Patients' choice preferences for specialist outpatient online consultations: A discrete choice experiment

BackgroundInternet hospitals are multiplying with solid support from the Chinese government. In internet hospitals, specialist outpatient online consultations (SOOC) are the primary services. However, the acceptance and utilization rates of this service are still low. Thus, the study of patients' choice preferences for SOOC is needed.ObjectiveTo analyze the choice preference of patients' SOOC via a discrete choice experiment, understand the influence of each factor and promote the development of internet hospitals.MethodsVia a discrete selection experiment, a total of 162 patients from two general hospitals and three specialized hospitals in Beijing were selected for the questionnaire survey. The choice preferences were analyzed by conditional logit regression.ResultsFrom high to low, patients' willingness to pay (WTP) for the attributes of SOOC is as follows: doctors' recommendation rate (βhighly recommend = 0.999), the convenience of applying SOOC services (βConvenient = 0.760), the increasing ratio of medical insurance payment for online services compared to offline (βIncrease by 10% = 0.545), and the disease's severity (βsevere = −3.024). The results of the subgroup analysis showed differences in patient choice preference by age, whether the patients had chronic diseases, income, and medical insurance types.ConclusionBoth price and nonprice attributes influence the choice preference of SOOC for patients. Among them, patients are more inclined to choose SOOC when doctors highly recommend it, when it is convenient to apply, when medical insurance increases by 10%, and when disease severity is mild. The current findings show the government and medical institutions formulate auxiliary policies and welfare strategies by clarifying core attributes and adjusting the levels of different attributes to improve patients' acceptance of SOOC. The utility of SOOC and the further development of internet hospitals are radically promoted

Case report: Pediatric floating elbow fracture with monteggia-equivalent lesion, ipsilateral humeral shaft fracture, and radial nerve injury: a unique case and favorable treatment outcomes

This case report presents a rare and intricate pediatric floating elbow fracture involving a Monteggia-equivalent fracture, ipsilateral humeral shaft fracture, and radial nerve injury. The unique mechanism of injury highlights the importance of increased awareness and parental education for accident prevention. Elastic intramedullary nailing was employed for both humeral shaft and forearm fractures, leading to favorable outcomes. Despite the severity of the fractures and radial nerve injury, the prognosis was positive, with nerve function restoration and satisfactory functional recovery. However, the development of avascular necrosis of the radial head remains a challenge, emphasizing the need for further research to better understand and manage these uncommon and complex injuries

Evaluation of the effectiveness and mechanism of action of the Chang-Kang-Fang formula combined with bifid triple viable capsules on diarrhea-predominant irritable bowel syndrome

IntroductionThe Chang-Kang-Fang (CKF) formula, a traditional Chinese herbal formula, can decrease serotonin (5-HT) levels and treat irritable bowel syndrome (IBS). Probiotics have a better synergistic effect on diarrhea-predominant IBS (IBS-D) when combined with 5-HT3 receptor antagonists. The present study aimed to elucidate the efficacy and the mechanisms of action of the CKF formula combined with bifid triple viable capsules (PFK) against IBS-D.MethodsThe rat models of IBS-D were induced by gavage with senna decoction plus restraint stress. The CKF formula, PFK and their combination were administered to the rats. Their effects were evaluated based on general condition of the rats and the AWR score. The levels of 5-HT and fos protein in the colon and hippocampus were measured by immunohistochemistry. The levels of SP and VIP, as well as ZO-1 and occludin in the colon, were determined by enzyme-linked immunosorbent assay and immunohistochemistry. The intestinal microbiota in faeces was analyzed by 16S rRNA high-throughput sequencing.ResultsThe results showed that the oral CKF formula combined with PFK (CKF + PFK) could significantly relieve the symptoms of IBS-D, including elevating the weight rate and decreasing the AWR score. Compared with the MC group, administration of CKF + PFK significantly reduced the expression of fos in the colon and hippocampus and that of 5-HT, SP and VIP in the colon and increased the levels of 5-HT in the hippocampus and ZO-1 and occludin in the colon. The above indexes exhibited statistical significance in the CKF + PFK group relative to those in the other groups. Moreover, treatment with CKF + PFK improved the diversity of intestinal microbiota and the abundance of Firmicutes, Lachnospiraceae and Ruminococcaceae but decreased those of Bacteroidetes and Prevotellaceae.ConclusionsThe CKF formula combined with PFK may have a synergistic effect on IBS-D by slowing gastrointestinal motility, lowering visceral hypersensitivity, enhancing the intestinal barrier function and modulating the composition of intestinal microbiota

Acute effect of particulate matter pollution on hospital admissions for cause-specific respiratory diseases among patients with and without type 2 diabetes in Beijing, China, from 2014 to 2020

