Racial Disparities in the Use of Cardiac Revascularization: Does Local Hospital Capacity Matter?

Objective

To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources

Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design

The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.

Principal Findings

Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.

Conclusions

County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.     

An Avida-ED digital evolution curriculum for undergraduate biology

We present an inquiry-based curriculum based on the digital evolution platform Avida-ED (http://avida-ed.msu.edu). We designed an instructional sequence and lab book consisting of an introduction to Avida-ED and a set of three lessons focused on specific evolutionary concepts. These served to familiarize students with experimental evolution and Avida-ED. Students then developed independent Avida-ED research projects to test their own questions. Curriculum design and implementation occurred over the course or two semesters, with a pilot implementation in the first semester, followed by curriculum revision and full implementation in the second semester. The curriculum was implemented in an undergraduate Introductory Cell and Molecular Biology course at a major research university. Full implementation of the curriculum in semester two involved the use of Avida-ED mainly in the teaching lab in parallel with a bacterial antibiotic resistance experimental research stream, allowing students to draw connections between Avidian digital evolution and the evolution of antibiotic resistance in microbial populations. After carrying out the introductory exercises, students developed independent Avida-ED projects to test their own research questions, and presented their data to researchers in the NSF-funded BEACON Center for the Study of Evolution in Action. Preliminary results of our studies to assess the impacts of an Avida-ED curriculum indicate a positive effect on student learning of evolutionary concepts, particularly in increasing the level of complexity of student explanations about the random nature of mutation.     

小蓬NeMT2基因的克隆及其植物表达载体的构建

该研究利用RACE ( Rapid amplification of cDNA ends)技术从小蓬中成功分离编码金属硫蛋白( Metal-lothionein,MT)的cDNA序列,命名为NeMT2,在GenBank中登录号为KT835290。该基因全长590 bp,开放阅读框为237 bp,编码78个氨基酸,编码的氨基酸序列中含有14个半胱氨酸残基( Cys,C),呈C-C,C-X-C,C-X-X-C排列,集中分布在肽链的N端和C端,基因编码蛋白的分子量为7.6036 kD,等电点为4.71。系统发育分析表明,小蓬金属硫蛋白NeMT2与藜科的海蓬子( AEF01492)和盐穗木( AHI62953)同源性最高,其次是甜菜( XP 010667708.1)。生物信息学分析表明,金属硫蛋白NeMT2无信号肽结构,属于非跨膜亲水性蛋白;疏水性分析表明,NeMT2蛋白的35~45个氨基酸之间有较强的疏水性,其中第41位Asp具最强的疏水性(1.444);结构预测分析该蛋白质二级结构的主要元件是无规则卷曲。通过RT-PCR对NeMT2基因的表达分析发现, NeMT2基因在铜矿区和非铜矿区的小蓬叶片中均有表达,但该基因在铜矿区小蓬叶片的表达量明显高于非铜矿区。将小蓬NeMT2基因定向克隆到植物表达载体pCAMBIA1300的35S 启动子下游,构建该基因的植物超表达载体pCAMBIA1300＋NeMT2。该研究结果为进一步研究该基因的功能和小蓬响应重金属胁迫的分子机制提供了一定基础。     

