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ObjectivesPatients’ sense of gain experience (PSGE) is the comprehensive feeling throughout the treatment process, which is a critical benchmark for evaluating comprehensive medical and health system reform in China. This study aims to assess the current status of PSGE in public hospitals and identify important associated factors, providing evidence-based recommendations for improving healthcare services.DesignThis was a cross-sectional study conducted from October to November 2023.SettingA total of 14 public hospitals in Foshan, Guangdong Province, China.ParticipantsThere were 3223 responses, including 1592 from outpatients and 1631 from inpatients.Primary outcome measurePSGE was assessed across five domains: time accessibility, service accessibility, cost affordability, patient participation and efficacy predictability. Participants were also asked to provide an overall rating of the PSGE.ResultsThe overall score for PSGE was 4.47±0.53 (mean±SD), with service accessibility receiving the highest score (4.68±0.50) and affordability the lowest (4.17±0.86). Secondary hospitals scored an overall PSGE of 4.55±0.50, while tertiary hospitals scored 4.42±0.54. Key factors associated with PSGE were overall satisfaction (β=0.164, p<0.001), treatment satisfaction (β=0.187, p<0.001), satisfaction with medical reforms (β=0.149, p<0.001), patient loyalty (β=0.072, p=0.001) and hospital reputation (β=0.223, p<0.001).ConclusionsThis study found that patients reported a positive PSGE with service accessibility but reported a less positive PSGE with cost affordability. A tier-based disparity was evident, with secondary hospitals outperforming tertiary hospitals in overall PSGE outcome. Stronger PSGE was positively associated with higher scores in overall satisfaction, treatment satisfaction, satisfaction with medical reforms, patient loyalty and hospital reputation. Demographic and institutional factors, such as hospital level, patient type and household registration, were associated with the PSGE. Efforts can be focused on enhancing clinicians’ willingness and competence in discussing treatment costs during clinical encounters. It is essential for policymakers to address disparities in healthcare experiences among patient groups across hospital tiers to advance equitable, patient-centred systems.

Vaccination is the primary defense against severe acute respiratory syndrome coronavirus 2, especially among older adults and those with chronic conditions. Using a nationally representative sample of 12,900 participants from the fifth wave (2021–2022) of the China Health and Retirement Longitudinal Study (CHARLS), we examined the coronavirus disease 2019 (COVID-19) vaccination status and the determinants of vaccination hesitancy in Chinese adults aged 52 and older. By July/August 2022, 92.3% of the Chinese population aged 60 years and older had received at least one COVID-19 vaccination, 88.6% had completed the primary series and 72.4% had received a booster. Those aged 80 years and older had lower vaccination rates, with 71.9% and 46.7% completing the primary series and booster shots, respectively. These statistics represent the situation before China ended the Zero-COVID policy in November 2022 because vaccination stagnated between July/August and November 2022. Multivariate regression analysis revealed that belonging to the oldest age groups (individuals aged 70 years and older and especially those aged 80 years and older) as well as being female and unmarried, residing in urban areas, being functionally dependent and having chronic conditions meant that these individuals were less likely to receive COVID-19 vaccines. Our regression analysis results were corroborated by self-reported reasons for nonvaccination. Vaccination hesitancy probably contributed to excessive mortality among vulnerable populations after China ceased its Zero-COVID policy. Our study provides important lessons on how to balance containment efforts with vaccination and treatment measures, as well as highlighting the need to clarify the side effects and contraindications of vaccines early on. Analysis of a longitudinal cohort revealed that only 72% of Chinese adults aged 60 years and older received a booster coronavirus disease 2019 vaccination by July 2022, with contraindications, advanced age and living with chronic conditions being the main determinants of vaccine hesitancy in this population.

