Collagen degradation assessment with an in vitro rotator cuff tendinopathy model using multiparametric ultrashort-TE magnetization transfer (UTE-MT) imaging.

PURPOSE: This study aims to assess ultrashort-TE magnetization transfer (UTE-MT) imaging of collagen degradation using an in vitro model of rotator cuff tendinopathy. METHODS: Thirty-six supraspinatus tendon specimens were divided into three groups and treated with 600 U collagenase (Group 1), 150 U collagenase (Group 2), and phosphate buffer saline (Group 3). UTE-MT imaging was performed to assess changes in macromolecular fraction (MMF), macromolecule transverse relaxation time (T2m), water longitudinal relaxation rate constant (R1m), the magnetization exchange rate from the macromolecular to water pool (Rm0 w) and from water to the macromolecular pool (Rm0 m), and magnetization transfer ratio (MTR) at baseline and following digestion and their differences between groups. Biochemical and histological studies were conducted to determine the extent of collagen degradation. Correlation analyses were performed with MMF, T2m, R1m, Rm0 w, Rm0 m, and MTR, respectively. Univariate and multivariate linear regression analyses were performed to evaluate combinations of UTE-MT parameters to predict collagen degradation. RESULTS: MMF, T2m, R1m, Rm0 m, and MTR decreased after digestion. MMF (r = -0.842, p < 0.001), MTR (r = -0.78, p < 0.001), and Rm0 m (r = -0.662, p < 0.001) were strongly negatively correlated with collagen degradation. The linear regression model of differences in MMF and Rm0 m before and after digestion explained 68.9% of collagen degradation variation in the tendon. The model of postdigestion in MMF and T2m and the model of MTR explained 54.2% and 52.3% of collagen degradation variation, respectively. CONCLUSION: This study highlighted the potential of UTE-MT parameters for evaluation of supraspinatus tendinopathy.

Assessment of triglyceride clearance of haemoperfusion from three cases of hypertriglyceridaemia-induced acute pancreatitis: a case series.

Rapid reduction of plasma triglycerides (TG) is believed to improve the outcome of pancreatitis in the context of hypertriglyceridaemia (HTG)-induced acute pancreatitis (HTG-AP). Previous studies have suggested that haemoperfusion (HP) with the Jafron cartridge series could be effective for reducing TG concentrations in patients with HTG-AP. However, the clearance capacity (CC) for TG removal has not been reported. This case series reports on data from three patients with HTG-AP who underwent HP with HA230 or HA330 cartridges. Blood samples were collected from both before and after the cartridge circuit every 30 min and the CC was calculated. Twelve pairs of blood samples were collected for each type of HP cartridge. The mean ± SD CC of the HA230 cartridge for TG removal in this case series was 0.009781 ± 1.117235 ml/min (95% confidence interval [CI], -0.7000762, 0.7196384 ml). The mean ± SD CC of the HA330 cartridge for TG removal in this case series was 0.344914 ± 1.412183 ml/min (95% CI, -0.5523448, 1.2421721 ml). Based on the findings of this small case series, special caution is advised when considering the use of the HA230 and HA330 cartridges for reducing blood TG concentration pending further conclusive evidence from larger studies.

Low-coverage whole genome sequencing of diverse Dioscorea bulbifera accessions for plastome resource development, polymorphic nuclear SSR identification, and phylogenetic analyses.

