ObjectivesChinese county hospitals have been excessively enlarging their scale during the healthcare reform since 2009. The purpose of this paper is to examine the technical efficiency and ...productivity of county hospitals during the reform process, and to determine whether, and how, efficiency is affected by various factors.Setting and participants114 sample county hospitals were selected from Henan province, China, from 2010 to 2012.Outcome measuresData envelopment analysis was employed to estimate the technical and scale efficiency of sample hospitals. The Malmquist index was used to calculate productivity changes over time. Tobit regression was used to regress against 4 environmental factors and 5 institutional factors that affected the technical efficiency.Results(1) 112 (98.2%), 112 (98.2%) and 104 (91.2%) of the 114 sample hospitals ran inefficiently in 2010, 2011 and 2012, with average technical efficiency of 0.697, 0.748 and 0.790, respectively. (2) On average, during 2010–2012, productivity of sample county hospitals increased by 7.8%, which was produced by the progress in technical efficiency changes and technological changes of 0.9% and 6.8%, respectively. (3) Tobit regression analysis indicated that government subsidy, hospital size with above 618 beds and average length of stay assumed a negative sign with technical efficiency; bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency.ConclusionsThere was considerable space for technical efficiency improvement in Henan county hospitals. During 2010–2012, sample hospitals experienced productivity progress; however, the adverse change in pure technical efficiency should be emphasised. Moreover, according to the Tobit results, policy interventions that strictly supervise hospital bed scale, shorten the average length of stay and coordinate the proportion among physicians, nurses and beds, would benefit hospital efficiency.
Typical LiMn2O4 cathode materials for lithium ion batteries suffer from the Jahn-Teller distortion, unstable phase transformation and the Mn3+ disproportionation. In this work, the Cu and Al elements ...are designed to be respectively doped into Mn sites and Li sites to reinforce the structural stability and thereby improve cyclic capacity and stability under wide electrochemical window. A conventional sol-gel method is used to synthesis Cu and Al co-doped Li1–3xAlxMn1.75Cu0.25O4 (x = 0, 0.02, 0.08 and 0.14) of lithium manganese oxide (LMO) spinel. Benefitting from the enhanced structural stability, improved ionic/electronic conductivity and decreased Jahn-Teller effects, at a high current density of 5 C, the Li0.94Al0.02Mn1.75Cu0.25O4 provides an initial capacity of 106.3 mA h g− 1 within a wide potential window of 2 − 4.8 V and harvests a high reversible capacity of 90.2 mA h g− 1 after 300 cycles (84.9% capacity retention), which is much higher than LMO (77.3 mA h g− 1) and LMCO (69.0 mA h g− 1). The Cu doping can enhance the phase transformation reversibility between λ-MnO2 and LiMn2O4, whereas the Al doping can strengthen the cubic-to-tetragonal reversibility. This work provides an effective strategy for engineering stable LiMn2O4 spinel cathodes under high current density and wide potential window for lithium ion battery.
Display omitted
Layered LiCoO2 (LCO) is one of the most successful cathode materials for lithium ion battery due to its high theoretical capacity and high compacted density. Nevertheless, However, several ...detrimental issues including surface degradation, destructive phase transformation, and inhomogeneous reactions, resulting in rapid capacity fading and short cycle life. Herein, a highly conformal and compatible spinel Li1-xCo2O4 was in situ reconstructed on LCO surface (S-LCO), which can be realized by thermal treating of in situ engineered LiCoO2@ZIF-67 composite experimentally. The intense and stable LiCoO2 and spinel Li1-xCo2O4 can promote rapid Li + transport and relieve the mechanical stress. Protected by the spinel Li1-xCo2O4, the optimized S-LCO harvests an initial reversible capacity of 171.9 mA h g−1 at 0.2 C within 4.5 V and offers 137 mA h g−1 at 1 C after 200 cycles with 77.0 % capacity retention (LCO: 68.5 mA h g−1 with 43.9 % capacity retention). The in situ XRD and ex situ SEM characterizations indicate that the spinel Li1-xCo2O4 can effectively enhance phase transformation reversibility (H1→H2→M1→H3→M2) without serious cell shrinkage and microstructure collapse. The feasible surface reconstruction strategy broadens the perspective for developing high-performance LCO-based cathodes.
