A Semisynthesis Platform for the Efficient Production and Exploration of Didemnin-Based Drugs

Plitidepsin (or dehydrodidemnin B), an approved anticancer drug, belongs to the didemnin family of cyclic depsipeptides, which are found in limited quantities in marine tunicate extracts. Herein, we introduce a new approach that integrates microbial and chemical synthesis to generate plitidepsin and its analogues. We screened a Tistrella strain library to identify a potent didemnin B producer, and then introduced a second copy of the didemnin biosynthetic gene cluster into its genome, resulting in a didemnin B titer of approximately 75 mg/L. Next, we developed two straightforward chemical strategies to convert didemnin B into plitidepsin, one of which involved a one-step synthetic route giving over 90 % overall yield. Furthermore, we synthesized 13 new didemnin derivatives and three didemnin probes, enabling research into structure-activity relationships and interactions between didemnin and proteins. Our study highlights the synergistic potential of biosynthesis and chemical synthesis in overcoming the challenge of producing complex natural products sustainably and at scale.

Effects of different doses of remimazolam on hemodynamics during general anesthesia in patients with septic shock

OBJECTIVE

The stability of hemodynamics plays a vital role in the process of anesthesia induction for patients with septic shock. As a new-type benzodiazepine, remimazolam has numerous advantages, including rapid induction, rapid recovery, stable hemodynamics, and mild respiratory depression. Nevertheless, reports about the effects of remimazolam on hemodynamics in patients with septic shock are still limited. The study aimed to evaluate the effects that different doses of remimazolam have on hemodynamics in inducing general anesthesia in patients with septic shock.

PATIENTS AND METHODS

Admitted to the intensive care unit of our hospital from January 2023 to June 2023, 75 patients with septic shock caused by acute appendicitis-induced sepsis were selected as observation subjects. They were randomly assigned to receive low-dose [0.2 mg/(kg·h)], medium-dose [0.3 mg/(kg·h)], and high-dose [0.4 mg/(kg·h)] remimazolam by using a random number table, with 25 patients in each group. Their intraoperative conditions were recorded, including operation duration, intraoperative hemorrhage volume, intraoperative transfusion volume, and decannulation time. Hemodynamic parameters, including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and stoke volume index (SVI) were collected at seven-time points (T0: before induction; T1: before intubation; T2: after intubation; T3: the start of operation; T4: 15 min after operation; T5: 30 min after operation; T6: the end of operation). We also compared hepatic and renal function indexes, including blood urea nitrogen (BUN), serum creatinine (sCr), procalcitonin (PCT), white blood cells (WBC), tumor necrosis factor-α2 (TNF-α2), and Interleukin-6 (IL-6), of the three groups of patients before operation and 1, 3, 5, 7 days after operation. In addition, the incidence of adverse reactions in the three groups was recorded and compared.

RESULTS

During remimazolam induction, the number of patients with intraoperative need for rescue remimazolam in the medium-dose and high-dose groups was significantly lower than in the low-dose group (p < 0.05). In terms of hemodynamic indexes, MAP in the high-dose group at T2 was lower than that at T0 (p < 0.05), and MAP at T2 was significantly lower in the high-dose group than that in the medium-dose group (p < 0.05). Furthermore, MAP at T4 in the medium-dose and high-dose groups declined compared with the low-dose group (p < 0.05). There were no significant differences in HR, CI, and SVI at different time points among the three groups (p > 0.05), but levels of HR and SVI decreased and CI increased after anesthesia compared with those before operation. Additionally, in comparison with the levels before operation, levels of sCR, BUN, PCT, WBC, TNF-α, and IL-6 were higher on postoperative days 1, 3 (p < 0.05) and lower on postoperative day 7 (p < 0.05). After the operation, both levels of BUN and sCR in the medium-dose and high-dose groups were lower than those in the low-dose group (p < 0.05).

CONCLUSIONS

Remimazolam is safe and effective for inducing general anesthesia in patients with septic shock. Low, medium, and high doses of remimazolam can maintain a stable hemodynamic state, and the recovery of hepatic and renal function is certain to depend on the dose.

