Theoretical System Dynamics Modeling for Taiwan Pediatric Workforce in an Era of National Health Insurance and Low Birth Rates

BackgroundIn an era of declining birth rates and a single-payer health care system, the pediatric workforce might overreact to its demands. System dynamics (SD) were therefore applied to establish models to predict the future need and demand for the pediatric workforce.Materials and methodsData of population and workforce were extracted from national databases and models developed using Vensim software.ResultsIn the past decade, the child-to-pediatrician ratio correlated with infant mortality in Taiwan (p < 0.001, r2 = 0.88, child-to-pediatrician ratio = 146 + 354 × infant mortality/1000 live births). Currently, the child-to-pediatrician ratio is 1742:1. Using the Millennium Development Goals (2.437/1000 live births) for infant mortality, the child-to-pediatrician ratio was estimated as 1009:1. The pediatric population model incorporated the birth and mortality rates in each age category, accurately predicted population changes between 1974 and 2010, and projected a decreasing trend until 2017. The pediatric workforce model, which considered rates of enrollment, completion, certification, and retention, predicted a decrease in the supply of pediatricians in the mid-2010s that could be delayed by policy incentives. When targeting the base scenario, the model indicated that discrepancies between demands and supply of pediatricians would occur in the late 2010s toward 2020. When targeting the Millennium Development Goals scenario, however, the discrepancies would be consistent.ConclusionEffective SD models were developed for the population and health care workforce. The strengths of the SD models are derived from simulation, which is subject to influence from new policies. Policies can, therefore, be examined and intervened in a timely manner

Analyzing and Visualizing Cosmological Simulations with ParaView

The advent of large cosmological sky surveys - ushering in the era of precision cosmology - has been accompanied by ever larger cosmological simulations. The analysis of these simulations, which currently encompass tens of billions of particles and up to trillion particles in the near future, is often as daunting as carrying out the simulations in the first place. Therefore, the development of very efficient analysis tools combining qualitative and quantitative capabilities is a matter of some urgency. In this paper we introduce new analysis features implemented within ParaView, a parallel, open-source visualization toolkit, to analyze large N-body simulations. The new features include particle readers and a very efficient halo finder which identifies friends-of-friends halos and determines common halo properties. In combination with many other functionalities already existing within ParaView, such as histogram routines or interfaces to Python, this enhanced version enables fast, interactive, and convenient analyses of large cosmological simulations. In addition, development paths are available for future extensions.Comment: 9 pages, 8 figure

Impaired dendritic cell maturation and IL-10 production following H. pylori stimulation in gastric cancer patients

The current study was to investigate the interaction between Helicobacter pylori and human dendritic cells (DCs). Whether impaired DC function can influence the outcome of H. pylori infections. Human monocyte-derived DCs (MDDCs) from five gastric cancer patients and nine healthy controls were stimulated with H. pylori. Maturation markers of MDDC were examined by flow cytometry. IL-10 and TNF-α released by MDDCs and IL-17 produced by T cells were measured by ELISA. Regulatory signaling pathways of IL-10 were examined by ELISA, western blotting, and chromatin immunoprecipitation assay. The results showed that as compared with healthy individuals, the maturation marker CD40 in MDDCs, IL-17A expression from T cells, and IL-10 expression from MDDCs were significantly lower in gastric cancer patients. Blocking DC-SIGN, TLR2, and TLR4 could reverse H. pylori-associated IL-10 production. Activation of the p38 MAPK and NF-kB signaling pathways concomitant with decreased tri-methylated H3K9 and increased acetylated H3 accounted for the effect of H. pylori on IL-10 expression. Furthermore, upregulated IL-10 expression was significantly suppressed in H. pylori-pulsed MDDCs by histone acetyltransferase and methyltransferase inhibitors. Taken together, impaired DC function contributes to the less effective innate and adaptive immune responses against H. pylori seen in gastric cancer patients. H. pylori can regulate IL-10 production through Toll-like and DC-SIGN receptors, activates p-p38 MAPK signaling and the transcription factors NF-kB, and modulates histone modification

Interval between Intra-Arterial Infusion Chemotherapy and Surgery for Locally Advanced Oral Squamous Cell Carcinoma: Impacts on Effectiveness of Chemotherapy and on Overall Survival

Background. The interval between intra-arterial infusion chemotherapy (IAIC) and surgery was investigated in terms of its effects on survival in patients with locally advanced oral squamous cell carcinoma (OSCC). Methods. This retrospective study analyzed 126 patients who had completed treatment modalities for stage IV OSCC. All patients were followed up for 3 years. Kaplan-Meier and Cox regression methods were used to determine how survival was affected by general factors, primary tumor volume, TNM stage, and duration of neoadjuvant chemotherapy. Results. In 126 patients treated for locally advanced OSCC by preoperative induction IAIC using methotrexate, multivariate analysis of relevant prognostic factors showed that an IAIC duration longer than 90 days was significantly associated with poor prognosis (hazard ratio, 1.77; P=0.0259). Conclusions. Duration of IAIC is a critical factor in the effectiveness of multimodal treatment for locally advanced OSCC. Limiting the induction course to 90 days improves overall survival

Association between the neutrophil-to-lymphocyte ratio and cognitive impairment: a meta-analysis of observational studies