Dioscorea bulbifera (Dioscoreaceae), a versatile herbaceous climber native to Africa and Asia, holds significant nutritional and medicinal value. Despite extensive characterization and genetic variability analyses of African accessions, studies on the genetic variation of this species in China are limited. To address this gap, we conducted low-coverage whole genome sequencing on D. bulbifera accessions from diverse regions across mainland China and Taiwan island. Our initial investigation encompassed comprehensive comparative plastome analyses of these D. bulbifera accessions, and developing plastome resources (including plastome-derived repetitive sequences, SSRs, and divergent hotspots). We also explored polymorphic nuclear SSRs and elucidated the intraspecific phylogeny of these accessions. Comparative plastome analyses revealed that D. bulbifera plastomes exhibited a conserved quadripartite structure with minimal size variation mainly attributed to intergenic spacer regions, reinforcing prior observations of a high degree of conservation within a species. We identified 46 to 52 dispersed repeats and 151 to 163 plastome-derived SSRs, as well as highlighted eight key divergent hotspots in these D. bulbifera accessions. Furthermore, we developed 2731 high-quality candidate polymorphic nuclear SSRs for D. bulbifera. Intraspecific phylogenetic analysis revealed three distinct clades, where accessions from Southeast China formed a sister group to those from South China and Taiwan island, and collectively, these two clades formed a sister group to the remaining accessions, indicating potential regional genetic divergence. These findings not only contributed to the understanding of the genetic variation of D. bulbifera, but also offered valuable resources for future research, breeding efforts, and utilization of this economically important plant species.

[Research on the Evaluation Method and Application of Provincial Differentiated Carbon Peaking in China].

Promoting regions with favorable conditions to take the lead in reaching a carbon peak is an inevitable step towards achieving the dual carbon goals under the "nationwide coordinated action" plan. Considering the differences among Chinese provinces, this study measured the peaking pressure of each province based on the spatial distribution of carbon emissions. We then constructed a provincial peaking capacity evaluation system based on five dimensions, namely, peaking pressure, emission reduction status, economic development, policy support, and resource endowment, to comprehensively evaluate the carbon peaking capacity of 30 provincial administrative regions in China, excluding Hong Kong, Macau, Taiwan, and Tibet, using the entropy value method to determine the index weights. The 30 provinces were divided into five peaking tiers according to the evaluation results. The results showed that:① 18 regions, such as Hainan and Beijing, displayed a surplus in carbon emission space; eight regions, including Hebei and Shandong, showed a deficit in carbon emission space; and the carbon emission spaces allocated to Zhejiang, Anhui, Henan, and Hubei were comparable to their respective actual emissions. ② Developed regions generally had a higher carbon peaking capacity than that of less developed regions, with Beijing and Shanghai showing outstanding carbon peaking capacity, whereas Jiangxi and Guizhou had more room to improve their capacity. Finally, differentiated peaking targets and priority actions were proposed according to the provinces' different peaking tiers and local conditions.

Persistence of severe global inequalities in the burden of blindness and vision loss from 1990 to 2019: findings from the Global Burden of Disease Study 2019.

AIMS: To assess the global burden and economic inequalities in the distribution of blindness and vision loss between 1990 and 2019. METHODS: A secondary analysis of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019. Data for disability-adjusted life-years (DALYs) due to blindness and vision loss were extracted from the GBD 2019. Data for gross domestic product per capita were extracted from the World Bank database. Slope index of inequality (SII) and concentration index were computed to assess absolute and relative cross-national health inequality, respectively. RESULTS: Countries with high, high-middle, middle, low-middle and low Socio-demographic Index (SDI) had decline of age-standardised DALY rate of 4.3%, 5.2%, 16.0%, 21.4% and 11.30% from 1990 to 2019, respectively. The poorest 50% of world citizens bore 59.0% and 66.2% of the burden of blindness and vision loss in 1990 and 2019, respectively. The absolute cross-national inequality (SII) fell from -303.5 (95% CI -370.8 to -236.2) in 1990 to -256.0 (95% CI -288.1 to -223.8) in 2019. The relative inequality (concentration index) for global blindness and vision loss remained essentially constant between 1991 (-0.197, 95% CI -0.234 to -0.160) and 2019 (-0.193, 95% CI -0.216 to -0.169). CONCLUSION: Though countries with middle and low-middle SDI were the most successful in decreasing burden of blindness and vision loss, a high level of cross-national health inequality persisted over the past three decades. More attention must be paid to the elimination of avoidable blindness and vision loss in low-income and middle-income countries.

Intraspecific phylogeny and genomic resources development for an important medical plant Dioscorea nipponica, based on low-coverage whole genome sequencing data.

