An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China.

BackgroundService providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.MethodsThis study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.ResultsSignificantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).ConclusionsThe MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs

Bootstrap inference for quantile treatment effects in randomized experiments with matched pairs

This paper examines methods of inference concerning quantile treatment effects (QTEs) in randomized experiments with matched-pairs designs (MPDs). We derive the limit distribution of the QTE estimator under MPDs, highlighting the difficulties that arise in analytical inference due to parameter tuning. It is shown that both the naive multiplier bootstrap and the naive multiplier bootstrap of the pairs fail to approximate the limit distribution of the QTE estimator under MPDs because they do not preserve the dependence structure within the matched pairs. To address this difficulty we propose two bootstrap methods that can consistently approximate the limit distribution: the gradient bootstrap and the multiplier bootstrap of the inverse propensity score weighted (IPW) estimator. The gradient bootstrap is free of tuning parameters but requires knowledge of the pair identities. The multiplier bootstrap of the IPW estimator does not require such knowledge but involves one tuning parameter. Both methods are straightforward to implement and able to provide pointwise confidence intervals and uniform confidence bands that achieve exact limiting coverage rates. We demonstrate their finite sample performance using simulations and provide an empirical application to a well-known dataset in macroinsurance.Comment: 89 page

The Attenuation of Moutan Cortex on Oxidative Stress for Renal Injury in AGEs-Induced Mesangial Cell Dysfunction and Streptozotocin-Induced Diabetic Nephropathy Rats

Oxidative stress (OS) has been regarded as one of the major pathogeneses of diabetic nephropathy (DN) through damaging kidney which is associated with renal cells dysfunction. The aim of this study was to investigate whether Moutan Cortex (MC) could protect kidney function against oxidative stress in vitro or in vivo. The compounds in MC extract were analyzed by HPLC-ESI-MS. High-glucose-fat diet and STZ (30 mg kg−1) were used to induce DN rats model, while 200 μg mL−1 AGEs were for HBZY-1 mesangial cell damage. The treatment with MC could significantly increase the activity of SOD, glutathione peroxidase (GSH-PX), and catalase (CAT). However, lipid peroxidation malondialdehyde (MDA) was reduced markedly in vitro or in vivo. Furthermore, MC decreased markedly the levels of blood glucose, serum creatinine, and urine protein in DN rats. Immunohistochemical assay showed that MC downregulated significantly transforming growth factor beta 2 (TGF-β2) protein expression in renal tissue. Our data provided evidence to support this fact that MC attenuated OS in AGEs-induced mesangial cell dysfunction and also in high-glucose-fat diet and STZ-induced DN rats

THE ANTIBACTERIAL EFFECT OF URENA LOBATA L. FROMV GUANGXI ON MICE WITH STAPHYLOCOCCUS AUREUS PNEUMONIA

Background: Alcohol extract from the root of Urena lobata L. (ULL) had broad spectrum antimicrobial activity. Studies in vitro have sho that ULL aqueous extract has antibacterial effect on S. aureusis, and the combination therapy of the ULL aqueous extract with cefazolin sodium showed additive effect. Materials and Methods: The mice underwent nasal inhalation with S. aureus, a subset of mice were intra-gastric gavage with ULL and/or intravenous injection cefazolin sodium twice daily. After being exposed to S. aureus for 5 days, 10 days and 14 days respectively, the white blood cells count (WBC), neutrophils absolute value (NEU) and the neutrophil percentage (NEU%) in peripheral blood, as well as the levels of serum immunoglobulin (Ig) G and IgM were determined using commercial kits. The colony count of S. aureus, the levels of interleukin (IL) -6 and IL-10 of mice lung tissue were detected, and the pathological changes of lung tissue were examined using H & E staining. Results: ULL significantly protected against S. aureus pneumonia, as evidenced by the remarkable decrease in the rate of S. aureus colony count/lung weight, WBC, NEU and NEU% in peripheral blood, as well as the attenuation of lung histopathological damage. Additionally, ULL+cefazolin could have markedly reduced the rate of S. aureus colony count/lung weight when compared with cefazolin. Furthermore, ULL and ULL+cefazolin both could significantly decrease the serum levels of IgG and IgM, and the levels of IL-6, IL-10 in mice lung tissue. Conclusion: This study first demonstrated that ULL may have potential use as a therapeutic agent for S. aureus pneumonia, and the roles of IgG, IgM, IL-6 and IL-10 in ULL protection against S. aureus pneumonia remain to be further studied

