Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission.

Backgroud: Acute myocardial infarction (AMI) has a high morbidity rate, high mortality rate, high readmission rate, high health care costs, and a high symptomatic, psychological, and economic burden on patients. Patients with AMI usually present with multiple symptoms simultaneously, which are manifested as symptom clusters. Symptom clusters have a profound impact on the quality of survival and clinical outcomes of AMI patients. Objective: The purpose of this study was to analyze unplanned hospital readmissions among cluster groups within a 1-year follow-up period, as well as to identify clusters of acute symptoms and the characteristics associated with them that appeared in patients with AMI. Methods: Between October 2021 and October 2022, 261 AMI patients in China were individually questioned for symptoms using a structured questionnaire. Mplus 8.3 software was used to conduct latent class analysis in order to find symptom clusters. Univariate analysis is used to examine characteristics associated with each cluster, and multinomial logistic regression is used to analyze a cluster membership as an independent predictor of hospital readmission after 1-year. Results: Three unique clusters were found among the 11 acute symptoms: the typical chest symptom cluster (64.4%), the multiple symptom cluster (29.5%), and the atypical symptom cluster (6.1%). The cluster of atypical symptoms was more likely to have anemia and the worse values of Killip class compared with other clusters. The results of multiple logistic regression indicated that, in comparison to the typical chest cluster, the atypical symptom cluster substantially predicted a greater probability of 1-year hospital readmission (odd ratio 8.303, 95% confidence interval 2.550-27.031, P < 0.001). Conclusion: Out of the 11 acute symptoms, we have found three clusters: the typical chest symptom, multiple symptom, and atypical symptom clusters. Compared to patients in the other two clusters, those in the atypical symptom cluster-which included anemia and a large percentage of Killip class patients-had worse clinical indicators at hospital readmission during the duration of the 1-year follow-up. Both anemia and high Killip classification suggest that the patient's clinical presentation is poor and therefore the prognosis is worse. Intensive treatment should be considered for anemia and high level of Killip class patients with atypical presentation. Clinicians should focus on patients with atypical symptom clusters, enhance early recognition of symptoms, and develop targeted symptom management strategies to alleviate their discomfort in order to improve symptomatic outcomes.

A Water-Soluble Polyacid Polymer Based on Hydrophilic Metal-Organic Frameworks Using Amphoteric Carboxylic Acid Ligands as Linkers for Hydroxycamptothecin Loading and Release In Vitro.

The poor water solubility and severe side effects of hydroxycamptothecin (HCPT) limit its clinical application; therefore, it is necessary to synthesize applicable nanodrug carriers with good solubility to expand the applications of HCPT. In this study, a hydrophilic metal-organic framework (MOF) with amphoteric carboxylic acid ligands as linkers was first synthesized and characterized. Then, water-soluble acrylamide and methacrylic acid were applied as monomers to prepare a water-soluble polyacid polymer MOF@P, which had a solubility of 370 µg/mL. The effects of the MOF@P material on the HCPT loading and solubility were investigated. The results showed that the polymer material could improve the HCPT solubility in water. Moreover, the in vitro release study indicated that the MOF@P polymeric composite exhibited a sustained-release effect on HCPT, with a cumulative release rate of 30.18% in 72 h at pH 7.4. Furthermore, the cytotoxicity test demonstrated that the hydrophilic MOF and the MOF@P had low cell toxicities. The results indicate that the prepared MOF@P polymeric complex can be applied for the sustained release of HCPT in clinics.

Online coupling Fe3O4@ZIF-67@α-glucosidase biomicroreactor with high performance liquid chromatography for rapid screening of α-glucosidase inhibitors in tea and their inhibitory activity research.

