs. When selective serotonin reuptake inhibitor was administered together with antipsychotics to schizophrenics showing depressive or obsessive symptoms and negative symptoms, meaningful results were observed. The objective of our research was to identify the changes in the concentration of plasma haloperidol when sertraline was administered to patients who already were being treated with haloperidol. Sixteen patients who did not respond to the traditional antipsychotics after 2 weeks of treatment with a certain dosage of haloperidol were administered with 50 mg of sertraline for a period of 2 weeks. The concentration changes between plasma haloperidol and the reduced haloperidol were observed using high-powered liquid chromatography equipped with a UV detector. There was a significant increase (P < 0.01) in the concentration of haloperidol, the change being from 8.52 +/- 4.22 to 10.91 +/- 5.38 ng/mL. However, the change in the concentration of reduced haloperidol was from 7.41 +/- 7.93 to 5.22 +/- 6.10 ng/mL, showing a significant decrease. The concentrations of total plasma haloperidol showed no significant changes at all. In comparing the ratio of the reduced haloperidol and the haloperidol, the reduction ratio was down to 0.39 +/- 0.27 from 0.94 +/- 0.65 showing a significant decrease. There seems to be few studies done on interactions using serotonergic drugs together with antipsychotics in spite of their clinically applicable possibility. According to similar studies done in the past, co-administering of such drugs not only increases the plasma concentration of antipsychotics, but it also results in clinical improvement of negative symptoms and aggravation of extrapyramidal symptoms. Changes in clinical symptoms and adverse effects were not observed in our study. However, we think these observations need to be included in upcoming larger scale studies.