江西金盆山自然保护区种子植物区系研究

江西金盆山自然保护区位于江西省龙南县、全南县与信丰县的交汇处,为武夷山脉与南岭山脉之间的过渡区域,保护区植物种类丰富、区系地理成分复杂。经野外实地调查、查阅相关文献资料,对保护区内种子植物的科、属、种分布区类型进行统计分析。结果表明：（1）金盆山保护区共有野生种子植物161科659属1 474种,其中裸子植物6科7属7种,占江西裸子植物总种数（83种）的8.43%,被子植物155科652属1 467种,占江西被子植物总种数（4 369种）的33.58%。（2）区系分析显示,金盆山保护区内科的分布区类型中热带分布和温带分布分别占总科数（除去世界分布）的64.22%和35.77%,热带分布占优势地位;属的分布区类型中热带分布和温带分布分别占总属数（除去世界分布）的50.95%和47.55%,二者接近平衡;种的分布区类型中热带分布种和温带分布分别占总种数（除去世界分布）的33.98%和37.15%,而且中国特有种419种,占总种比的28.88%。（3）金盆山保护区种子植物具有单种属、寡种属多,植物区系起源古老的特点,其中有寡种属212属,占总属比的32.17%;单种属374属,占总属比的56.75%;其中寡种属所含种数537种,占总种比的36.43%。（4）与邻近6个保护区的植物区系比较表明,金盆山保护区与武夷山脉的联系较南岭山脉更近,而且金盆山保护区表现出比邻近的阳际峰等武夷山脉地区热带性质更明显。     

急性冠脉综合征患者NLR、MPV与Gensini评分的相关性分析

目的:探讨急性冠脉综合征(Acute Coronary Syndrome,ACS)患者的中性粒细胞/淋巴细胞(Neutrophils/lymphocyte,NLR)、平均血小板体积(Mean platelet volume,MPV)与Gensini评分的相关性。方法:将156例ACS患者依据冠状动脉造影结果分为单支病变组、双支病变组及三支病变组,比较各组间NLR、MPV、Gensini评分及一般临床资料,并分析不同指标之间的相关性。结果:与双支病变组、单支病变组相比较,三支病变组吸烟、糖尿病、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、尿酸(uric acid,UA)、NLR、MPV、Gensini评分均显著升高(P0.05);与单支病变组相比较,双支病变组吸烟、糖尿病、LDL-C、HDL-C、UA、NLR、MPV、Gensini评分均显著升高(P0.05);三组间年龄、性别、高血压、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、肌酐(creatinine,Cr)比较差异均无统计学意义(P0.05)。Pearson相关性分析表明:NLR、MPV与Gensini评分均呈正相关(r=0.482、0.702, P0.05)。结论:ACS患者MPV和NLR与冠状动脉病变程度呈显著正相关,可有效评估冠状动脉狭窄程度。     

Seedling response to water stress in valley oak (Quercus lobata) is shaped by different gene networks across populations

Drought is a major stress for plants, creating a strong selection pressure for traits that enable plant growth and survival in dry environments. Many drought responses are conserved species‐wide responses, while others vary among populations distributed across heterogeneous environments. We tested how six populations of the widely distributed California valley oak (Quercus lobata) sampled from contrasting climates would differ in their response to soil drying relative to well‐watered controls in a common environment by measuring ecophysiological traits in 93 individuals and gene expression (RNA‐seq) in 42 individuals. Populations did not differ in their adjustment of turgor loss point during soil drying, suggesting a generalized species‐wide response. Differential expression analysis identified 689 genes with a common response to treatment across populations and 470 genes with population‐specific responses. Weighted gene co‐expression network analysis (WGCNA) identified groups of genes with similar expression patterns that may be regulated together (gene modules). Several gene modules responded differently to water stress among populations, suggesting regional differences in gene network regulation. Populations from sites with a high mean annual temperature responded to the imposed water stress with significantly greater changes in gene module expression, indicating that these populations may be locally adapted to respond to drought. We propose that this variation among valley oak populations provides a mechanism for differential tolerance to the increasingly frequent and severe droughts in California.     

外源脱落酸对富士苹果果实膨大后期光合产物向果实运输的影响

为了明确脱落酸(ABA)对苹果果实糖分积累的影响机理,本试验以5年生‘烟富3’/M26/平邑甜茶为试材,采用¹³C同位素标记技术,研究在果实膨大后期用不同浓度(0、50、100和150 mg·L^-1)脱落酸溶液及氟啶酮(ABA生物合成抑制剂)处理果实对光合产物向果实运输及糖代谢的影响.结果表明: 随着ABA浓度的增加,糖代谢相关酶活性、蔗糖转运蛋白基因MdSUT1、MdSUT2.2和山梨醇转运蛋白基因MdSUT3相对表达量呈先升高后降低趋势,均以100 mg·L^-1ABA处理时最高.氟啶酮处理显著抑制了糖代谢酶活性和糖转运蛋白基因相对表达量.与其他处理相比,100 mg·L^-1ABA处理显著减少了叶片¹³C含量,增加了果实¹³C含量,提升了光合产物由叶片向果实的运输速率.表明外源ABA通过增强果实库强,促进更多的光合产物向果实运输,提高了成熟期果实可溶性糖含量.     