Protective Effect of Compound Tongluo Decoction on Brain Vascular Endothelial Cells after Ischemia-Reperfusion by Inhibition of Ferroptosis Through Regulating Nrf2/ARE/SLC7A11 Signaling Pathway

Cerebral infarction is one of the most common diseases for aged people. Compound Tongluo Decoction (CTLD), a classic traditional Chinese Medicine prescription, has been widely used in the treatment of ischemic cerebral infarction. Transient middle cerebral artery occlusion (tMCAO) rat model is established for the animal experiment and oxygen-glucose deprivation and reperfusion (OGD/R) human umbilical vein endothelial cells (HUVECs) model are established for the cell experiment. This also use Nrf2-/- rats to detect the role of nuclear factor erythroid 2-related factor 2 (Nrf2). Longa score, Evans blue staining, brain water content measurement, and histological observation are done. The levels of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), and other ferroptosis-related components are detected respectively. In the vivo experiment, CTLD relieved ischemia-reperfusion (IR) injury symptoms and attenuated IR injury in brain tissues of tMCAO rats by relieving peroxidation injury in brain tissues and inhibiting ferroptosis in tMCAO rats. Moreover, CTLD reversed OGD/R-induced oxidative damage of endothelial cells via suppressing ferroptosis. After knocking out the Nrf2 gene, the protective effect of CTLD is sharply reduced. This study put forward that CTLD can inhibit ferroptosis in I/R-injured vascular endothelium by regulating Nrf2/ARE/SLC7A11 signaling to improve the relative symptoms of rats after cerebral I/R injury, thus providing a viable treatment option for cerebrovascular disease.

Unveiling a CAAX Protease-Like Protein Involved in Didemnin Drug Maturation and Secretion

The assembly line biosynthesis of the powerful anticancer-antiviral didemnin cyclic peptides is proposed to follow a prodrug release mechanism in Tristella bacteria. This strategy commences with the formation of N-terminal prodrug scaffolds and culminates in their cleavage during the cellular export of the mature products. In this study, a comprehensive exploration of the genetic and biochemical aspects of the enzymes responsible for both the assembly and cleavage of the acylated peptide prodrug scaffolds is provided. This process involves the assembly of N-acyl-polyglutamine moieties orchestrated by the nonribosomal peptide synthetase DidA and the cleavage of these components at the post-assembly stage by DidK, a transmembrane CAAX hydrolase homolog. The findings not only shed light on the complex prodrug mechanism that underlies the synthesis and secretion of didemnin compounds but also offer novel insights into the expanded role of CAAX hydrolases in microbes. Furthermore, this knowledge can be leveraged for the strategic design of genome mining approaches aimed at discovering new bioactive natural products that employ similar prodrug biochemical strategies.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors.

MATERIALS/METHODS

Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation.

RESULTS

Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04).

CONCLUSION

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

Detection of Circulating Tumor DNA Correlates with Recurrence and Survival in Localized Non-Small-Cell Lung Cancer: A Meta-Analysis

PURPOSE/OBJECTIVE(S)

Circulating tumor DNA (ctDNA) is approved recently to use in clinical practice of solid tumor. Several large-scale prospective studies also revealed that minimal residual disease based on ctDNA (ctDNA-MRD) is a potential predictive and prognostic biomarker of localized non-small-cell lung cancer (NSCLC) receiving curative treatment (surgery or radiotherapy). However, there are still barriers to clinical management of ctDNA/ctDNA-MRD in localized NSCLC, and the most significant is effectiveness and detection times of ctDNA/ctDNA-MRD. This meta-analysis aims to clarify the prognostic value of the ctDNA and ctDNA-MRD in predicting the disease recurrence and survival of localized NSCLC.

MATERIALS/METHODS

Electronic databases (Pubmed/MEDLINE, Web of Science, Cochrane Library, meeting abstracts) were comprehensively searched for eligible studies from January 2001 to January 2023. The Hazard ratio (HR) from relevant reports was extracted to better evaluate the correlation of ctDNA and ctDNA-MRD detected in plasma with clinical outcomes among patients with localized NSCLC. Pooled results including ctDNA detection rate, disease-/relapse-/progression- free survival (DFS/RFS/PFS) and overall survival (OS) were obtained and analyzed by Review Manager 5.4.1.

RESULTS

A total of 18 eligible studies with 2692 patients were enrolled in the final analysis. The pooled analysis revealed that ctDNA detection in pretreatment plasma indicated poor prognosis for DFS/RFS/PFS (HR 3.82, 95% CI 2.85 - 5.12, p < .00001; Figure 1) with a long-term effect on OS (HR 4.88, 95% CI 3.29 - 7.24, p < .00001; Figure 2). The same result was also observed in patients with positive posttreatment ctDNA-MRD who have shorter DFS/RFS/PFS (HR 7.15, 95% CI 5.50 - 9.31, p < .00001; Figure 3) and OS (HR 4.34, 95% CI: 2.51-7.51, p < .00001; Figure 4) compared to negative groups.

