No abstract

Innovations in chronic disease management are growing rapidly as advancements in technology broaden the scope of tools. Older adults are less likely to be willing or able to use patient portals or smartphone apps for health-related tasks. The authors conducted a cross-sectional survey of older adults (ages ≥50) with hypertension or diabetes to examine relationships between portal usage, interest in health-tracking tools, and eHealth literacy, and to solicit practical solutions to encourage technology adoption. Among 247 patients surveyed in a large integrated delivery health system between August 2015 and January 2016, eHealth literacy was positively associated with portal usage (OR [95% CI]: 1.3 [1.2-1.5]) and interest in health-tracking tools (1.2 [1.1-1.3]). Portal users compared to nonusers (N = 137 vs.110) had higher rates of interest in using websites/smartphone apps to track blood pressure (55% vs. 36%), weight (53% vs. 35%), exercise (53% vs. 32%), or medication (46% vs 33%, all P < 0.05). Portal users noted cumbersome processes for accessing portals and variations in provider availability for online scheduling and response times to messages. Portal nonusers expressed concerns about data security, lack of personalization, and limited perceived value of using portals. Both groups noted the importance of computer literacy and technical support. Patient stakeholders recommended marketing initiatives that capture patient stories demonstrating real-life applications of what patients can do with digital technology, how to use it, and why it may be useful. Health systems also must screen for eHealth literacy, provide training, promote proxy users, and institute quality assurance that ensures patients' experiences will not vary across the system.

Metal nanoparticles-on-smooth-electrode (NOSE) was used as the substrate in a potential-dependent surface-enhanced hyper-Raman(SEHRS), hyper-Rayleigh(SEHRyS) and Raman (SERS) study of adsorbed molecules of pyridine, pyrazine and benzene. The three molecules are chosen because they are known to adsorb in different orientations on an Ag surface, thus allowing us to examine the sensitivity of SEHRS and SERS signals to the orientation of adsorbed molecules on the NOSE substrate. A computational subroutine is developed and interfaced with Gaussian-98 to calculate the numeric infrared, Raman and hyper-Raman intensities, as well as their projections along any molecular-fixed orientation axis at the level of finite perturbation theory. In this study, we tried to make four types of systematic comparisons. First, we compared the performance of Ag n jAg NOSE substrate with that of traditional substrates such as a randomly roughened Ag electrode or a randomly aggregated Ag sol in SEHRS and SERS. Secondly, we tried to compare between infrared, Raman and hyper-Raman spectra, which represent the parity-differentiated one-photon, two-photon and three-photon processes, respectively, with the aim of examining the complementarity between SEHRS and SERS as well as between SEHRS and infrared absorption. Thirdly, we compared isotropic normal spectra with surface-enhanced spectra (SEHRS and SERS), with the aim of examining the effect of surface adsorption on the selectivity and enhancement. Lastly, we made a systematic comparison between the observed and calculated spectra for both isotropic and surface spectra, which allowed us to assign and interpret the observed data and to infer the most likely orientation of the adsorbed molecules. The NOSE method can be generalized easily to other metal nanoparticles dispersed on a smooth inert metal electrode. The rapid development in the synthesis of metal nanoparticles of various sizes, shapes and crystalline states makes the NOSE method a much more flexible and versatile substrate in the study and applications of SERS and SEHRS techniques.

Diabetic nephropathy (DN) is a complication of diabetes that is increasing in prevalence in China. Extracellular vesicles (EVs) carrying microRNAs (miRs) may represent a useful tool in the development of therapies for DN. Here, we report that EVs released by adipose-derived mesenchymal stem cells (ADSCs) during DN contain a microRNA (miR), miR-26a-5p, that suppresses DN. Using bioinformatic analyses, we identified differentially expressed miRs in EVs from ADSCs and in DN and predicted downstream regulatory target genes. We isolated mesenchymal stem cells (MSCs) from adipose tissues, and collected EVs from the ADSCs. We exposed mouse glomerular podocytes and MP5 cells to high glucose (HG), ADSCs-derived EVs, miR-26a-5p inhibitor/antagomir, Toll-like receptors 4 (TLR4) plasmids, or the NF-κB pathway activator (phorbol-12-myristate-13-acetate, PMA). We used the CCK-8 assay and flow cytometry to investigate the impact of miR-26a-5p on cell viability and apoptosis and validated the results of these assays with in vivo experiments in nude mice. We found that in DN, miR-26a-5p is expressed at very low levels, whereas TLR4 is highly expressed. Of note, EVs from ADSCs ameliorated the pathological symptoms of DN in diabetic mice, and transferred miR-26a-5p to HG-induced MP5 cells, improving viability while suppressing apoptosis of MP5 cells. We also found that miR-26a-5p protects HG-induced MP5 cells from injury by targeting TLR4, inactivating the NF-κB pathway and down-regulating vascular endothelial growth factor A (VEGFA). Moreover, ADSCs-derived EVs transferred miR-26a-5p to mouse glomerular podocytes, which ameliorated DN pathology. These findings suggest that miR-26a-5p from ADSC-derived EVs protects against DN.