Displaying publications 1 - 20 of 27 in total

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  1. Yang B, Tan Y, Sarker MNI, Deng W, Yuan J, Firdaus RBR
    Heliyon, 2024 Feb 29;10(4):e26247.
    PMID: 38390186 DOI: 10.1016/j.heliyon.2024.e26247
    A scientific performance evaluation model is necessary to establish a performance evaluation index system for compulsory education in ethnic areas and to conduct objective and impartial evaluations. After conducting theoretical analysis and reviewing literature, it was determined that existing educational input performance evaluation models are general and fail to reflect the unique characteristics of compulsory education development in ethnic areas of China. Therefore, this study intends to improve their self-adaptability and degree of fit. Based on the features of China's ethnic areas and the current situation of compulsory education development, a trinity evaluation model of compulsory education input performance in ethnic regions was constructed using the classical performance evaluation theoretical framework. This model includes the "implementation topic - target concept - performance dimension." The government is the main organization responsible for organizing and implementing the entire performance evaluation, with publicness and responsiveness as the value idea of evaluation. The "4E″ of enough, equity, efficiency, and effectiveness are the evaluation objectives, and input, allocation, output, and effect are the dimensions of the building of the performance evaluation index system. The "4E″ evaluation objectives are integrated into the performance evaluation dimensions and index system. The reconstructed theoretical model of performance evaluation combines universality and specificity, highlights the dual attributes of "tool-value," realizes the organic combination of internal and external performance evaluation, illustrates the overall performance evaluation process and ensures objective, fair, and accurate performance evaluation results. It provides useful guidelines for further optimizing compulsory education investment policies and promoting high-quality and well-balanced compulsory education in China's ethnic areas.
  2. Sun, J., Jiang, Y., Amin, I., Li, Z., Prasad, K.N., Duan, X., et al.
    MyJurnal
    This research was to determine nutritional composition, essential and toxic elemental content, and major phenolic acid with antioxidant activity in Kadsura coccinea fruit. The results indicated that Kadsura coccinea fruit exhibited the high contents of total protein, total fat, ash and essential elements such as calcium (Ca), ferrum (Fe) and phosphorus (P). The levels of four common toxic elements, i.e. cadmium (Cd), mercury (Hg), arsenic (As) and lead (Pb), were lower than legal limits. By high-performance liquid chromatography (HPLC) analysis, gallic acid was identified as major phenolic acid in peel and pulp tissues. Its contents were no significant difference in both tissues. In comparison with two commercial antioxidants, the major phenolic acid extracted from Kadsura coccinea exhibited stronger 1,1-diphenyl-2-picrylhydrazyl radical-scavenging activity and reducing power. Kadsura coccinea fruit is a good source of nutrition and natural antioxidant. It is worthwhile to popularize this exotic fruit around the world.
  3. Yang J, Gao Z, Yu Z, Hou Y, Tang D, Yan H, et al.
    PMID: 37599623 DOI: 10.1080/10408398.2023.2248244
    Aurones are a subclass of active flavonoids characterized with a scaffold of 2-benzylidene-3(2H)-benzofuranone. This type of chemicals are widely distributed in fruit, vegetable and flower, and contribute to human health. In this review, we summarize the natural aurones isolated from dietary plants. Their positive effects on immunomodulation, antioxidation, cancer prevention as well as maintaining the health status of cardiovascular, nervous system and liver organs are highlighted. The biosynthesis strategies of plant-derived aurones are elaborated to provide solutions for their limited natural abundance. The potential application of natural aurones in food coloration are also discussed. This paper combines the up-to-date information and gives a full image of dietary aurones.
  4. Kong TW, Ryu HS, Kim SC, Enomoto T, Li J, Kim KH, et al.
    J Gynecol Oncol, 2019 Mar;30(2):e39.