Iron-based PAA activation process is a promising advanced oxidation process for water decontamination which depends on Fe(II) as the main reactive site for PAA activation, resulting in various ...reactive oxidative species (ROSs) generation. For practical application, the impact of water matrix chloride ion (Cl-) on ROSs production and contaminants removal should be carefully considered. In this study, it's found that the introduction of Cl- (0.1-10 mM) could significantly enhance the reaction rate of the rapid stage (kobs1) up to 2.15 times at the initial pH of 4.25 in the Fe(II)/PAA system. Further studies demonstrated that the improved removal capacity of NAP resulted from Cl- induced R-O• generation as indicated by the exposure dose of R-O• increasing from 7.74 × 10-11 M•s to 1.44 × 10-10 M•s, rather than chlorine-containing radicals' generation. DFT calculation results suggested that the formed Fe(II)-Cl- complexes could easily activate PAA to generate more ROSs for NAP removal. Moreover, Fe(II)/PAA treatment can alleviate the biological toxicity of pollutants via both the Escherichia coli test and toxicity assessment. The obtained new knowledge manifested that Cl- can boost ROSs generation and conversion in iron-based PAA systems, providing guidance for the efficient decontamination of chlorine-containing sewage with PAA-based AOPs.
The mechanism of transition from chronic pressure overload‐induced cardiac hypertrophy to heart failure is still unclear. Angiotensin II (Ang II) may be an important factor that mediates the ...transition in the end‐stage of cardiac hypertrophy. In the present study, Goldblatt two‐kidney one‐clip (2K1C) rat model was used to simulate Ang II‐induced hypertension. The elevated Ang II not only induced the concentric hypertrophy of left ventricle and cardiac fibrosis, but also increased the expression and glycosylation of CD147 in 2K1C rats. The left ventricular structure and function detected by echocardiogram showed a sign of the transition from cardiac hypertrophy to heart failure in 16 weeks of 2K1C rats. Ang II can activate N‐acetylglucosamine transferase V (GnT‐V), a key enzyme for CD147 glycosylation. Retinoic acid, an agonist of GnT‐V, further increased glycosylated CD147, and activated matrix metalloproteinase‐2/‐9 (MMP‐2 and MMP‐9) in the hypertrophied left ventricle of 2K1C rat. Meanwhile, collagen cross‐linking in the hypertrophied left ventricle significantly reduced in 2K1C rats. On the contrary, tunicamycin, an inhibitor of N‐glycan biosynthesis, inhibited glycosylation of CD147 and activity of MMP‐2 and MMP‐9, and then maintained a stable of collagen cross‐linking in the 2K1C rat hearts. The above results suggested that Ang II increased glycosylated CD147 which activated MMP‐2 and MMP‐9. Collagens were degraded by the activated MMPs and then reduced collagen cross‐linking. Finally, the hypertrophied left ventricle was progressively dilated in chronic pressure overload due to losing the limitation of collagen cross‐linking. Therefore, the compensated hypertrophy of left ventricle gradually transited to congestive heart failure.
The above study provides new insights into exploring the pathogenesis of heart failure, and CD147 is expected to become a potential target for myocardial protection, which provides a new strategy for the prevention and treatment of cardiovascular disease.
The incidence of inflammatory bowel disease, a chronic intestinal inflammatory disorder that includes Crohn's disease (CD) and ulcerative colitis, is rising. Circular RNAs are considered valuable ...diagnostic biomarkers for CD. Current evidence supports the views that epithelial-mesenchymal transition (EMT) plays an important role in CD pathogenesis, and that hsa-miR-130a-3p can inhibit transforming growth factor-β1 (TGF-β1)-induced EMT. Our previous study revealed that hsa_circRNA_102610 was upregulated in CD patients. Moreover, we predicted an interaction between hsa_circRNA_102610 and hsa-miR-130a-3p. Thus, we hypothesized that hsa_circRNA_102610 may play roles in the proliferation and EMT of intestinal epithelial cells by sponging hsa-miR-130a-3p to participate in the pathogenesis of CD.
To explore the mechanism of hsa_circRNA_102610 in the pathogenesis of CD.
The relative expression levels of hsa_circRNA_102610 and hsa-miR-130a-3p in patients were detected by quantitative reverse transcription-polymerase chain reaction. The proliferation of human intestinal epithelial cells (HIECs) and normal-derived colon mucosa cell line 460 (NCM460) cells was detected by cell counting kit-8, 5-ethynyl-2'-deoxyuridine staining and cell cycle assays following overexpression or downregulation of hsa_circRNA_102610. Cell proliferation assays were performed as described above in a rescue experiment with hsa-miR-130a-3p mimics. The interaction of hsa_circRNA_102610 and hsa-miR-130a-3p was verified by fluorescence in situ hybridization and dual luciferase reporter assays. The relative expression levels of CyclinD1, mothers against decapentaplegic homolog 4 (SMAD4), E-cadherin, N-cadherin and Vimentin were detected by western blotting following hsa_circRNA_102610 overexpression, TGF-β1-induced EMT or hsa-miR-130a-3p mimic transfection (in rescue experiments).