CONCLUSION

Based on the results from our meta-analysis, the presence of pretreatment ctDNA or posttreatment ctDNA-MRD in radically treated localized NSCLC is associated with higher risk of recurrence and poorer survival. This finding is supportive of ctDNA/ctDNA-MRD becoming a widespread prognostic biomarker in localized NSCLC.

The Impact of a High Radiation Dose to the Immune Cells on Tumor Control and Survival in Patients with Non-Small Cell Lung Cancer Undergoing Postoperative Radiotherapy

PURPOSE/OBJECTIVE(S)

Previous studies showed that the estimated dose of radiation to immune cells (EDRIC) was correlated with the overall survival (OS) of patients who received definitive thoracic radiotherapy. However, planning target volume (PTV) may be a confounding factor. The PTV is relatively uniform for patients undergoing postoperative radiotherapy (PORT). We further assessed the prognostic value of EDRIC on survival in patients with non-small cell lung cancer (NSCLC) undergoing PORT.

MATERIALS/METHODS

Patients with NSCLC who received PORT between 2004 and 2019 were analyzed. EDRIC was calculated as a function of the number of radiation fractions and mean doses to the lung, heart, and remaining body based on a model developed by Jin et al. The correlation between EDRIC and OS, PFS, local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) were analyzed using univariable and multivariable Cox models. Kaplan-Meier method was used to show the survival difference between patients with high and low EDRIC.

RESULTS

A total of 345 patients were eligible. The mean EDRIC was 7.6 Gy. Multivariate analysis showed that EDRIC was associated with OS (HR 1.14, P = 0.002), PFS (HR 1.08, P = 0.016), LRFS (HR 1.111, P = 0.008), and DMFS (HR 1.10, P = 0.018). Patients were divided into low and high EDRIC groups according to median EDRIC. The 3-year OS was 82.7% and 72.2% (p = 0.03). The 3-year PFS was 40.3% and 17.8% (p < 0.01). The 3-year LRFS was 71.39% and 59.18% (p = 0.05). The 3-year DMFS was 74.4% and 63.4% (p = 0.06).

CONCLUSION

EDRIC was an independent prognostic factor for survival. Higher doses of radiation to the immune system were associated with tumor progression and death after the PORT of NSCLC. The organ at risk for the immune system should be considered during radiotherapy planning.

A Machine Learning Method to Predict Pathological Complete Response of Esophageal Cancer after Neoadjuvant Chemoradiotherapy with Clinicohematological Markers and MR Radiomics: A Multi-Center Study

PURPOSE/OBJECTIVE(S)

Nearly 30% of patients with local advanced esophageal cancer achieved pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT), who may benefit from organ-preservation strategy under accurate prediction of pCR. We aimed to develop and validate machine learning models based on clinicohematological markers and MR radiomics to accurately predict pCR of esophageal cancer after nCRT.

MATERIALS/METHODS

In this multi-center study, eligible patients with esophageal cancer who received baseline MR scan (T2-weighted image) and nCRT plus surgery were enrolled between September 2014 and September 2022 at institution 1 (training set) and between December 2017 and August 2021 at institution 2 (testing set). Pre-nCRT and post-nCRT blood test results were collected to calculate hematological markers. Models were constructed by machine learning based on clinicohematological markers and MR radiomics to predict pCR. Area under the curve (AUC) and cut-off analysis were used to evaluate model performances.

RESULTS

Totally 154 patients (81 in the training set and 73 in the testing set) were enrolled. The combined model integrating pre-nCRT monocyte-to-lymphocyte ratio and 6 radiomics features achieved AUC of 0.800 (95% CI 0.671-0.918) in the testing set, with sensitivity of 79.2% (95% CI 62.5%-95.8%), specificity of 83.7% (95% CI 73.5%-93.9%), positive predictive value of 76.0% (95% CI 62.5%-90.0%), and negative predictive value of 89.6% (95% CI 82.0%-95.8%).

CONCLUSION

A machine learning model based on clinicohematological markers and MR radiomics to predict pCR after nCRT for patients with esophageal cancer was developed and validated, providing a novel tool for personalized treatment. It is necessary to further validate in more large datasets.

Clinical Verification of a Nomogram Model for Prediction of Brain Metastases in Patients with pⅢA-N2 Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

Brain metastasis is one of the most common failure patterns of pⅢA-N2 non-small cell lung cancer (NSCLC) after complete resection. Prophylactic Cranial Irradiation (PCI) can improve intracranial control but not overall survival. Thus, it is particularly important to identify risk factors that are associated with brain metastasis and subsequently provide instructions for selecting patients who will optimally benefit from PCI. We have reported a nomogram model which was established based on the condition of histology, bronchial invasion, perineural invasion, and adjuvant chemotherapy, through which we can predict high risk brain metastases in patients with pⅢA-N2 NSCLC. The purpose of this study is to verify the accuracy of the nomogram model by using new cases information.