Spatiotemporal patterns of global forest net primary productivity (NPP) are pivotal for us to understand the interaction between the climate and the terrestrial carbon cycle. In this study, we use Google Earth Engine (GEE), which is a powerful cloud platform, to study the dynamics of the global forest NPP with remote sensing and climate datasets. In contrast with traditional analyses that divide forest areas according to geographical location or climate types to retrieve general conclusions, we categorize forest regions based on their NPP levels. Nine categories of forests are obtained with the self-organizing map (SOM) method, and eight relative factors are considered in the analysis. We found that although forests can achieve higher NPP with taller, denser and more broad-leaved trees, the influence of the climate is stronger on the NPP; for the high-NPP categories, precipitation shows a weak or negative correlation with vegetation greenness, while lacking water may correspond to decrease in productivity for low-NPP categories. The low-NPP categories responded mainly to the La Niña event with an increase in the NPP, while the NPP of the high-NPP categories increased at the onset of the El Niño event and decreased soon afterwards when the warm phase of the El Niño-Southern Oscillation (ENSO) wore off. The influence of the ENSO changes correspondingly with different NPP levels, which infers that the pattern of climate oscillation and forest growth conditions have some degree of synchronization. These findings may facilitate the understanding of global forest NPP variation from a different perspective.

Mastitis is an acute clinical inflammatory response. The occurrence and development of mastitis seriously disturb women's physical and mental health. Licochalcone A, a phenolic compound in , has anti-inflammatory properties. Here, we examined the effect of licochalcone A on blood-milk barrier and inflammatory response in LPS-induced mice mastitis. , we firstly established mice models of mastitis by canal injection of LPS to mammary gland, and then detected the effect of licochalcone A on pathological indexes, inflammatory responses and blood-milk barrier in this model. , Mouse mammary epithelial cells (mMECs) were treated with licochalcone A prior to the incubation of LPS, and then the inflammatory responses, tight junction which is the basic structure of blood-milk barrier were analyzed. Last, we elucidated the anti-inflammatory mechanism by examining the activation of mitogen-activated protein kinase MAPK) and AKT/NF-κB signaling pathways and . The results showed that licochalcone A significantly decreased the histopathological impairment and the inflammatory responses, and improved integrity of blood-milk barrier. The results demonstrated that licochalcone A inhibited LPS-induced inflammatory responses and increase the protein levels of ZO-1, occludin, and claudin3 in mMECs. The and mechanistic study found that the anti-inflammatory effect of licochalcone A in LPS-induced mice mastitis was mediated by MAPK and AKT/NF-κB signaling pathways. Our experiments collectively indicate that licochalcone A protected against LPS-induced mice mastitis via improving the blood-milk barrier integrity and inhibits the inflammatory response by MAPK and AKT/NF-κB signaling pathways.

Alzheimer’s disease (AD) is a common neurodegenerative disease. Aβ plays an important role in the pathogenesis of AD. Sodium butyrate (NaB) is a short-chain fatty acid salt that exerts neuroprotective effects such as anti-inflammatory, antioxidant, antiapoptotic, and cognitive improvement in central nervous system diseases. The aim of this study is to research the protective effects of NaB on neurons against Aβ toxicity and to uncover the underlying mechanisms. The results showed that 2 mM NaB had a significant improvement effect on Aβ-induced N2a cell injury, by increasing cell viability and reducing ROS to reduce injury. In addition, by acting on the GPR109A receptor, NaB regulates the expression of AD-related genes such as APP, NEP, and BDNF. Therefore, NaB protects N2a cells from Aβ-induced cell damage through activating GPR109A, which provides an innovative idea for the treatment of AD.