    PMID: 30740961 DOI: 10.3802/jgo.2019.30.e39
    The Asian Society of Gynecologic Oncology International Workshop 2018 on gynecologic oncology was held in the Ajou University Hospital, Suwon, Korea on the 24th to 25th August 2018. The workshop was an opportunity for Asian doctors to discuss the latest findings of gynecologic cancer, including cervical, ovarian, and endometrial cancers, as well as the future of fertility-sparing treatments, minimally invasive/radical/debulking surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. Clinical guidelines and position statement of Asian countries were presented by experts. Asian clinical trials for gynecologic cancers were reviewed and experts emphasized the point that original Asian study is beneficial for Asian patients. In Junior session, young gynecologic oncologists presented their latest research on gynecologic cancers.
  5. Han H, Chou CC, Li R, Liu J, Zhang L, Zhu W, et al.
    Sci Rep, 2018 06 22;8(1):9566.
    PMID: 29934599 DOI: 10.1038/s41598-018-27724-3
    Chalocomoracin (CMR), one of the major secondary metabolites found in fungus-infected mulberry leaves, is a potent anticancer agent. However, its anticancer mechanism remains elusive. Here, we demonstrated the potent anti-tumor activity and molecular mechanism of CMR both in vitro and in vivo. We showed for the first time that CMR treatment markedly promoted paraptosis along with extensive cytoplasmic vacuolation derived from the endoplasmic reticulum, rather than apoptosis, in PC-3 and MDA-MB-231cell lines. Additional studies revealed that ectopic expression of Myc-PINK1 (PTEN-induced kinase 1), a key regulator of mitophagy, rendered LNCap cells susceptible to CMR-induced paraptosis, suggesting that the mitophagy-dependent pathway plays a crucial role in inducing paraptosis by activating PINK1. CMR treatment directly upregulated PINK1 and downregulated Alix genes in MDA-MB-231 and PC-3 cell lines. Furthermore, mitophagy signaling and paraptosis with cytoplasmic vacuolation could be blocked by antioxidant N-acetylcysteine (NAC), indicating the novel pathway was triggered by reactive oxygen species (ROS) production. An in vivo MDA-MB-231 xenograft tumor model revealed that CMR suppressed tumor growth by inducing vacuolation production through the same signal changes as those observed in vitro. These data suggest that CMR is a potential therapeutic entity for cancer treatment through a non-apoptotic pathway.
  6. Huang W, Chen X, Guan Q, Zhong Z, Ma J, Yang B, et al.
    Gene, 2019 Mar 20;689:43-50.
    PMID: 30528270 DOI: 10.1016/j.gene.2018.11.083
    Atmospheric CO2 level is one of the most important factors which affect plant growth and crop production. Although many crucial genes and pathways have been identified in response to atmospheric CO2 changes, the integrated and precise mechanisms of plant CO2 response are not well understood. Alternative splicing (AS) is an important gene regulation process that affects many biological processes in plants. However, the AS pattern changes in plants in response to elevated CO2 levels have not yet been investigated. Here, we used RNA-Seq data of Arabidopsis thaliana grown under different CO2 concentration to analyze the global changes in AS. We found that AS increased with the rise in CO2 concentration. Additionally, we identified 345 differentially expressed (DE) genes and 251 differentially alternative splicing (DAS) genes under the elevated CO2 condition. Moreover, the results showed that the expression of most of the DAS genes did not change significantly, indicating that AS can serve as an independent mechanism for gene regulation in response to elevated CO2. Furthermore, our analysis of function categories revealed that the DAS genes were associated mainly with the stimulus response. Overall, this the first study to explore the changes of AS in plants in response to elevated CO2.
  7. Chen X, Yang B, Huang W, Wang T, Li Y, Zhong Z, et al.
    Int J Mol Sci, 2018 Dec 05;19(12).