Dioscorea nipponica Makino, a perennial twining herb with medicinal importance, has a disjunctive distribution in the Sino-Japanese Floristic Region. It has a long history in traditional Chinese medicine, with demonstrated efficacy against various health conditions. However, the limited genomic data and knowledge of genetic variation have hindered its comprehensive exploration, utilization and conservation. In this study, we undertook low-coverage whole genome sequencing of diverse D. nipponica accessions to develop both plastome (including whole plastome sequences, plastome-derived SSRs and plastome-divergent hotspots) and nuclear genomic resources (including polymorphic nuclear SSRs and single-copy nuclear genes), as well as elucidate the intraspecific phylogeny of this species. Our research revealed 639 plastome-derived SSRs and highlighted six key mutational hotspots (namely CDS ycf1, IGS trnL-rpl32, IGS trnE-trnT, IGS rps16-trnQ, Intron 1 of clpP, and Intron trnG) within these accessions. Besides, three IGS regions (i.e., ndhD-cssA, trnL-rpl32, trnD-trnY), and the intron rps16 were identified as potential markers for distinguishing D. nipponica from its closely related species. In parallel, we successfully developed 988 high-quality candidate polymorphic nuclear SSRs and identified 17 single-copy nuclear genes for D. nipponica, all of which empower us to conduct in-depth investigations into phylogenetics and population genetics of this species. Although our phylogenetic analyses, based on plastome sequences and single-copy nuclear genes revealed cytonuclear discordance within D. nipponica, both findings challenged the current subspecies classification. In summary, this study developed a wealth of genomic resources for D. nipponica and enhanced our understanding of the intraspecific phylogeny of this species, offering valuable insights that can be instrumental in the conservation and strategic utilization of this economically significant plant.

The econometric analysis of voluntary environmental regulations and total factor productivity in agribusiness under digitization.

Under the new development pattern, both "digital" and "low-carbon" development have entered the fast track, and digital transformation has become an important path to promote green development and enhance total factor productivity in agriculture. Based on the data of agricultural companies, this paper empirically verifies the impact of voluntary environmental regulations on total factor productivity. The empirical results show that voluntary environmental regulation has a significant positive impact on total factor productivity of agribusiness. In the mechanistic analysis, it is found that voluntary environmental regulations accelerate the digital transformation process of firms, which in turn increases their total factor productivity. In addition, the level of government environmental concern contributes to the increase of voluntary environmental regulations on firms' total factor productivity. The findings have practical implications for the sustainable development of agribusiness, providing empirical evidence for policy formulation and adjustment, and helping the agricultural economy to achieve high-quality development.

Cost-effectiveness analysis of imatinib versus dasatinib in the treatment of pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia when combined with conventional chemotherapy in China.

BACKGROUND: Tyrosine kinase inhibitors combined with conventional chemotherapy (CC) in treating Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL) has achieved promising efficacy and safety outcomes. The study was conducted to compare the cost-effectiveness between imatinib (HANSOH Pharma, Jiangsu, China) and dasatinib (CHIATAI TIANQING Pharma, Jiangsu, China) in treating pediatric Ph-positive ALL when combined with CC from the perspective of the health system in China. METHODS: A Markov model was established to simulate a hypothetical cohort of pediatric Ph-positive ALL patients receiving imatinib or dasatinib, combined with CC. The model was designed using a 10-year horizon, a 3- month cycle, and a 5% discount rate. Three health states were included: alive with progression-free survival, progressed disease, and death. Patient characteristics and transition probabilities were estimated based on clinical trials. Other relevant data, such as direct treatment costs and health utility data were extracted from published literature and Sichuan Province's centralized procurement and supervision platform. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results. The willingness-to-pay (WTP) was set as three times China's GDP per capita in 2021. RESULTS: In the base-case analysis, the total medical costs were $89,701 and $101,182, and the quality-adjusted life years (QALYs) gained were 1.99 and 2.70, for imatinib and dasatinib regimens, respectively. The incremental cost-effectiveness ratio for dasatinib versus imatinib was $16,170/QALY. The probabilistic sensitivity analysis indicated that treatment with dasatinib combined with CC achieved a 96.4% probability of cost-effectiveness at a WTP threshold of $37,765/QALY. CONCLUSIONS: Dasatinib combined with CC is likely to be a cost-effective strategy compared to imatinib combination therapy for pediatric Ph-positive ALL in China at a WTP threshold of $37,765/QALY.

