Constructing an Urban Population Model for Medical Insurance Scheme Using Microsimulation Techniques

China launched a pilot project of medical insurance reform in 79 cities in 2007 to cover urban nonworking residents. An urban population model was created in this paper for China's medical insurance scheme using microsimulation model techniques. The model made it clear for the policy makers the population distributions of different groups of people, the potential urban residents entering the medical insurance scheme. The income trends of units of individuals and families were also obtained. These factors are essential in making the challenging policy decisions when considering to balance the long-term financial sustainability of the medical insurance scheme

Tip induced unconventional superconductivity on Weyl semimetal TaAs

Weyl fermion is a massless Dirac fermion with definite chirality, which has been long pursued since 1929. Though it has not been observed as a fundamental particle in nature, Weyl fermion can be realized as low-energy excitation around Weyl point in Weyl semimetal, which possesses Weyl fermion cones in the bulk and nontrivial Fermi arc states on the surface. As a firstly discovered Weyl semimetal, TaAs crystal possesses 12 pairs of Weyl points in the momentum space, which are topologically protected against small perturbations. Here, we report for the first time the tip induced superconductivity on TaAs crystal by point contact spectroscopy. A conductance plateau and sharp double dips are observed in the point contact spectra, indicating p-wave like unconventional superconductivity. Furthermore, the zero bias conductance peak in low temperature regime is detected, suggesting potentially the existence of Majorana zero modes. The experimentally observed tunneling spectra can be interpreted with a novel mirror-symmetry protected topological superconductor induced in TaAs, which can exhibit zero bias and double finite bias peaks, and double conductance dips in the measurements. Our work can open a broad avenue in search for new topological superconducting phases from topological Weyl materials and trigger intensive investigations for pursuing Majorana fermions

The role of echocardiography in prognosis for dysfunction and abandonment of radiocephalic arteriovenous fistula in elderly Chinese patients on hemodialysis

The objective of this study was to examine the impact of cardiac structure and function at baseline on the outcomes associated with arteriovenous fistula (AVF) in patients on hemodialysis (HD). Patients who initiated HD aged ≥70 years and received a mature AVF creation were included retrospectively. Echocardiographic parameters measured within 1 week before AVF creation were acquired. The observational period for each patient was from the point of AVF creation to the last time of follow‐up unless AVF abandonment or death occurred. Kaplan‐Meier and Cox proportional hazard regression analyses were conducted. A total of 82 elderly Chinese HD patients with mature radiocephalic AVF (RCAVF) and EF ≥50% were analyzed. During the median study period of 26.8 (12‐40) months, 42 (51.2%) experienced RCAVF dysfunction and 34 (41.5%) progressed to abandonment. Primary and cumulative patencies at 6, 12, 24, and 36 months were 81%, 73%, 48%, 38%, and 84%, 81%, 68%, 55%, respectively. Left ventricle end‐diastolic volume (LVEDV) ≤103.5 mL (HR = 2.5, P = .019) and the right side of RCAVF (HR = 3.59, P = .003) significantly predicted RCAVF dysfunction. The main pulmonary artery internal diameter (MPAID) ≤21.5 mm (HR = 4.3, P = .001) as well as the right side (HR = 2.95, P = .047) were the independent predictors for RCAVF abandonment. In conclusion, LVEDV, MPAID assessed by echocardiography and the right side of RCAVF, showed significant predictive implications for the outcomes of RCAVF. Disparities among nationalities in the areas of utilization and patency of AVFs necessitate additional studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156158/2/sdi12871.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156158/1/sdi12871_am.pd

A study of factors influencing long-term glycemic variability in patients with type 2 diabetes: a structural equation modeling approach

AimThe present study aims to utilize structural equation modeling (SEM) to investigate the factors impacting long-term glycemic variability among patients afflicted with type 2 diabetes.MethodThe present investigation is a retrospective cohort study that involved the collection of data on patients with type 2 diabetes mellitus who received care at a hospital located in Chengdu, Sichuan Province, over a period spanning from January 1, 2013, to October 30, 2022. Inclusion criteria required patients to have had at least three laboratory test results available. Pertinent patient-related information encompassing general demographic characteristics and biochemical indicators was gathered. Variability in the dataset was defined by standard deviation (SD) and coefficient of variation (CV), with glycosylated hemoglobin variation also considering variability score (HVS). Linear regression analysis was employed to establish the structural equation models for statistically significant influences on long-term glycemic variability. Structural equation modeling was employed to analyze effects and pathways.ResultsDiabetes outpatient special disease management, uric acid variability, mean triglyceride levels, mean total cholesterol levels, total cholesterol variability, LDL variability, baseline glycated hemoglobin, and recent glycated hemoglobin were identified as significant factors influencing long-term glycemic variability. The overall fit of the structural equation model was found to be satisfactory and it was able to capture the relationship between outpatient special disease management, biochemical indicators, and glycated hemoglobin variability. According to the total effect statistics, baseline glycated hemoglobin and total cholesterol levels exhibited the strongest impact on glycated hemoglobin variability.ConclusionThe factors that have a significant impact on the variation of glycosylated hemoglobin include glycosylated hemoglobin itself, lipids, uric acid, and outpatient special disease management for diabetes. The identification and management of these associated factors can potentially mitigate long-term glycemic variability, thereby delaying the onset of complications and enhancing patients’ quality of life

Achieving structural white inspired by quasiordered microstructures in Morpho theseus

Microstructures in organisms are often in quasiordered distribution, which brings specific functions and performance stability. Here, a numerical model was built to demonstrate the structural whiteness caused by the quasiordered state of the tubular architectures in Morpho theseus wing scales. The method is beneficial to tailored disorder in periodic structures to achieve better properties

Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients

Background/Aims: Blood pressure variability (BPV) is a novel cardiovascular risk factor for the population undergoing hemodialysis (HD). Methods: We conducted a retrospective cohort study of 526 HD patients. Four short-term peridialysis BPV metrics were analyzed: systolic blood pressure (SBP) change, SBP coefficient of variation (CV), SBP intradialytic average real variability (ARV), and absolute SBP residual. Multi variate analysis with Cox regression models were used to account for the potential confounders. Results: Short-term BPV is found to be affected by age, pre-dialysis SBP, antihypertensive drugs, dialysis time, and vascular access. Calcium-channel blockers (CCBs) were found to be associated with lower BPV than those on non-CCB therapy or no antihypertensive drugs. Patients dialyzed in the morning had a greater absolute SBP change than those dialyzed in the afternoon or evening. Patients using fistulas had a lower BPV than catheters. Higher BPV metrics including SBP CV (unadjusted hazard ratio [HR]: 1.37, 95% confidence interval [CI] 1.14-1.66, p=0.001), SBP intradialytic ARV (unadjusted HR: 1.46, 95% CI: 1.20-1.77, p< 0.001), and SBP residual (unadjusted HR: 1.47, 95% CI: 1.21-1.79, p< 0.001) were associated with a greater risk of cardiovascular events. After complete multivariate adjustment for other potential confounders, the HR remained statistically significant for SBP intradialytic ARV (HR 1.31, 95% CI: 1.04-1.66, p=0.024). Conclusion: Peridialytic BPV may be a potential target for improved blood pressure (BP) management in HD patients. Each short-term BPV metric has different advantages and disadvantages and should be applied according to the clinical context and purpose

Process Optimization of Enzyme-Assisted Extraction of Polysaccharides from Artificially-Cultivated Cordyceps cicadae and Its Kinetic, Thermodynamic and Antioxidant Activities Analysis

Objective: To optimize the enzyme-assisted extraction process of polysaccharides from artificially-cultivated Cordyceps cicadae was conducted in this study. Four different parameters were considered to evaluate the yield of polysaccharides including liquid to solid ratio, enzyme dosage, enzymatic temperature and extraction time. Methods: A four-factor-three-level experimental design was employed to establish a mathematical model by Box-Behnken method, and the scavenging capacity of polysaccharides against three radicals was examined. Afterward, Fick's second law was used to build the kinetic model for the extraction of polysaccharide from artificially-cultivated Cordyceps cicadae. The parameters including rate constants, relative extraction rate, and activation energy were employed to analyze the kinetic and thermodynamic features. Results: Based on the response surface analysis, the optimal extraction process was presented to be as following: Liquid to solid ratio 1:30 g/mL, enzyme dosage 1.6%, enzymatic digestion temperature 67 ℃ and extraction time 90 min. The polysaccharide yield under the above condition was 7.91%, which was close to the predicted value. Moreover, the results of antioxidant capacities indicated that the obtained crude polysaccharides under optimal conditions showed strong DPPH radical scavenging and hydroxyl radical scavenging with IC50 values for 0.60 and 0.54 mg/mL, respectively, and its ORAC value was 45.62 Trolox μmol/g, suggesting potent antioxidant activity in vitro. Conclusion：The study of enzyme-assisted extraction of artificially-cultivated Cordyceps cicadae flower polysaccharides provide theoretical support for the production of polysaccharide fractions from this kind of commercialized Cordyceps cicadae resources

Sesquiterpenoids from the Florets of Carthamus tinctorius (Safflower) and Their Anti-Atherosclerotic Activity

(1) Background: The florets of Carthamus tinctorius L. are traditionally used as a blood-activating drug and can be used for the treatment of atherosclerosis, but no compounds with anti-atherosclerotic activity have been reported. (2) Methods: This study investigated the chemical compounds from the florets of C. tinctorius. Comprehensive spectroscopic techniques revealed their structures, and ECD calculations established their absolute configurations. Nile Red staining, Oil Red O staining, and cholesterol assessment were performed on these compounds and their aglycones for the inhibitory activity against the formation of foam cells induced by oxidized low-density lipoprotein (ox-LDL) in RAW264.7 macrophages. In addition, RAW264.7 macrophages were tested for their anti-inflammatory activity by measuring the inhibition of NO production caused by LPS. (3) Results: Five new sesquiterpenoids (1–5) isolated from the florets of C. tinctorius were identified as (–)-(1R,4S,9S,11R)-caryophyll-8(13)-en-14-ol-5-one (1), (+)-(1R,4R,9S,11R)-caryophyll-8(13)-en-14-ol-5-one (2), (–)-(3Z,1R,5S,8S,9S,11R)-5,8-epoxycaryophyll-3-en-14-O-β-D-glucopyranoside (3), (+)-(1S,7R,10S)-guai-4-en-3-one-11-O-β-D-fucopyranoside (4), and (–)-(2R,5R,10R)-vetispir-6-en-8-one-11-O-β-D-fucopyranoside (5). All compounds except for compound 3 reduced the lipid content in ox-LDL-treated RAW264.7 cells. Compounds 3 and 4 and their aglycones were found to reduce the level of total cholesterol (TC) and free cholesterol (FC) in ox-LDL-treated RAW264.7 cells. However, no compounds showed anti-inflammatory activity. (4) Conclusion: Sesquiterpenoids from C. tinctorius help to decrease the content of lipids, TC and FC in RAW264.7 cells, but they cannot inhibit NO production, which implies that their anti-atherogenic effects do not involve the inhibition of inflammation