    PMID: 30563128 DOI: 10.3390/ijms19123897
    Polyphenol oxidase (PPO) catalyzes the o-hydroxylation of monophenols and oxidation of o-diphenols to quinones. Although the effects of PPO on plant physiology were recently proposed, little has been done to explore the inherent molecular mechanisms. To explore the in vivo physiological functions of PPO, a model with decreased PPO expression and enzymatic activity was constructed on Clematis terniflora DC. using virus-induced gene silencing (VIGS) technology. Proteomics was performed to identify the differentially expressed proteins (DEPs) in the model (VC) and empty vector-carrying plants (VV) untreated or exposed to high levels of UV-B and dark (HUV-B+D). Following integration, it was concluded that the DEPs mainly functioned in photosynthesis, glycolysis, and redox in the PPO silence plants. Mapman analysis showed that the DEPs were mainly involved in light reaction and Calvin cycle in photosynthesis. Further analysis illustrated that the expression level of adenosine triphosphate (ATP) synthase, the content of chlorophyll, and the photosynthesis rate were increased in VC plants compared to VV plants pre- and post HUV-B+D. These results indicate that the silence of PPO elevated the plant photosynthesis by activating the glycolysis process, regulating Calvin cycle and providing ATP for energy metabolism. This study provides a prospective approach for increasing crop yield in agricultural production.
  8. Yang B, Hong B, Anderson JR, Fu WW, Ren Y, Gou NN, et al.
    Curr Zool, 2023 Feb;69(1):103-105.
    PMID: 36974153 DOI: 10.1093/cz/zoac020
  9. Li D, Faiza M, Ali S, Wang W, Tan CP, Yang B, et al.
    Appl Biochem Biotechnol, 2018 Apr;184(4):1061-1072.
    PMID: 28948493 DOI: 10.1007/s12010-017-2594-1
    A highly efficient process for reducing the fatty acid (FA) content of high-acid rice bran oil (RBO) was developed by immobilized partial glycerides-selective lipase SMG1-F278N-catalyzed esterification/transesterification using methanol as a novel acyl acceptor. Molecular docking simulation indicated that methanol was much closer to the catalytic serine (Ser-171) compared with ethanol and glycerol, which might be one of the reasons for its high efficiency in the deacidification of high-acid RBO. Additionally, the reaction parameters were optimized to minimize the FA content of high-acid RBO. Under the optimal conditions (substrate molar ratio of methanol to FAs of 1.8:1, enzyme loading of 40 U/g, and at 30 °C), FA content decreased from 25.14 to 0.03% after 6 h of reaction. Immobilized SMG1-F278N exhibited excellent methanol tolerance and retained almost 100% of its initial activity after being used for ten batches. After purification by molecular distillation, the final product contained 97.86% triacylglycerol, 2.10% diacylglycerol, and 0.04% FA. The acid value of the final product was 0.09 mg KOH/g, which reached the grade one standard of edible oil. Overall, methanol was a superior acyl acceptor for the deacidification of high-acid RBO and the high reusability of immobilized SMG1-F278N indicates an economically attractive process.
  10. Choy SY, Prasad KM, Wu TY, Raghunandan ME, Yang B, Phang SM, et al.
    Environ Sci Pollut Res Int, 2017 Jan;24(3):2876-2889.
    PMID: 27838910 DOI: 10.1007/s11356-016-8024-z
    Fruit wastes constituting up to half of total fruit weight represent a large pool of untapped resources for isolation of starch with diverse applications. In this work, the possibility of isolating starch from tropical fruit wastes and its extended application as a natural coagulant was elucidated. Amongst the 12 various parts of fruit wastes selected, only jackfruit seeds contained more than 50% of total starch content. Using alkaline extraction procedures, starch has been successfully isolated from local jackfruit seeds with a yield of approximately 18%. Bell-shaped starch granules were observed under SEM with a granule size ranging from 1.1 to 41.6 μm. Detailed starch characteristics were performed to provide a comparison between the isolated seed starch and also conventional starches. Among them, chemical properties such as the content of starch, amylose, amylopectin and the corresponding molecular weights are some of the key characteristics which governed their performance as natural coagulants. The potential use of isolated seed starch as an aid was then demonstrated in both suspensions of kaolin (model synthetic system) and Chlorella sp. microalga (real-time application) with plausible outcomes. At optimized starch dosage of 60 mg/L, the overall turbidity removal in kaolin was enhanced by at least 25% at a fixed alum dosage of 2.1 mg/L. Positive turbidity and COD removals were also observed in the treatment of Chlorella suspensions. Starches which served as bridging agents aided in the linkage of neighbouring microflocs and subsequently, forming macroflocs through a secondary coagulation mechanism: adsorption and bridging.