MATERIALS/METHODS

Between January 1, 2015 and December 31, 2019, patients of pⅢA-N2 NSCLC were retrospectively analyzed, to verify the consistency between actual and predictive brain metastases. The verification group was divided into two groups according to the years when genetic testing has been widely used in clinic (group1:2015-2016, group2:2017-2019). ROC curves and calibration curves were chosen for validation.

RESULTS

A total of 770 patients were enrolled in our retrospective study (group1:294 patients, group2: 476patients). The 1-, 3- and 5-year survival rates were 97.2%, 76.5%, 63.2% in group1, and 95.8%, 84.5%, 76.9% in group2, respectively. The 1-, 3- and 5-year brain metastasis rates were 7.9%, 19.7%, 25.8%, and 5.4%, 14.5%, 26.3% in group2, respectively. The AUC were 0.74 (95% CI:0.72 - 0.76) in group1, and 0.71(95% CI:0.70 - 0.73) in group 2.The 1.3.5-year calibration curves of the two groups show that the prediction is in good agreement with the actual observation.

CONCLUSION

The nomogram model can predict brain metastases high risk patients with pⅢA-N2 NSCLC. Whether gene test or not, it can be used as a basis to screening out patients of high-risk brain metastases in future clinical trials for PCI.

Overall Survival Following Salvage Thoracic Radiotherapy for Locoregional Recurrence in Patients with Completely Resected PIIIA-N2 NSCLC

PURPOSE/OBJECTIVE(S)

Locoregional recurrence is a common failure pattern for patients with completely resected pIIIA-N2 NSCLC. The salvage thoracic radiotherapy is administered in some pIIIA-N2 NSCLC patients despite postoperative radiotherapy (PORT). Salvage thoracic radiotherapy could be well tolerated and might improve survival from several small sample retrospective studies, while the high-level clinical evidence is presently lacking. We conducted this retrospective case control study to demonstrate the efficacy of salvage thoracic radiotherapy for completely resected pIIIA-N2 NSCLC patients with locoregional recurrence.

MATERIALS/METHODS

Between January 2003 and June 2019, patients who had undergone lobectomy or pneumonectomy plus mediastinal lymph node dissection or systematic sampling in our single institution were retrospectively reviewed. Those with pⅢA-N2 NSCLC that did not receive PORT and suffered locoregional recurrence being the first treatment failure were enrolled. The log-rank test was used to analyze differences between the groups, and the Kaplan-Meier method was used for survival analysis. Univariate and multivariate analyses using Cox proportional hazards regression models were performed to evaluate potential prognostic factors for survival. Statistically significant difference was set as p<0.05.

RESULTS

Of all the patients with pⅢA-N2 NSCLC reviewed, 105 suffered locoregional recurrence as the first treatment failure and didn't receive PORT. Among these patients, 51 (48.6%) received salvage thoracic radiotherapy and 54 (51.4%) did not. The median OS was 47.7 months of all patients. Survival analysis showed that the median OS in salvage thoracic radiotherapy group (69.0 months) was significantly longer than that in non-salvage thoracic radiotherapy group (37.7 months) (p = 0.029). For patients of EGFR wild type, salvage thoracic radiotherapy group had significantly longer median OS of 69.0 months compared with non-salvage thoracic radiotherapy group of 31.3 months (p = 0.004). When assessed by histological types, salvage thoracic radiotherapy significantly improved the survival of patients with lung squamous cell carcinoma with median OS not reached compared with non-salvage thoracic radiotherapy group of 31.3 months (p<0.001), while in patients with non-squamous cell carcinoma, this survival benefit was not observed (p = 0.829).

CONCLUSION

Salvage thoracic radiotherapy is an effective treatment for completely resected pIIIA-N2 NSCLC patients that have not received PORT and suffered post-operative locoregional recurrence.

Exercise adherence and suicidal ideation of Chinese college students: a chain mediation model test

Objective

The purpose of this study was to explore the relationship between exercise adherence and suicidal ideation in college students, as well as the mediating role of meaning in life and internet addiction.

Methods

A total of 1925 college students (M_age = 19.51 years, SD_age = 2.393 years) were recruited by stratified cluster sampling method in Zhaoqing University, among which 890 were males and 1,035 were females. Exercise adherence, meaning in life, internet addiction and suicidal ideation were assessed by using standard scales. Data were analyzed by Pearson Correlation Analysis, and bias-correction percentile Bootstrap method.