In this work, α-glucosidase was immobilized on a type of nanoscaledmagnetic materials Fe3O4@ZIF-67 to construct a biomicroreactor for rapid screening α-glucosidase inhibitors. The parameters that affected the immobilization efficiency were investigated. Under optimal conditions, the amount of α-glucosidase loaded was up to 79.07 µg·mg-1. Then, the enzyme biomicroreactor was immobilized by an external magnetic field in a tube connecting HPLC and micro-injection pump at both ends to form a magnetic online screening system. The screening flow rate and eluent organic solvent ratio during the screening process were optimized. XinYang MaoJian crude tea extract was tested to verify this online screening method, and three inhibitors (catechin, epigallocatechin gallate and epicatechin gallate) were fished by this magnetic online screening system. Based on the classical pNPG method, the inhibitory activities on α-glucosidase were further verified and studied. Compared with the traditional ligand fishing methods, the screening method established in this work can integrate screening, elution and analysis. It can simply, efficiently and directly screen and identify potential α-glucosidase inhibitors from natural sources. This method was expected to provide an effective basis for accelerating the development of new hypoglycemic drugs.

Molecularly Imprinting Polymers (MIP) Based on Nitrogen Doped Carbon Dots and MIL-101(Fe) for Doxorubicin Hydrochloride Delivery.

MIL-based molecularly imprinted polymer (MIP) nanocomposites were successfully synthesized through a simple and versatile stirring auxiliary encapsulation method. MIP as a carrier has been applied to the highly efficient selective recognition and sustained release of doxorubicin hydrochloride (DOX). The adsorption mechanism and release behavior of MIP@DOX in vitro were also discussed. Adsorption studies showed that MIP using DOX as template had specific selectivity to DOX, and its optimal drug loading efficiency reached 97.99%. The adsorption isotherm accorded with Freundlich models. The cumulative release curve showed that at the conditions of pH 5.5 and 7.4, the nanomaterials have a slow-release effect on the release of DOX. In addition, the cytotoxicity and bioactivity of MIP nanoparticles on HepG2 and HL-7702 cell lines measured by MTT assay also proved their low toxicity and biological activity. The cell activity of HepG2 and HL-7702 incubated with MIP for 24 h was 69.9% and 76.07%, respectively. These results collectively illustrated that the MIP nano-materials synthesized in this study can be efficiently employed to the drug delivery systems.

Development of an on-line immobilized α-glucosidase microreactor coupled to liquid chromatography for screening of α-glucosidase inhibitors.

In order to rapidly screen α-glucosidase (α-GLU) inhibitors from Chinese herbs extract, an online screening method was developed by using enzymatic microreactors in combination with HPLC. A type of dodecahedral and porous material (ZIF-90) was synthesized at room temperature and employed as supports to construct enzymatic microreactor. The amount of α-glucosidase immobilized on ZIF-90 was 58.65 µg per mg carrier under the optimized conditions. In the online screening process, the eluent of 30 s was selected for detection. For the application of this on-line screening system, three α-glucosidase inhibitors with known structure (2,4-dimethoxy-6,7-dihydroxyphenanthrene, batatasin I, 3,5-dimethoxy-2'-hydroxyaiaryl) were selectively extracted from Dioscorea opposita Thunb. Three compounds screened from honeysuckle leaves were isochlorogenic acid B, 1,5-dicaffeoylquinic acid and isochlorogenic acid C, respectively. Two compounds including (+)-catechin and (-)-epigallocatechin gallate were screened from Xinyang Maojian tea. Three unknown ingredients were also screened out from Radix Rehmanniae Praeparata. The nanomaterials in the microreactor can be conveniently replaced. The screening flow rate and elution time can be easily adjusted and controlled by microinjection pump. Considering the specificity of enzyme binding and convenience of online screening system, this method has great potential for fast real-time fishing of α-glucosidase inhibitors from Chinese herbal medicines.

Spatiotemporal transmission and determinants of typhoid and paratyphoid fever in Hongta District, Yunnan Province, China.