BackgroundSystemic inflammation is one of the underlying mechanisms of cognitive impairment. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a systemic inflammation indicator. This meta-analysis aimed to evaluate the association between high NLR and cognitive impairment (CI) risk.MethodA comprehensive systematic search was conducted to identify eligible studies published until May 30, 2023. The reference group comprised patients with the lowest NLR level, whereas the exposure group comprised those with the highest NLR level. The main outcome was to examine the relationship between NLR and CI risk. The secondary outcome included the association between patient characteristics or comorbidities and CI risk.ResultsThis meta-analysis included 11 studies published between 2018 and 2023, involving 10,357 patients. Patients with CI had a higher NLR than those without (mean difference=0.35, 95% confidence interval [CI]: 0.26–0.44, p &lt; 00001, I2 = 86%). Consistently, pooled results revealed an association between high NLR and CI risk (odds ratio [OR]=2.53, 95% CI:1.67–3.82, p&lt;0.0001, I2 = 84%). Furthermore, aging (mean difference =4.31 years, 95% CI:2.83–5.8, p &lt; 0.00001, I2 = 92%), diabetes (OR=1.59, 95% CI:1.35–1.88, p &lt; 0.00001, I2 = 66%), and hypertension (OR=1.36, 95% CI:1.19–1.57, p &lt; 0.00001, I2 = 0%) were significant risk factors for CI. However, no significant associations were observed between CI and male gender (OR = 0.84, 95% CI:0.64–1.11, p = 0.22, I2 = 81%), body mass index (mean = −0.32 kg/m2, 95% CI: −0.82, 0.18, p = 0.2, I2 = 82%), alcohol consumption (OR = 1.11, 95% CI:0.95−1.3, p = 1.35, I2 = 0%), and smoking (OR = 0.99, 95% CI:0.87–1.13, p = 0.86, I2 = 0%). Meta-regression found that diabetes and hypertension, but not age, significantly moderated the association between NLR and CI.ConclusionThis meta-analysis showed a significant association between high NLR and increased CI risk. Moreover, meta-regression identified diabetes and hypertension, but not age, as significant moderating factors in the relationship between NLR and CI. To validate and strengthen these findings, further large-scale studies are required.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023430384, identifier CRD42023430384

Secondary Metabolites from the Leaves of Aquilaria agallocha

Twelve compounds, including three flavonoids, 5-hydroxy-4¢,7- dimethoxyflavone (1) [22], luteolin-7,3¢,4¢-trimethyl ether (2) and 5,3¢- dihydroxy-7,4¢-dimethoxyflavone (3), five benzenoids, methylparaben (4), vanillic acid (5), p-hydroxybenzoic acid (6), syringic acid (7), and isovanillic acid (8) and four steroids, b-sitosterol (9), stigmasterol (10), b-sitostenone (11) and stigmasta-4,22-dien-3- one (12) were isolated from the leaves of Aquilaria agallocha (Thymelaeaceae). All of these compounds (1-12) were obtained for the first time from the leaves of this plant

Rho Kinases Regulate the Renewal and Neural Differentiation of Embryonic Stem Cells in a Cell Plating Density–Dependent Manner

[[abstract]]BACKGROUND: Rho kinases (ROCKs) mediate cell contraction, local adhesion, and cell motility, which are considered to be important in cell differentiation. We postulated that ROCKs are involved in controlling embryonic stem (ES) cell renewal and differentiation. METHODOLOGY/PRINCIPAL FINDINGS: CCE, a murine ES cell, was treated with Y-27632 for 48 to 96 hours and colony formation was evaluated. Y-27632 blocked CCE colony formation and induced CCE to grow as individual cells, regardless of the initial seeding cell density either at 10(4)/cm(2) ("high" seeding density) or 2x10(3)/cm(2) ("low" density). However, at high seeding density, Y-27632-treated cells exhibited reduction of alkaline phosphatase (AP) staining and Oct3/4 expression. They expressed SOX-1, nestin, and MAP2c, but not betaIII-tubulin or NG-2. They did not express endoderm or mesoderm lineage markers. After removal of Y-27632, the cells failed to form colonies or regain undifferentiated state. Silencing of ROCK-1 or ROCK-2 with selective small interference RNA induced CCE morphological changes similar to Y-27632. Silencing of ROCK-1 or ROCK-2 individually was sufficient to cause reduction of AP and Oct3/4, and expression of SOX-1, nestin, and MAP2c; and combined silencing of both ROCKs did not augment the effects exerted by individual ROCK siRNA. Y-27632-treated CCE cells seeded at 2x10(3) or 6.6x10(3) cells/cm(2) did not lose renewal factors or express differentiation markers. Furthermore, they were able to form AP-positive colonies after removal of Y-27632 and reseeding. Similar to ROCK inhibition by Y-27632, silencing of ROCK-1 or ROCK-2 in cells seeded at 2x10(3)/cm(2) did not change renewal factors. CONCLUSIONS/SIGNIFICANCE: We conclude that ROCKs promote ES cell colony formation, maintain them at undifferentiated state, and prevent them from neural differentiation at high seeding density. ROCK inhibition represents a new strategy for preparing large numbers of neural progenitor cells