Endoscopic grading of gastric atrophy and histological gastritis staging on risk assessment for early gastric cancer: A case-control study.

OBJECTIVES: To assess the predictive value of endoscopic grading of gastric atrophy using Kimura-Takemoto classification, histological grading systems of operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric cancer (EGC) and other potential risk factors of EGC. METHODS: A single-center, case-control study was retrospectively conducted including 68 patients with EGC treated with endoscopic submucosal dissection and 68 age- and sex-matched control subjects. Kimura-Takemoto classification, OLGA and OLGIM systems, and other potential risk factors were evaluated between the two groups. RESULTS: Of the 68 EGC lesions, 22 (32.4%) were well differentiated, 38 (55.9%) were moderately differentiated, and 8 (11.8%) were poorly differentiated, respectively. Multivariate analysis revealed O-type Kimura-Takemoto classification (adjusted odds ratio [AOR] 3.282, 95% confidence interval [CI] 1.106-9.744, P = 0.032) and OLGIM stage III/IV (AOR 17.939, 95% CI 1.874-171.722, P = 0.012) were significantly related to a higher risk of EGC. Especially, O-type Kimura-Takemoto classification within 6-12 months before EGC diagnosis (AOR 4.780, 95% CI 1.650-13.845, P = 0.004) was independently associated with EGC risk. Areas under the receiver operating characteristic curve of the three systems for EGC were comparable. CONCLUSIONS: Endoscopic Kimura-Takemoto classification and histological OLGIM stage III/IV are independent risk factors for EGC, which may reduce the need for biopsies in risk stratification of EGC. Further multicenter prospective studies of large sizes are needed.

Performance-based neuropsychological assessment tools for executive function among preschoolers in China: A systematic review.

Objective: There is an increasing demand for the assessment of executive function (EF) among Chinese preschoolers. However, there exists methodological and cross-cultural challenges of performance-based EF assessment. The current review aims to 1) identify and summarize the current application of performance-based EF assessment tools for Chinese preschoolers in China and 2) offer recommendation guidelines for different application scenarios, such as clinical or scientific research, and for related personnel.Method: A literature search was conducted from Web of Science, PubMed, PsycInfo, Scopus and China National Knowledge Infrastructure databases. We focused exclusively on performance-based tools assessing EF among children aged three to six years, encompassing tasks of inhibition, working memory, cognitive flexibility, reasoning, problem solving, and/or planning. Clinical (e.g. children with autism spectrum disorders) and multilingual populations residing outside of China (e.g. Chinese Americans) were excluded. Two authors independently screened, extracted, and evaluated each tool for characteristics (e.g. name, domain, type, version, language, approach of administration, and scoring) and sample information (e.g. sample size, age, and region). Results: A total of 98 articles were included, with 255 tools being identified that were further classified into 44 unique types, covering nine EF domains. Most tools were original or informally sinicized, with notable variations in tool selection, administration, and interpretation process. Given that a complete set of EF tools has not been identified as perfectly suitable for Chinese preschoolers, we also offered recommendations based on empirically adapted evaluation criteria. Conclusions: Our findings highlighted the need for appropriate adaptation, administration, and interpretation of the current EF tools.

Financial hardship and psychosocial well-being and quality of life among prostate cancer survivors in the United States.

Prostate cancer is the most common cancer diagnosis among men in the United States and the prevalence of prostate cancer survivors is growing. Cancer treatment and lasting or late effects of disease and treatment can adversely affect financial health, psychosocial well-being, and health-related quality of life for prostate cancer survivors, even many years after cancer diagnosis and treatment. These outcomes are important, especially because most men live for many years following a prostate cancer diagnosis. In this essay, we describe health care spending associated with prostate cancer, including patient out-of-pocket costs, and summarize research examining medical financial hardship and associations of financial hardship and psychosocial well-being and health-related quality of life among cancer survivors. We then discuss implications for health care delivery and opportunities to mitigate financial hardship for patients with prostate cancer and their families.