  11. Yang B, Tan ML, Zhang R, Singh D, Leong Bin Abdullah MFI
    PLoS One, 2023;18(6):e0287466.
    PMID: 37352311 DOI: 10.1371/journal.pone.0287466
    BACKGROUND AND AIMS: Kratom (Mitragyna speciosa Korth.) is widely use worldwide despite its addictive potential. Although psychostimulant use has been linked to occurrence of endoplasmic reticulum (ER) stress, data is lacking on how regular kratom use affects ER stress. This case-control study first determined differences in ER stress sensor protein expression (BiP, sXBP1, ATF4, CHOP, JNK, and p-JNK) between regular kratom users and healthy controls. Second, it evaluated the association between kratom use characteristics, targeted ER stress sensor protein expression, and "kratom use disorder" diagnosed with Diagnostic and Statistical Manual for Mental Disorders 5th Edition (DSM-5) among regular kratom users.

    METHODS: In total, 60 regular kratom users and 50 healthy control-group participants were recruited and administered a sociodemographic and clinical characteristics questionnaire. While participants who used kratom were also administered a kratom use characteristics questionnaire. Blood samples were collected from all participants, and targeted ER stress sensor protein expression was determined via Western blot analysis.

    RESULTS: The study's findings revealed first that kratom users registered significantly higher protein expression in all targeted ER stress sensors compared to the control group. Second, higher protein expression of CHOP (B = 5.061, standard error [SE] = 2.547, Wald = 3.948, adjusted odds ratio [AOR] = 5.382, 95% confidence interval [CI] = 1.071 to 9.656, p = 0.047) and p-JNK (B = 5.795, SE = 2.635, Wald = 4.544, AOR = 17.025, 95% CI = 1.395 to 24.123, p = 0.017) increased the odds of kratom use disorder occurrence. Kratom use characteristics and other ER stress sensor protein expression were not associated with kratom use disorder.

    CONCLUSION: Regular kratom use may induce protracted ER stress, leading to the decompensation of the unfolded protein response to maintain ER homeostasis. This effect may be linked to kratom use disorder occurrence.

  12. Zhong Z, Zhu W, Liu S, Guan Q, Chen X, Huang W, et al.
    Plant Cell Physiol, 2018 Nov 01;59(11):2214-2227.
    PMID: 30020500 DOI: 10.1093/pcp/pcy138
    Pharmaceutically active compounds from medical plants are attractive as a major source for new drug development. Prenylated stilbenoids with increased lipophilicity are valuable secondary metabolites which possess a wide range of biological activities. So far, many prenylated stilbenoids have been isolated from Morus alba but the enzyme responsible for the crucial prenyl modification remains unknown. In the present study, a stilbenoid-specific prenyltransferase (PT), termed Morus alba oxyresveratrol geranyltransferase (MaOGT), was identified and functionally characterized in vitro. MaOGT recognized oxyresveratrol and geranyl diphosphate (GPP) as natural substrates, and catalyzed oxyresveratrol prenylation. Our results indicated that MaOGT shared common features with other aromatic PTs, e.g. multiple transmembrane regions, conserved functional domains and targeting to plant plastids. This distinct PT represents the first stilbenoid-specific PT accepting GPP as a natural prenyl donor, and could help identify additional functionally varied PTs in moraceous plants. Furthermore, MaOGT might be applied for high-efficiency and large-scale prenylation of oxyresveratrol to produce bioactive compounds for potential therapeutic applications.