Results

(1) There is a significant correlation between exercise adherence, meaning in life, internet addiction and suicide ideation; (2) meaning in life plays a significant mediating role between exercise adherence and suicidal ideation; internet addiction plays a significant mediating role between exercise adherence and suicidal ideation; meaning in life and internet addiction play a chain mediating role between exercise adherence and suicide ideation.

Conclusion

Exercise adherence can not only directly predict college students' suicidal ideation, but also indirectly predict college students' suicidal ideation through the independent mediation and chain mediation of meaning in life and internet addiction.

Views of inpatients on the prevention of venous thrombosis with ankle pump exercise: A cross-sectional survey

INTRODUCTION

This study investigated the current status of patients' knowledge and clinical compliance with ankle pump exercises in order to better enhance patient education and improve patient compliance with ankle pump exercises.

METHODS

A cross-sectional survey of the current status of ankle pump exercise awareness and compliance was conducted using a self-designed questionnaire. The questionnaire consisted of a general demographic information questionnaire, a questionnaire on patients' perceptions of ankle pump exercise and a compliance questionnaire.

RESULTS

A total of 2,203 patients from 53 clinical departments participated in this survey. 87.8% of patients considered ankle pump exercise important, 92.1% could grasp the knowledge of ankle pump exercise, 48.5% could self-monitor and exercise daily as instructed, 81.5% of health care workers would often supervise patients to complete ankle pump exercise, poor self-control (34.6%), lack of physical strength (21.1%) and perceived hassle (18.9%) were the top 3 factors contributing to patients' inability to complete the ankle pump exercise. Regression analysis showed that the factors influencing patients' compliance with the ankle pump exercise were literacy, economic level, number of comorbidities and caprini risk class (p < .05).

CONCLUSION

The patient's cognition of ankle pump exercise is good, but the compliance needs to be improved. It is suggested that the compliance of ankle pump exercise in hospitalized patients should be improved in the future to reduce the incidence of Venous thromboembolism.

The Relationship Between Physical Exercise and Prosocial Behavior of Junior Middle School Students in Post-Epidemic Period: The Chain Mediating Effect of Emotional Intelligence and Sports Learning Motivation and Gender Differences

Purpose

This study examined the relationship between physical exercise (PE) and prosocial behavior (PSB) and constructed a chain mediation model through the mediating effect of physical education learning motivation (PELM) and emotional intelligence (EI).

Methods

Through the stratified random sampling, 1053 students (average age = 14 years, SD = 0.96 years) that complied with the requirements were surveyed from Henan Province in China. PE, EI, PELM, and PSB were assessed using standard scales. For data analysis, Pearson's correlation analysis, structural equation model test, and bias-corrected percentile Bootstrap method were carried out in turn.

Results

(1) There was a significant positive correlation between PE and PSB (r = 0.137), and the direct path between PE and PSB was significant (β = 0.09, t = 4.73, p < 0.01); (2) PE can positively predict EI (β= 0.08, t = 5.27, p < 0.01) and PELM (β= 0.04, t = 2.07, p < 0.05), EI can significantly and positively PSB (β= 0.67, t = 22.12, p < 0.01), PELM can significantly and positively predict PSB (β= 0.05, t =2.20, p<0.05); (3) EI and physical learning motivation play a significant intermediary role between PE and PSB. The mediating effect consists of three indirect effects: PE → EI → PSB (the mediating effect value is 0.055), PE → PELM → PSB (the mediating effect value is 0.002), PE → EI → PELM → PSB (the mediating effect value is 0.002); (4) The chain mediation effect is significant in girls, but not in boys.

Conclusion

(1) PE can positively predict PSB. (2) EI and PELM had significant mediating effects between PE and PSB, including single mediating effects of EI and PELM and chain mediating effects of EI-PELM; (3) There are gender differences in the chain mediation effect.

The Relationship Between Empowering Motivational Climate in Physical Education and Social Adaptation of Senior High School Students: An Analysis of Chain Mediating Effect