Upregulation of hsa_circRNA_102610 was determined to be positively correlated with elevated fecal calprotectin levels in CD (
= 0.359,
= 0.007) by Pearson correlation analysis. Hsa_circRNA_102610 promoted the proliferation of HIECs and NCM460 cells, while hsa-miR-130a-3p reversed the cell proliferation-promoting effects of hsa_circRNA_102610. Fluorescence in situ hybridization and dual luciferase reporter assays showed that hsa_circRNA_102610 directly bound hsa-miR-130a-3p in NCM460 and 293T cells. An inverse correlation between downregulation of hsa-miR-130a-3p and upregulation of hsa_circRNA_102610 in CD patients was observed (
= -0.290,
= 0.024) by Pearson correlation analysis. Moreover, overexpression of hsa_circRNA_102610 promoted SMAD4 and CyclinD1 protein expression validated by western-blotting. Furthermore, over-expression of hsa_circRNA_102610 promoted TGF-β1 induced EMT in HIECs and NCM460 cells
targeting of hsa-miR-130a-3p, with increased expression of Vimentin and N-cadherin and decreased expression of E-cadherin.
Hsa_circRNA_102610 upregulation in CD patients could promote the proliferation and EMT of intestinal epithelial cells
sponging of hsa-miR-130a-3p.
The association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, circulating levels of homocysteine (Hcy), and the severity of coronary lesion in patients with acute coronary ...syndrome (ACS) remains unknown.Consecutive ACS patients were included. MTHFR C677T polymorphisms were determined via amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Gensini scores were used to evaluate the severity of coronary lesions.Three hundred ten ACS patients were included, and grouped according to the MTHFR C677T polymorphism variant: CC (n = 78, 25.2%), CT (n = 137, 44.2%), and TT (n = 95, 30.6%) groups. No significant differences were detected with respect to baseline characteristics. Patients in TT group had significantly higher Hcy, and significantly lower folic acid (FA) levels as compared with those in the other 2 groups (P < .05 for both). More importantly, patients with TT had more severe coronary lesions as compared with those from the other 2 groups, as evidenced by higher Gensini scores (P < .05 for both); however, no significant differences were observed with respect to the numbers of affected coronary arteries, or the number, length, and diameter of stents implanted in each group (P > .05 for all). On multivariate logistic regression analysis, presence of a T allele in MTHFR C677T was found to be independently associated with higher circulating Hcy (odds ratio OR = 1.06, 95% confidence interval CI: 1.01-1.12, P = .024), and higher Gensini scores (OR: 1.01, 95% CI: 1.00-1.02, P = .046).MTHFR C677T TT polymorphism was associated with higher Hcy levels and more severe coronary lesions in patients with ACS.
N-acetylneuraminic acid (Neu5Ac) is a functional metabolite involved in coronary artery disease (CAD). We aimed to evaluate the relationship between serum Neu5Ac and the risk and prognosis of acute ...coronary syndrome (ACS) in a real-world prospective study.
Patients with suspected ACS who underwent coronary angiography were included. Serum Neu5Ac was measured at admission. Coronary lesion severity was evaluated by Gensini Score. GRACE risk stratification was performed at admission. Major adverse cardiac events (MACEs) were recorded during follow-up.
A total of 766 patients, including 537 with unstable angina (UAP), 100 with myocardial infarction (MI), and 129 without CAD were included. The circulating Neu5Ac level was significantly higher in patients with MI (median 1QR: 297220, 374 ng/ml) than in those with UAP (227 114, 312 ng/ml) or without CAD (207 114, 276 ng/ml; both p < 0.001). Serum level of Neu5Ac was positively correlated with age, hypertension, serum uric acid, creatinine, MB isoform of creatine kinase (CK-MB), and Gensini score (all p < 0.05). Receiver operating characteristic curve analysis showed that a higher serum Neu5Ac was potentially associated with MI and high-risk GRACE stratification in ACS patients. Logistic analysis identified only elevated serum Neu5Ac as an independent predictor of MACEs in these patients (odds ratio OR: 1.003, 95% confidence interval CI: 1.002-1.005, p < 0.001).
Serum Neu5Ac is associated with myocardial injury, GRACE risk category, and prognosis in ACS patients.
PDF