  13. Tee LH, Yang B, Nagendra KP, Ramanan RN, Sun J, Chan ES, et al.
    Food Chem, 2014 Dec 15;165:247-55.
    PMID: 25038673 DOI: 10.1016/j.foodchem.2014.05.084
    Dacryodes species are evergreen, perennial trees with fleshy fruits and belong to the family Buseraseae. Many Dacryodes species are underutilized but are widely applied in traditional folk medicine to treat malaria, fever and skin diseases. The nutritional compositions, phytochemicals and biological activities of Dacryodes edulis, Dacryodes rostrata, Dacryodes buettneri, Dacryodes klaineana and Dacryodes hexandra are presented. The edible fruits of D. edulis are rich in lipids, proteins, vitamins, fatty acids and amino acids. Its extracts (leaf, fruit and resin) exhibit antioxidant, anti-microbial, anti-carcinogenic and other bioactivities. D. rostrata fruit has significant nutrient content, and is rich in proteins, lipids and minerals. These fruits are also highly rich in polyphenols, anthocyanins and antioxidant activities. This comprehensive review will assist the reader in understanding the nutritional benefits of Dacryodes species and in identifying current research needs.
  14. Zhu W, Zhong Z, Liu S, Yang B, Komatsu S, Ge Z, et al.
    Int J Mol Sci, 2019 Jan 16;20(2).
    PMID: 30654535 DOI: 10.3390/ijms20020365
    Morus alba is an important medicinal plant that is used to treat human diseases. The leaf, branch, and root of Morus can be applied as antidiabetic, antioxidant, and anti-inflammatory medicines, respectively. To explore the molecular mechanisms underlying the various pharmacological functions within different parts of Morus, organ-specific proteomics were performed. Protein profiles of the Morus leaf, branch, and root were determined using a gel-free/label-free proteomic technique. In the Morus leaf, branch, and root, a total of 492, 414, and 355 proteins were identified, respectively, including 84 common proteins. In leaf, the main function was related to protein degradation, photosynthesis, and redox ascorbate/glutathione metabolism. In branch, the main function was related to protein synthesis/degradation, stress, and redox ascorbate/glutathione metabolism. In root, the main function was related to protein synthesis/degradation, stress, and cell wall. Additionally, organ-specific metabolites and antioxidant activities were analyzed. These results revealed that flavonoids were highly accumulated in Morus root compared with the branch and leaf. Accordingly, two root-specific proteins named chalcone flavanone isomerase and flavonoid 3,5-hydroxylase were accumulated in the flavonoid pathway. Consistent with this finding, the content of the total flavonoids was higher in root compared to those detected in branch and leaf. These results suggest that the flavonoids in Morus root might be responsible for its biological activity and the root is the main part for flavonoid biosynthesis in Morus.
  15. Prasad N, Yang B, Kong KW, Khoo HE, Sun J, Azlan A, et al.
    PMID: 23710209 DOI: 10.1155/2013/154606
    Nypa fruticans Wurmb. is one of the important underutilized fruit of Malaysia, which lacks scientific attention. Total phenolics, flavonoid content, and antioxidant capacities from endosperm extracts of Nypa fruticans (unripe and ripe fruits) were evaluated. Endosperm extract of unripe fruits (EEU) exhibited the highest phenolics (135.6 ± 4.5 mg GAE/g), flavonoid content (68.6 ± 3.1 RE/g), and antioxidant capacity. Free radical scavenging capacity of EEU as assessed by 2-2'-azino-bis (3-ethylbenz-thiazoline-6-sulfonic acid (ABTS) and 1,1-diphenyl-2-picryl hydrazyl (DPPH) radicals showed inhibitory activity of 78 ± 1.2% and 85 ± 2.6%, respectively. Beta carotene bleaching coefficient of EEU was higher (2550 ± 123), when compared to endosperm extract of ripe fruits (1729 ± 172). Additionally, EEU exhibited high antioxidant capacity by phosphomolybdenum method and ferric reducing antioxidant power values. Eight phenolic compounds from Nypa fruticans endosperm extracts were identified and quantified by ultra-high-performance liquid chromatography. Chlorogenic acid, protocatechuic acid, and kaempferol were the major phenolic compounds. Thus this fruit could be used as a potential source of natural antioxidant.