This study aims to contribute to understanding the mechanisms underlying the association between empowering motivational climate in physical education and social adaptation among senior high school students, and has important implications for interventions that aim at improving social adaptation among senior high school students. Through the quota sampling, 1,526 students (average age = 17 years, SD = 0.714 years) who came from Anhui Province and met the requirements participated and completed the Empowering Motivational Climate Questionnaire in Physical Education (EMCQ-PE), the Physical Education Engagement Scale (PEES-S), the Emotional Intelligence Scale (EIS) (Chinese version), and the Adolescent Social Adaptation Assessment Questionnaire (ASAAQ). For data analysis, Pearson’s correlation analysis, structural equation model test, and bias-corrected percentile Bootstrap method were carried out in turn. The results showed that empowering motivational climate in physical education positively predicted social adaptation (β = 0.282, p < 0.01), empowering motivational climate in physical education positively predicted physical education engagement and emotional intelligence (β = 0.169, p < 0.01; β = 0.690, p < 0.01), physical education engagement positively predicted emotional intelligence and social adaptation (β = 0.591, p < 0.01; β = 0.058, p < 0.05), and emotional intelligence positively predicted social adaptation (β = 0.365, p < 0.01). Physical education engagement and emotional intelligence played a mediating role in empowering motivational climate in physical education and social adaptation, with a total mediating effect value of 0.251. This study shows that empowering motivational climate in physical education not only directly predicts social adaptation but also indirectly predicts social adaptation through the chain mediating effect of physical education engagement and emotional intelligence.

The Relationship Between Physical Exercise and Mobile Phone Addiction Tendency of University Students in China: A Moderated Mediation Model

This study aims to explore the relationship between physical exercise (PE), self-control (SC), physical exercise atmosphere (PEA), and mobile phone addiction tendency (MPAT) among Chinese university students. Through the quota sampling, 1,433 students complied with the requirements were surveyed from 10 universities in China. PE, SC, PEA, and MPAT were assessed using standard scales. For data analysis, common method deviation test, mean number, standard deviation, correlation analysis and structural equation model analysis were carried out in turn. The results showed PE and MPAT were negatively related (r = -0.158, p < 0.05); PE significantly positively predicted SC (β = 0.082, t = 3.748, p < 0.01), and SC significantly negatively predicted MPAT (β = -0.743, t = -19.929, p < 0.01). Bootstrap method was used to test the mediating effect of SC. The results showed that 95% confidence interval did not include 0. After adding the mediating variable of SC, PE did not significantly negatively predict the tendency of MPAT (β = -0.027, t = -1.257, p > 0.05). The interaction item PEA and SC could significantly positively predict the tendency of MPAT (β = 0.165, t = 2.545, p < 0.05). In the high PEA group, SC had a significant negative predictive effect on the tendency of MPAT (β = -0.665, t = -14.408, p < 0.01); However, in the low PEA group, the negative predictive effect was stronger (β = -0.834, t = -15.015, p < 0.01). The present study shows that PE significantly negatively predicted the tendency of MPAT, and SC played a complete mediating role in the relationship between PE and MPAT; The second half of the indirect effect of PE and MPAT was regulated by the PEA. The PEA will enhance the influence of SC on MPAT, but the high PEA will increase the level of MPAT of individuals at a very high level of SC.

Compound Tongluo Decoction inhibits endoplasmic reticulum stress-induced ferroptosis and promoted angiogenesis by activating the Sonic Hedgehog pathway in cerebral infarction

ETHNOPHARMACOLOGICAL RELEVANCE

Cerebral infarction is one of the most common types of cerebrovascular diseases that threaten people's health. Compound Tongluo Decoction (CTLD), a traditional Chinese medicine formula, has various pharmacological activities, including the alleviation of cerebral infarction symptoms.

AIM OF THE STUDY

This study aims to explore the potential mechanism by which CTLD alleviates cerebral infarction.

MATERIAL AND METHODS

Middle cerebral artery occlusion (MCAO) rat model and oxygen-glucose deprivation and reperfusion (OGD/R) cell model were established for research. The expression of proteins related to endoplasmic reticulum (ER) stress, ferroptosis, Sonic Hedgehog (SHH) pathway and angiogenesis was analyzed by Western blot analysis. The expression of CD31 was detected by immunofluorescence to investigate angiogenesis. In addition, the expression of GRP78 and XBP-1 in brain tissues was investigated by immunohistochemistry. With the application of Prussian blue staining, iron deposition in brain tissue was detected. The levels of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD) were detected using ELISA kits. The angiogenesis was analyzed by tube formation assay.

RESULTS

The results presented in this research showed that CTLD and 4-phenyl butyric acid (4-PBA; the inhibitor of ER stress) could alleviate cerebral infarction. Mechanistically, CTLD and 4-PBA rescued ER stress and ferroptosis, but promoted SHH signaling in rats with cerebral infarction. In addition, cerebral infarction exhibited a high level of angiogenesis, which was aggravated by CTLD but suppressed by 4-PBA. Furthermore, CTLD inhibited ER stress and ferroptosis, but promoted SHH signaling and angiogenesis in OGD/R-induced PC12 cells, which was partly abolished by SANT-1, an antagonist of SHH signaling.