BACKGROUND: Typhoid and paratyphoid fever are endemic in Hongta District and their prevalence, at 113 per 100,000 individuals, remains the highest in China. However, the exact sources of the disease and its main epidemiological characteristics have not yet been clearly identified. METHODS AND FINDINGS: Numbers of typhoid and paratyphoid cases per day during the period 2006 to 2010 were obtained from the Chinese Center of Disease Control (CDC). A number of suspected disease determinants (or their proxies), were considered for use in spatiotemporal analysis: these included locations of discharge canals and food markets, as well as socio-economic and environmental factors. Results showed that disease prevalence was spatially clustered with clusters decreasing with increasing distance from markets and discharge canals. More than half of the spatial variance could be explained by a combination of economic conditions and availability of health facilities. Temporal prevalence fluctuations were positively associated with the monthly precipitation series. Polluted hospital and residential wastewater was being discharged into rainwater canals. Salmonella bacteria were found in canal water, on farmland and on vegetables sold in markets. CONCLUSION: DISEASE TRANSMISSION IN HONGTA DISTRICT IS DRIVEN PRINCIPALLY BY TWO SPATIOTEMPORALLY COUPLED CYCLES: one involving seasonal variations and the other the distribution of polluted farmland (where vegetables are grown and sold in markets). Disease transmission was exacerbated by the fact that rainwater canals were being used for disposal of polluted waste from hospitals and residential areas. Social factors and their interactions also played a significant role in disease transmission.

[Burden of disease regarding paratyphoid fever A - based on the Syndromic Surveillance System on Fever].

OBJECTIVE: To evaluate the burden of paratyphoid fever A in Hongta district, Yuxi city, Yunnan province from May 1, 2008 to April 30, 2009 so as to provide information for the development of comprehensive intervention measures. METHODS: Based on the Fever Syndromic Surveillance System, information as attendance rate of patients with fever, rate of patients being sampled, laboratory testing rate, sensitivity on the detection of blood culture and the rate of case reporting etc. were calculated. According to the pyramid model of food-borne disease on disease burden, the local actual incidence of paratyphoid fever A was estimated and analyzed. RESULTS: Under the Fever Syndromic Surveillance System, there were 6642 fever cases being detected, among whom 6570 cases were sampled and undergone testing, with the sampling rate as 98.92% and all the samples received laboratory testing. There were 354 positive cases of paratyphoid fever A reported, all from the Hongta district. Data showed that the attendance rate of the feverish patients was 73.53%, with the highest rate seen in whose under 10 years old (100%). Assumed that the sensitivity of paratyphoid fever blood culture was 70%, and the case reporting rate was 90%, we estimated that the annual incidence of paratyphoid fever A in Hongta was 220.33 (95%CI: 170.1 - 521.4) per 100 thousand, with 965 (95%CI: 745 - 2284) as new cases. Among all the age groups, the incidence in the age group from 15 to 44 years old was estimated to be at the highest (318.27 per 100 thousand). CONCLUSION: Hongta seemed to be an endemic region for paratyphoid fever A, with the highest incidence occurred in the age group of between 15 and 44 years old. These findings highlighted the urgent need to carry out further investigation on the risk factors and to implement targeted effective prevention and control measures.

[Epidemiologie investigation on murine typhus in Hongta areas of Yuxi city, Yunnan province of China].

OBJECTIVE: To identify epidemic status of murine typhus in Hongta areas of Yuxi city and to provide evidence for control and prevention of the disease. METHODS: Serologic survey was conducted among residents and rodents. Isolation of Rickettsia moseri was performed. RESULTS: The overall infection rate among general population was 28.92% (96/332) with geometric meantiter (GMT) as 10.83 and there was no difference between males and females (26.71%, 43/161 vs. 30.99%, 53/171, P > 0.05). Significant differences were found between age groups (P < 0.05) with positive rates of 29.63% (8/27), 18.06% (13/72), 39.62% (42/106), 27.50% (22/80) and 23.40% (11/47) among age groups 0-6, 7-18, 19-39, 40-59 and over 60, respectively. The overall rate of infection in mouse was 44.95% (89/198) with GMT as 30.30. Five isolates of R. moseri from mouse specimen, three from fleas plus one case of murine typhus were diagnosed. Rattus norvegicus and Rattus flavipectus were the predominant species of rodent animals (99.49%, 197/198) and Xenopsylla cheopis was the major species of vector (74.26%, 303/408). Flea index and mouse density were 2.06 and 11.13% respectively. CONCLUSION: High infection rates on R. moseri were demonstrated in rodents and residents as well as high risk of murine typhus outbreak might occur in these areas.