  16. Guan Q, Yu J, Zhu W, Yang B, Li Y, Zhang L, et al.
    Gene, 2018 Mar 01;645:60-68.
    PMID: 29274907 DOI: 10.1016/j.gene.2017.12.045
    Ultraviolet-B (UVB) irradiation induces oxidative stress in plant cells due to the generation of excessive reactive oxygen species. Morus alba L. (M. abla) is an important medicinal plant used for the treatment of human diseases. Also, its leaves are widely used as food for silkworms. In our previous research, we found that a high level of UVB irradiation with dark incubation led to the accumulation of secondary metabolites in M. abla leaf. The aim of the present study was to describe and compare M. alba leaf transcriptomics with different treatments (control, UVB, UVB+dark). Leaf transcripts from M. alba were sequenced using an Illumina Hiseq 2000 system, which produced 14.27Gb of data including 153,204,462 paired-end reads among the three libraries. We de novo assembled 133,002 transcripts with an average length of 1270bp and filtered 69,728 non-redundant unigenes. A similarity search was performed against the non-redundant National Center of Biotechnology Information (NCBI) protein database, which returned 41.08% hits. Among the 20,040 unigenes annotated in UniProtKB/SwissProt database, 16,683 unigenes were assigned 102,232 gene ontology terms and 6667 unigenes were identified in 287 known metabolic pathways. Results of differential gene expression analysis together with real-time quantitative PCR tests indicated that UVB irradiation with dark incubation enhanced the flavonoid biosynthesis in M. alba leaf. Our findings provided a valuable proof for a better understanding of the metabolic mechanism under abiotic stresses in M. alba leaf.
  17. Sharif HMA, Mahmood N, Wang S, Hussain I, Hou YN, Yang LH, et al.
    Chemosphere, 2021 Jun;273:129695.
    PMID: 33524756 DOI: 10.1016/j.chemosphere.2021.129695
    Recently, the discharge of flue gas has become a global issue due to the rapid development in industrial and anthropogenic activities. Various dry and wet treatment approaches including conventional and hybrid hybrid wet scrubbing have been employing to combat against these toxic exhaust emissions. However, certain issues i.e., large energy consumption, generation of secondary pollutants, low regeneration of scrubbing liquid and high efficieny are hindering their practical applications on industrial level. Despite this, the hybrid wet scrubbing technique (advanced oxidation, ionic-liquids and solid engineered interface hybrid materials based techniques) is gaining great attention because of its low installation costs, simultaneous removal of multi-air pollutants and low energy requirements. However, the lack of understanding about the basic principles and fundamental requirements are great hurdles for its commercial scale application, which is aim of this review article. This review article highlights the recent developments, minimization of GHG, sustainable improvements for the regeneration of used catalyst via green and electron rich donors. It explains, various hybrid wet scrubbing techniques can perform well under mild condition with possible improvements such as development of stable, heterogeneous catalysts, fast and in-situ regeneration for large scale applications. Finally, it discussed recovery of resources i.e., N2O, NH3 and N2, the key challenges about several competitive side products and loss of catalytic activity over time to treat toxic gases via feasible solutions by hybrid wet scrubbing techniques.
  18. Yuan Y, Wang YB, Jiang Y, Prasad KN, Yang J, Qu H, et al.
    Int J Biol Macromol, 2016 Jan;82:696-701.