Altered electrophysiology mechanism related to inhibitory control in adults with insomnia

BackgroundInsomnia disorder (ID), one of the most common psychophysiological disorders, can cause a serious burden on the individual's work and academic performance. Cognitive dysfunction often exists in patients with insomnia, which negatively affects their living quality. Inhibitory control (IC), as a vital cognitive function, allows individuals to suppress attention, behavior, or thoughts that are irrelevant to the task, so as to effectively adapt to the current goal. The earlier studies on the inhibitory control of insomnia patients predominantly used subjective scales for evaluation and that can have drawbacks because they don't provide an objective assessment.MethodsIn order to investigate the inhibitory control function of insomniacs, this research subdivides inhibitory control into response inhibition and conflict inhibition. The response inhibition and conflict inhibition capacities of insomniacs were evaluated using the two-choice oddball task and the color-word stroop task, and accordingly the association between insomnia disorder and inhibitory control capacity as well as its cognitive neural mechanism was able to be examined.ResultsBehavioral results finding, insomniacs conducted the two-choice oddball test and the color-word stroop task with lower accuracy and slower reaction times when compared to healthy sleepers. ERP results finding, when performing the two-choice oddball task, the P3 amplitude of the insomniacs was significantly lower than that of healthy sleepers while there was no significant difference between the two groups' N2 amplitudes. At the same time, when completing the color-word stroop task, the insomniacs' N450 amplitude was significantly lower than that of healthy sleepers.DiscussionThe above findings suggest that in response inhibition tasks, insomniacs may have weaker motor inhibition abilities, and similarly perform weaker conflict monitoring abilities in conflict inhibition tasks, which indicates that insomniacs' inhibitory control is impaired compared to that of healthy sleepers. This study thus relates to the finding at the electrophysiological level that there is a certain correlation between insomnia and a decline in inhibitory control ability, which may suggest that improving inhibitory control function in patients with insomnia is a clinically significant and worthwhile area of adjuvant treatment

Hybrid hydrogels containing vertically aligned carbon nanotubes with anisotropic electrical conductivity for muscle myofiber fabrication

Biological scaffolds with tunable electrical and mechanical properties are of great interest in many different fields, such as regenerative medicine, biorobotics, and biosensing. In this study, dielectrophoresis (DEP) was used to vertically align carbon nanotubes (CNTs) within methacrylated gelatin (GelMA) hydrogels in a robust, simple, and rapid manner. GelMA-aligned CNT hydrogels showed anisotropic electrical conductivity and superior mechanical properties compared with pristine GelMA hydrogels and GelMA hydrogels containing randomly distributed CNTs. Skeletal muscle cells grown on vertically aligned CNTs in GelMA hydrogels yielded a higher number of functional myofibers than cells that were cultured on hydrogels with randomly distributed CNTs and horizontally aligned CNTs, as confirmed by the expression of myogenic genes and proteins. In addition, the myogenic gene and protein expression increased more profoundly after applying electrical stimulation along the direction of the aligned CNTs due to the anisotropic conductivity of the hybrid GelMA-vertically aligned CNT hydrogels. We believe that platform could attract great attention in other biomedical applications, such as biosensing, bioelectronics, and creating functional biomedical devices

Defect Analysis in Microgroove Machining of Nickel-Phosphide Plating by Small Cross-Angle Microgrooving

Crystalline nickel-phosphide (c-Ni-P) plating is a newly developed mold material for precision glass molding (PGM) to fabricate microgrooves. In the ultraprecision cutting process of the c-Ni-P plating material, the neighboring microgrooves are required to adjoin with each other to ensure acute microgroove ridges and miniaturize the microgroove size. Generally, defects of burrs and fracture pits can easily occur on the ridges when the plating layer is grooved. Burrs appear when tears dominate in material removal with a large adjacent amount. With the change of the adjacent amount, the removed material is sheared out from the workpiece, and when the cutting depth of the groove ridge is over the brittle-ductile transition thickness, fracture pits arise. To restrict these defects, a small cross-angle microgrooving method is proposed to test the critical adjacent amount range efficiently. It is found that an acute ridge of the microgroove is formed with a small enough adjacent amount; when this amount is in the range of 570 nm~720 nm in the microgroove machining process, fracture pits begin to arise on the gradient edge. High-quality microgrooves can be obtained based on this methodology