Baphicacanthus cusia (Nees) Bremek (B. cusia) is an effective herb for the treatment of acute promyelocytic leukemia and psoriasis in traditional Chinese medicine. Methyl jasmonate (MeJA) is a well-known signaling phytohormone that triggers gene expression in secondary metabolism. Currently, MeJA-mediated biosynthesis of indigo and indirubin in B. cusia is not well understood. In this study, we analyzed the content of indigo and indirubin in leaf and root tissues of B. cusia with high-performance liquid chromatography and measured photosynthetic characteristics of leaves treated by MeJA using FluorCam6 Fluorometer and chlorophyll fluorescence using the portable photosynthesis system CIRAS-2. We performed de novo RNA-seq of B. cusia leaf and root transcriptional profiles to investigate differentially expressed genes (DEGs) in response to exogenous MeJA application. The amount of indigo in MeJA-treated leaves were higher than that in controled leaves (p = 0.004), and the amounts of indigo in treated roots was higher than that in controlled roots (p = 0.048); Chlorophyll fluorescence of leaves treated with MeJA were significantly decreased. Leaves treated with MeJA showed lower photosynthetic rate compared to the control in the absence of MeJA. Functional annotation of DEGs showed the DEGs related to growth and development processes were down-regulated in the treated leaves, while most of the unigenes involved in the defense response were up-regulated in treated roots. This coincided with the effects of MeJA on photosynthetic characteristics and chlorophyll fluorescence. The qRT-PCR results showed that MeJA appears to down-regulate the gene expression of tryptophan synthase β-subunits (trpA-β) in leaves but increased the gene expression of anthranilate synthase (trp 3) in roots responsible for increased indigo content. The results showed that MeJA suppressed leaf photosynthesis for B. cusia and this growth-defense trade-off may contribute to the improved adaptability of B. cusia in changing environments.

The phase, mechanical properties, corrosion resistance, hydrophobicity, and interfacial contact resistance of Hastelloy X were investigated to evaluate its performance in proton exchange membrane fuel cells (PEMFCs). For comparison, the corresponding performance of 304 stainless steel (304SS) was also tested. Hastelloy X exhibited a single-phase face-centered cubic structure with a yield strength of 445.5 MPa and a hardness of 262.7 HV. Both Hastelloy X and 304SS exhibited poor hydrophobicity because the water contact angles were all below 80°. In a simulated PEMFC working environment (0.5 M H2SO4 + 2 ppm HF, 80 °C, H2), Hastelloy X exhibited better corrosion resistance than 304SS. At 140 N·cm−2, the interfacial contact resistance of Hastelloy X can reach as low as 7.4 mΩ·cm2. Considering its overall performance, Hastelloy X has better potential application than 304SS as bipolar plate material in PEMFCs.

Background Sarcopenia is a common and progressive skeletal muscle disorder characterized by atrophic muscle fibres and contractile dysfunction. Accumulating evidence shows that the number and function of satellite cells (SCs) decline and become impaired during ageing, which may contribute to impaired regenerative capacity. A series of myokines/small extracellular vesicles (sEVs) released from muscle fibres regulate metabolism in muscle and extramuscular tissues in an autocrine/paracrine/endocrine manner during muscle atrophy. It is still unclear whether myokines/sEVs derived from muscle fibres can affect satellite cell function during ageing. Methods Aged mice were used to investigate changes in the myogenic capacity of SCs during ageing‐induced muscle atrophy. The effects of atrophic myotube‐derived sEVs on satellite cell differentiation were investigated by biochemical methods and immunofluorescence staining. Small RNA sequencing was performed to identify differentially expressed sEV microRNAs (miRNAs) between the control myotubes and atrophic myotubes. The target genes of the miRNA were predicted by bioinformatics analysis and verified by luciferase activity assays. The effects of identified miRNA on the myogenic capacity of SCs in vivo were investigated by intramuscular injection of adeno‐associated virus (AAV) to overexpress or silence miRNA in skeletal muscle. Results Our study showed that the myogenic capacity of SCs was significantly decreased (50%, n = 6, P < 0.001) in the tibialis anterior muscle of aged mice. We showed that atrophic myotube‐derived sEVs inhibited satellite cell differentiation in vitro (n = 3, P < 0.001) and in vivo (35%, n = 6, P < 0.05). We also found that miR‐690 was the most highly enriched miRNA among all the screened sEV miRNAs in atrophic myotubes [Log2 (Fold Change) = 7, P < 0.001], which was verified in the atrophic muscle of aged mice (threefold, n = 6, P < 0.001) and aged men with mean age of 71 ± 5.27 years (2.8‐fold, n = 10, P < 0.001). MiR‐690 can inhibit myogenic capacity of SCs by targeting myocyte enhancer factor 2, including Mef2a, Mef2c and Mef2d, in vitro (n = 3, P < 0.05) and in vivo (n = 6, P < 0.05). Specific silencing of miR‐690 in the muscle can promote satellite cell differentiation (n = 6, P < 0.001) and alleviate muscle atrophy in aged mice (n = 6, P < 0.001). Conclusions Our study demonstrated that atrophic muscle fibre‐derived sEV miR‐690 may inhibit satellite cell differentiation by targeting myocyte enhancer factor 2 during ageing.