BACKGROUND: Scientific studies have identified various adverse effects of particulate matter (PM) on respiratory disease (RD) and type 2 diabetes (T2D). However, whether short-term exposure to PM triggers the onset of RD with T2D, compared with RD without T2D, has not been elucidated. METHODS: A two-stage time-series study was conducted to evaluate the acute adverse effects of PM on admission for RD and for RD with and without T2D in Beijing, China, from 2014 to 2020. District-specific effects of PM and PM were estimated using the over-dispersed Poisson generalized addictive model after adjusting for weather conditions, day of the week, and long-term and seasonal trends. Meta-analyses were applied to pool the overall effects on overall and cause-specific RD, while the exposure-response (E-R) curves were evaluated using a cubic regression spline. RESULTS: A total of 1550,154 admission records for RD were retrieved during the study period. Meta-analysis suggested that per interquartile range upticks in the concentration of PM corresponded to 1.91% (95% CI: 1.33-2.49%), 2.16% (95% CI: 1.08-3.25%), and 1.92% (95% CI: 1.46-2.39%) increments in admission for RD, RD with T2D, and RD without T2D, respectively, at lag 0-8 days, lag 8 days, and lag 8 days. The effect size of PM was statistically significantly higher in the T2D group than in the group without T2D (z = 3.98, P \u3c 0.01). The effect sizes of PM were 3.86% (95% CI: 2.48-5.27%), 3.73% (95% CI: 1.72-5.79%), and 3.92% (95% CI: 2.65-5.21%), respectively, at lag 0-13 days, lag 13 days, and lag 13 days, respectively, and no statistically significant difference was observed between T2D groups (z = 0.24, P = 0.81). Significant difference was not observed between T2D groups for the associations of PM and different RD and could be found between three groups for effects of PM on RD without T2D. The E-R curves varied by sex, age and T2D condition subgroups for the associations between PM and daily RD admissions. CONCLUSIONS: Short-term PM exposure was associated with increased RD admission with and without T2D, and the effect size of PM was higher in patients with T2D than those without T2D

Leep1 interacts with PIP3 and the Scar/WAVE complex to regulate cell migration and macropinocytosis

Polarity is essential for diverse functions in many cell types. Establishing polarity requires targeting a network of specific signaling and cytoskeleton molecules to different subregions of the cell, yet the full complement of polarity regulators and how their activities are integrated over space and time to form morphologically and functionally distinct domains remain to be uncovered. Here, by using the model system Dictyostelium and exploiting the characteristic chemoattractant-stimulated translocation of polarly distributed molecules, we developed a proteomic screening approach, through which we identified a leucine-rich repeat domain–containing protein we named Leep1 as a novel polarity regulator. We combined imaging, biochemical, and phenotypic analyses to demonstrate that Leep1 localizes selectively at the leading edge of cells by binding to PIP3, where it modulates pseudopod and macropinocytic cup dynamics by negatively regulating the Scar/WAVE complex. The spatiotemporal coordination of PIP3 signaling, Leep1, and the Scar/WAVE complex provides a cellular mechanism for organizing protrusive structures at the leading edge

The structure of a prokaryotic viral envelope protein expands the landscape of membrane fusion proteins

Lipid membrane fusion is an essential function in many biological processes. Detailed mechanisms of membrane fusion and the protein structures involved have been mainly studied in eukaryotic systems, whereas very little is known about membrane fusion in prokaryotes. Haloarchaeal pleomorphic viruses (HRPVs) have a membrane envelope decorated with spikes that are presumed to be responsible for host attachment and membrane fusion. Here we determine atomic structures of the ectodomains of the 57-kDa spike protein VP5 from two related HRPVs revealing a previously unreported V-shaped fold. By Volta phase plate cryo-electron tomography we show that VP5 is monomeric on the viral surface, and we establish the orientation of the molecules with respect to the viral membrane. We also show that the viral membrane fuses with the host cytoplasmic membrane in a process mediated by VP5. This sheds light on protein structures involved in prokaryotic membrane fusion.Peer reviewe

Layer-by-Layer Assembly of Supported Lipid Bilayer Poly-l-Lysine Multilayers.

Multilayer lipid membranes perform many important functions in biology, such as electrical isolation (myelination of axons), increased surface area for biocatalytic purposes (thylakoid grana and mitochondrial cristae), and sequential processing (golgi cisternae). Here we develop a simple layer-by-layer methodology to form lipid multilayers via vesicle rupture onto existing supported lipid bilayers (SLBs) using poly l-lysine (PLL) as an electrostatic polymer linker. The assembly process was monitored at the macroscale by quartz crystal microbalance with dissipation (QCM-D) and the nanoscale by atomic force microscopy (AFM) for up to six lipid bilayers. By varying buffer pH and PLL chain length, we show that longer chains (≥300 kDa) at pH 9.0 form thicker polymer supported multilayers, while at low pH and shorter length PLL, we create close packed layers (average lipid bilayers separations of 2.8 and 0.8 nm, respectively). Fluorescence recovery after photobleaching (FRAP) and AFM were used to show that the diffusion of lipid and three different membrane proteins in the multilayered membranes has little dependence on lipid stack number or separation between membranes. These approaches provide a straightforward route to creating the complex membrane structures that are found throughout nature, allowing possible applications in areas such as energy production and biosensing while developing our understanding of the biological processes at play

Towards sustainability: An assessment of an urbanisation bubble in China using a hierarchical - stochastic multicriteria acceptability analysis - Choquet integral method

Urbanisation bubbles have become an increasingly serious problem. Attention has been paid to the speed of urbanisation; however, the issue of quality has been neglected, particularly in the case of China. Therefore, the aim of this research is to evaluate China’s urbanisation bubbles by employing a hierarchical - stochastic multicriteria acceptability analysis (SMAA) - Choquet integral method. In order to highlight regional disparities, we measure the urbanisation bubbles at a provincial level. Our study aggregates the urbanisation bubble indices using the Choquet integral preference model, and considers the interactions between various indicators. Furthermore, robust ordinal regression and SMAA are applied to resolve the robustness issues associated with the entire set of weights assigned to the urbanisation bubble composite indicator. In addition, by employing a multiple criteria hierarchy process, the study aggregates urbanisation bubble indices not only at the comprehensive level, but also at the intermediate levels of the hierarchy. Our findings suggest that the ranking of urbanisation bubbles is positively related to the level of regional development. This study contributes to the evaluation of regional urbanisation and sustainable development