    PMID: 26505952 DOI: 10.1016/j.ijbiomac.2015.10.069
    The water-soluble bioactive polysaccharides can contribute to the health benefits of Lycium barbarium fruit. However, the structure characteristics of these polysaccharides remain unclear yet. An important polysaccharide (LBPA) was isolated and purified from L. barbarium in this work. It was identified by chemical and spectroscopic methods as arabinogalactan with β-d-(1→6)-galactan as backbone, which was different to any reported polysaccharides from this species before. This arabinogalactan was comprised of Araf, Galp, GlcpA and Rhap with a molar ratio of 9.2:6.6:1.0:0.9. The side chains, including α-l-Araf-(1→, α-l-Araf-(1→5)-α-l-Araf-(1→, β-l-Araf-(1→5)-α-l-Araf-(1→ and α-l-Rhap-(1→4)-β-d-GlcpA-(1→6)-β-d-Galp-(1→, were linked to β-d-(1→6)-galactan at O-3. The putative structure was drawn as below. The molecular weight was determined to be 470,000g/mol by gel permeation chromatography.
  19. Yang B, Prasad KN, Jiang Y
    Carbohydr Polym, 2016 Feb 10;137:570-575.
    PMID: 26686165 DOI: 10.1016/j.carbpol.2015.10.088
    As a health-beneficial fruit, litchi is widely accepted by people in subtropical and tropical regions. However, the critical chemicals responsible for the health benefits are not clear yet. As a large amount of polysaccharides are present in litchi, they might play an important role in the health benefits. In this work, the main water-soluble polysaccharide (LPPBa) was purified from litchi pulp. The chemical structure was characterized as arabinogalactan by gas chromatography and nuclear magnetic resonance spectrometry (NMR). NMR data revealed the glycosidic linkages and their locations in backbone and branches. The precise structure was putatively identified as below, and it was different to those commonly occurred arabinogalactans. The molecular weight was determined to be 2.4 × 10(6)Da by gel permeation chromatography.
  20. Viecelli AK, Teixeira-Pinto A, Valks A, Baer R, Cherian R, Cippà PE, et al.
    BMC Nephrol, 2022 Nov 19;23(1):372.
    PMID: 36402958 DOI: 10.1186/s12882-022-02987-1
    BACKGROUND: A functioning vascular access (VA) is crucial to providing adequate hemodialysis (HD) and considered a critically important outcome by patients and healthcare professionals. A validated, patient-important outcome measure for VA function that can be easily measured in research and practice to harvest reliable and relevant evidence for informing patient-centered HD care is lacking. Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID) aims to assess the accuracy and feasibility of measuring a core outcome for VA function established by the international Standardized Outcomes in Nephrology (SONG) initiative.

    METHODS: VALID is a prospective, multi-center, multinational validation study that will assess the accuracy and feasibility of measuring VA function, defined as the need for interventions to enable and maintain the use of a VA for HD. The primary objective is to determine whether VA function can be measured accurately by clinical staff as part of routine clinical practice (Assessor 1) compared to the reference standard of documented VA procedures collected by a VA expert (Assessor 2) during a 6-month follow-up period. Secondary outcomes include feasibility and acceptability of measuring VA function and the time to, rate of, and type of VA interventions. An estimated 612 participants will be recruited from approximately 10 dialysis units of different size, type (home-, in-center and satellite), governance (private versus public), and location (rural versus urban) across Australia, Canada, Europe, and Malaysia. Validity will be measured by the sensitivity and specificity of the data acquisition process. The sensitivity corresponds to the proportion of correctly identified interventions by Assessor 1, among the interventions identified by Assessor 2 (reference standard). The feasibility of measuring VA function will be assessed by the average data collection time, data completeness, feasibility questionnaires and semi-structured interviews on key feasibility aspects with the assessors.

    DISCUSSION: Accuracy, acceptability, and feasibility of measuring VA function as part of routine clinical practice are required to facilitate global implementation of this core outcome across all HD trials. Global use of a standardized, patient-centered outcome measure for VA function in HD research will enhance the consistency and relevance of trial evidence to guide patient-centered care.

    TRIAL REGISTRATION: Clinicaltrials.gov: NCT03969225. Registered on 31st May 2019.

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