Tropical forests are of vital importance for maintaining biodiversity, regulating climate and material cycles while facing deforestation, agricultural reclamation, and managing various pressures. Remote sensing (RS) can support effective monitoring and mapping approaches for tropical forests, and to facilitate this we propose a deep neural network with an encoder–decoder architecture here to classify tropical forests and their environment. To deal with the complexity of tropical landscapes, this method utilizes a multi-scale convolution neural network (CNN) to expand the receptive field and extract multi-scale features. The model refines the features with several attention modules and fuses them through an upsampling module. A two-stage training strategy is proposed to alleviate misclassifications caused by sample imbalances. A joint loss function based on cross-entropy loss and the generalized Dice loss is applied in the first stage, and the second stage used the focal loss to fine-tune the weights. As a case study, we use Hainan tropical reserves to test the performance of this model. Compared with four state-of-the-art (SOTA) semantic segmentation networks, our network achieves the best performance with two Hainan datasets (mean intersection over union (MIoU) percentages of 85.78% and 82.85%). We also apply the new model to classify a public true color dataset which has 17 semantic classes and obtain results with an 83.75% MIoU. This further demonstrates the applicability and potential of this model in complex classification tasks.

Mastitis is one of three bovine diseases recognized as a cause of substantial economic losses every year throughout the world. Niacin is an important feed additive that is used extensively for dairy cow nutrition. However, the mechanism by which niacin acts on mastitis is not clear. The aim of this study is to investigate the mechanism of niacin in alleviating the inflammatory response of mammary epithelial cells and in anti-mastitis. Mammary glands, milk, and blood samples were collected from mastitis cows not treated with niacin (n = 3) and treated with niacin (30 g/d, n = 3) and healthy cows (n = 3). The expression of GPR109A, IL-6, IL-1β, and TNF-α in the mammary glands of the dairy cows with mastitis was significantly higher than it was in the glands of the healthy dairy cows. We also conducted animal experiments in vivo by feeding rumen-bypassed niacin. Compared with those in the untreated mastitis group, the somatic cell counts (SCCs) and the expression of IL-6, IL-1β, and TNF-α in the blood and milk were lower. In vitro, we isolated the primary bovine mammary epithelial cells (BMECs) from the mammary glands of the healthy cows. The mRNA levels of IL-6, IL-1β, TNF-α, and autophagy-related genes were detected after adding niacin, shRNA, compound C, trans retinoic acid, 3-methyladenine to BMECs. Then GPR109A, AMPK, NRF-2, and autophagy-related proteins were detected by Western blot. We found that niacin can activate GPR109A and phosphorylate AMPK, and promote NRF-2 nuclear import and autophagy to alleviate LPS-induced inflammatory response in BMECs. In summary, we found that niacin can reduce the inflammatory response of BMECs through GPR109A/AMPK/NRF-2/autophagy. We also preliminarily explored the alleviative effect of niacin on mastitis in dairy cows.