CONCLUSION

In conclusion, this study revealed that CTLD might inhibit ferroptosis induced by endoplasmic reticulum stress and promote angiogenesis by activating the Sonic Hedgehog pathway in rats with cerebral infarction.

Compound Tongluo Decoction promotes generation and homing of endothelial progenitor cells after cerebral infarction in rats by activating Shh signaling

Purpose: To investigate the protective effects of Compound Tongluo decoction (CTD)on neurological function in rats, and the mechanism involved in its angiogenesis-promoting effect. Methods: Rats were arbitrarily assigned to sham group, permanent middle cerebral artery infarction (pMCAO) group, and PMCAO+CTD group (pMCAO plus 7-day oral treatment with CTD). Neurological deficit scores and volume of stroke-damaged areas were measured after 7 days of treatment. The levels of bone marrow-derived endothelial progenitor cells (BMEPCs) in serum and brain tissues were determined by flow cytometry and immunofluorescence. The expression levels of sonic hedgehog (Shh), vascular endothelial growth factor (VEGF), and angiopoietin-1(Ang-1) at infarct sites and in BMEPCs were quantitated using western blot assay. Results: The results showed that CTD markedly ameliorated neurological deficit, reduced volume of affected areas, and promoted the production and homing of BMEPCs. Moreover, CTD upregulated Shh, VEGF and Ang-1expressions at ischemic sites and EPCs, but promoted the proliferation and metastasis of EPCs. The CTD-induced changes were significantly suppressed by Shh inhibitor cyclopamine (CP). Conclusion: These results demonstrate that CTD promotes angiogenesis after cerebral infarction, probably by stimulating Shh signaling and triggering production and homing of EPCs, thereby providing neuroprotection against cerebral infarction. Thus, CTD is a potential neuroprotective agent against cerebral infarction in humans.

The Relationship Between Empowering Motivational Climate in Physical Education and Social Responsibility of High School Students: Chain Mediating Effect Test

Objective: This study aimed to contribute to understanding the mechanisms underlying the association between empowering motivational climate in physical education and social responsibility among high school students, and have important implications for interventions aimed at improving social responsibility among high school students. Methods: Through the quota sampling, 802 students (average age = 17 years, SD = 0.97 years) that complied with the requirements were surveyed from Anhui Province in China. Empowering motivational climate in physical education, social responsibility, interpersonal disturbance, and general self-efficacy were assessed using standard scales. For data analysis, Pearson's correlation analysis, structural equation model test, and bias-corrected percentile Bootstrap method were carried out in turn. Results: (1) Common method biases can be accepted in this study, and the correlation among empowering motivational climate in physical education, social responsibility, interpersonal disturbance, and general self-efficacy are all significant; (2)Empowering motivational climate in physical education, interpersonal disturbance and general self-efficacy can all predict social responsibility significantly; (3) Structural equation modeling indicates good fit: χ2/df = 2.86, RMESA = 0.068, CFI = 0.92, NNFI = 0.91, NFI = 0.90, GFI = 0.93. It indicates that interpersonal disturbance and general self-efficacy can play mediating roles between empowering motivational climate in physical education and social responsibility, respectively. After that, interpersonal disturbance as well as general self-efficacy in turn plays the chain mediating effect in the relationship between empowering motivational climate in physical education and social responsibility. The effect size of the mediating effect of interpersonal disturbance and general self-efficacy in the relationship between empowering motivational climate in physical education and social responsibility is 0.048 and 0.148, respectively, and the effect size of the chain mediating effect is 0.031. Conclusion: Empowering motivational climate in physical education not only has a direct effect on social responsibility among high school students, but also influences social responsibility by the chain mediating effect of interpersonal disturbance and general self-efficacy.

83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

Introduction

Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity.

Method

This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations.

Results

Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up.

Conclusions

The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

122 A Medication Self-Management Intervention to Improve Medication Adherence for Older People with Multimorbidity: A Pilot Trial

Introduction

Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity.

Method

This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations.

Results

Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up.

Conclusions

The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

Neuroprotective Effects and Related Mechanisms of Echinacoside in MPTP-Induced PD Mice

OBJECTIVE

To explore the neuroprotective effect and the related mechanisms of echinacoside (ECH) in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson's disease (PD) mice.

METHODS

Parkinson's disease is induced in mice by MPTP and the neurobehaviors of mice in different groups are observed. Then, immunohistochemistry and Western blot analysis are adopted to measure the expression of tyrosine hydroxylase (TH) and α-synuclein in the substantia nigra (SN). The content of dopamine (DA) and other neurotransmitters in the brain is detected by high-performance liquid chromatography. The expression of nerve growth factors and inflammatory factors in SN in mice in each group is measured by quantitative polymerase chain reaction. Finally, the expression of oxidative stress-related parameters in each group is measured.