ESI-Q-TOF-MS直接进样法比较陕西五个不同地区丹参的化学成分差异

该研究采用ESI-Q-TOF-MS直接进样分析法对陕西商州、洛南、大荔、丹凤和铜川等五个地区丹参的化学成分进行了比较分析,通过丹参水溶性和脂溶性成分的质谱丰度差异评价了不同地区丹参化学成分含量的变化,对不同产地丹参的化学成分进行了鉴定,综合分析选出了最优的丹参种植产地。结果表明:五地丹参均含有丹参酮ⅡA、隐丹参酮、丹参酮Ⅰ、二氢丹参酮、丹参酚酮、次丹参醌、丹参醌Ⅱ等9种脂溶性化学成分和丹参素、咖啡酸、阿魏酸、迷迭香酸、原紫草酸、紫草酸、原儿茶醛、丹酚酸A、丹酚酸B等9种水溶性化学成分,其中丹参素钠、紫草酸、丹酚酸B和隐丹参酮的含量普遍较高,质谱丰度均大于30%。但是,随着种植环境不同,不同地区丹参的化学成分含量差异很大,如商州产丹参中含有较多具有生物活性的丹参酮类物质,其中丹参酮Ⅰ含量远远高于其他四个产地,质谱丰度达到72.6%,而其他地区丹参酮Ⅰ的质谱丰度为1.8%～11.3%。这表明丹参质量按照地区排序为商州>铜川>大荔>洛南>丹凤。该方法为中药药材质量评价提供了科学、可靠、便捷的途径,为药材规格等级的制定提供了新途径,为陕西丹参种植区域的选择提供了重要信息。     

人嗅黏膜间充质干细胞来源外泌体的分离鉴定及生物学特性研究

外泌体是指释放到细胞外微环境中的直径约50～130 nm的纳米级的膜性囊泡。嗅黏膜间充质干细胞（olfactory mucosa mesenchymal stem cells,OM-MSCs）作为一类新发现的间充质干细胞,在许多疾病中均具有治疗作用,且其内在机制与其旁分泌的外泌体密切相关,但OM-MSCs外泌体的分离、鉴定及生物学特性的研究尚未见报道。本研究采用超速离心法提取OM-MSCs培养液中的外泌体,应用流式细胞术及免疫荧光进行细胞鉴定后,分别用透射电子显微镜、纳米粒径分析及Western印迹对外泌体形态、颗粒大小和表面的特异性分子标志进行分析鉴定。采用CCK8增殖实验,Western印迹和划痕实验,分析其对人脑微血管内皮细胞增殖和迁移的影响。电镜、Western 印迹和纳米粒径分析的结果显示：OM-MSCs来源外泌体形态多为圆形,直径约为40～150 nm;表达外泌体标记物CD63,CD81;CCK-8法检测显示：不同浓度的OM-MSCs源外泌体可提高人脑微血管内皮细胞的增殖活性,且其增殖促进作用具有浓度依赖性（P<0.05）。Western 印迹检测结果显示：相比空白对照组,OM-MSCs源外泌体可显著提高内皮细胞的增殖细胞核抗原蛋白质水平表达（P<0.01）,细胞划痕实验结果显示,OM-MSCs源外泌体可增强内皮细胞的迁移能力,且高于对照组（P<0.01）。本研究表明：通过超速离心法可以分离纯化获得OM-MSCs源外泌体,且该外泌体具有促进人脑微血管内皮细胞迁移和增殖的作用。