RESULTS

Compared with the model group, the pole-climbing time among mice in the moderate and high-dose ECH groups is significantly reduced (P < 0.01). The rotarod staying time, as well as fore and hind-limb strides, shows a significant increase (P < 0.01), as does spontaneous activity (P < 0.01). Moreover, the expression levels of TH, DA, glial cell line-derived neurotrophic factor, and brain-derived neurotrophic factor in SN in mice show significant increases in these two groups (P < 0.01). The content of superoxide dismutase, catalase, and glutathione peroxidase indicates significant increases in the low, moderate, and high-dose ECH groups (P < 0.01), and the content of MDA was reduced (P < 0.01). In the high-dose ECH group, the expression of interleukin (IL) 6 and tumor necrosis factor-α is significantly reduced (P < 0.01), while the expression of IL-10 shows a marked increase (P < 0.01) alongside a decrease in the expression of α-synuclein (P < 0.01).

CONCLUSION

Echinacoside improves neurobehavioral symptoms in PD mice and significantly increases the expression of TH and DA. The neuroprotective effect potentially correlates with anti-inflammation and anti-oxidation actions, promotes the expression of nerve growth factor, and reduces the accumulation of α-synuclein.

A small molecule interacts with pMAC-derived hydroperoxide reductase and enhances the activity of aminoglycosides

The threat of antimicrobial resistance calls for more efforts in basic science, drug discovery, and clinical development, particularly gram-negative carbapenem-resistant pathogens. We sought to identify novel antibacterial agents against Acinetobacter baumannii ATCC19606 using whole cell-based screening. A small molecule named 6D1 with the chemical structure of 6-fluorobenzo[d]isothiazol-3(2H)-one was identified and exhibited activity against A. baumannii ATCC19606 strain (minimal inhibitory concentration, MIC = 1 mg l^-1). The mutation in the plasmid-derived ohrB gene that encodes a peroxidase was identified in spontaneously resistant mutants. Treatment of the bacteria with 6D1 resulted in increased sensitivity to peroxide, such as tert-butyl hydroperoxide. The binding of 6D1 and OhrB was confirmed by surface plasmon resonance. Interestingly, the MIC of kanamycin and gentamicin against spontaneously resistant mutants decreased. Finally, we identified the effect of 6D1 on enhancing the antibacterial activity of kanamycin and gentamicin, including against New Delhi metallo-β-lactamase (NDM-1)-producing carbapenem-resistant Klebsiella pneumoniae, but not in strains carrying aminoglycosides resistance genes. In this study, we identified a small molecule that suppresses the growth of A. baumannii, interacts with hydroperoxide reductase from A. baumannii ATCC19606 plasmid pMAC, and enhances the antibacterial activity of kanamycin and gentamicin. We propose that peroxidase may be potentially used as a target for aminoglycosides adjuvant development.

Mechanism of Autophagy Regulation in MPTP-Induced PD Mice via the mTOR Signaling Pathway by Echinacoside

OBJECTIVE

The present study aimed to investigate the effect of echinacoside on autophagy-related indicators through the mTOR signaling pathway, especially the effect on the clearance of autophagy substrate P62 and α-synuclein, the core pathological products of Parkinson's disease (PD), to provide new strategies for the treatment of PD.

METHODS

A mouse model of subacute PD was established by the intraperitoneal injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). First, the neurobehavioral symptoms in mice of each group were evaluated, and the monoamine neurotransmitters in the striatum in each group were measured with a high-performance liquid phase. Immunofluorescence double staining was adopted to observe the expression of tyrosine hydroxylase (TH), α-synuclein, and LC3. The transmission electron microscope was used to observe the changes of ultrastructure in substantia nigra and the formation of autophagosomes. Then, the expressions of TH, α-synuclein, Beclin 1, LC3, P62, mTOR, and the up-stream protein AKT were detected by Western blot.

RESULTS

When compared with the model group, the neurobehavioral function significantly improved in the echinacoside group (P < 0.01), together with increased expression of TH, DA, and DOPAC in the brain (P < 0.01). In the echinacoside group, while the expressions of Beclin 1 and LC3-II increased (P < 0.01), the expression levels of P62 and α-synuclein decreased significantly (P < 0.01). Echinacoside could up-regulate the expression level of the survival signal p-AKT/AKT and decrease the expression of mTOR.

CONCLUSION

Echinacoside could increase autophagy by inhibiting the expression of mTOR, thereby promoting the clearance of α-synuclein and the degradation of the autophagy substrate P62 and exerting the neuroprotective effect.