Cost analysis of childhood hematopoietic stem cell transplantation in Sichuan, China.

Objective: To analyze the inpatient cost of hematopoietic stem cell transplantation (HSCT) in children, so as to support clinical decision-making. Methods: Study population were children who received HSCT in a tertiary children's hospital (Sichuan, China) between 1st January 2020 and 31st December 2021. The median and interquartile range (IQR) of total cost at 100 days post transplantation were calculated. Subgroup analyses were conducted based on age, gender, transplantation types, and post-transplant complications. The cost differences between subgroups were analyzed to determine whether it had an impact on the total costs. Results: A total of 142 pediatric patients were included in the study with a total cost of 250721.78 yuan (197019.16-315740.52, 1 yuan equals to around 0.15 US dollars). Drug costs accounted for 51.85% of the total cost, followed by medical service costs (12.57%) and treatment expenses (12.24%). In terms of transplantation types, the cost of autologous transplantation was lower than that of allogeneic transplantation (115722.98 yuan vs. 256043.99 yuan, p < 0.05), and the cost of human leukocyte antigen (HLA) complete matched was lower compared with that of partial matched (213760.88 yuan vs. 294044.84 yuan, p < 0.05). As for post-transplant complications, cases with <3 types of complications cost less than those with ≥3 types (212893.25 yuan vs. 286064.60 yuan, p < 0.05), and those with severity ≤ grade 2 cost less than those > grade 2 (235569.37 yuan vs. 280061.58 yuan, p < 0.05). Age and gender of patients did not lead to statistical differences in the total cost, while the transplantation types and post-transplant complications influenced the total cost. Conclusion: The total cost at 100 days post transplantation associated with HSCT treatment were substantial for pediatric patients. The HLA compatibility between donors and recipients, and post-transplant complications were important factors affecting the total cost.

Global monthly sectoral water use for 2010-2100 at 0.5° resolution across alternative futures.

Water usage is closely linked with societal goals that are both local and global in scale, such as sustainable development and economic growth. It is therefore of value, particularly for long-term planning, to understand how future sectoral water usage could evolve on a global scale at fine resolution. Additionally, future water usage could be strongly shaped by global forces, such as socioeconomic and climate change, and the multi-sector dynamic interactions those forces create. We generate a novel global gridded monthly sectoral water withdrawal and consumption dataset at 0.5° resolution for 2010-2100 for a diverse range of 75 scenarios. The scenarios are harmonized with the five Shared Socioeconomic Pathways (SSPs) and four Representative Concentration Pathways (RCPs) scenarios to support its usage in studies evaluating the implications of uncertain human and earth system change for future global and regional dynamics. To generate the data, we couple the Global Change Analysis Model (GCAM) with a land use spatial downscaling model (Demeter), a global hydrologic framework (Xanthos), and a water withdrawal downscaling model (Tethys).

Spatio-temporal heterogeneity in the international trade resilience during COVID-19.

The COVID-19 pandemic and subsequent lockdowns have created immeasurable health and economic crises, leading to unprecedented disruptions to world trade. The COVID-19 pandemic shows diverse impacts on different economies that suffer and recover at different rates and degrees. This research aims to evaluate the spatio-temporal heterogeneity of international trade network vulnerabilities in the current crisis to understand the global production resilience and prepare for the future crisis. We applied a series of complex network analysis approaches to the monthly international trade networks at the world, regional, and country scales for the pre- and post- COVID-19 outbreak period. The spatio-temporal patterns indicate that countries and regions with an effective COVID-19 containment such as East Asia show the strongest resilience, especially Mainland China, followed by high-income countries with fast vaccine roll-out (e.g., U.S.), whereas low-income countries (e.g., Africa) show high vulnerability. Our results encourage a comprehensive strategy to enhance international trade resilience when facing future pandemic threats including effective non-pharmaceutical measures, timely development and rollout of vaccines, strong governance capacity, robust healthcare systems, and equality via international cooperation. The overall findings elicit the hidden global trading disruption, recovery, and growth due to the adverse impact of the COVID-19 pandemic.

A Machine Learning Approach to Support Urgent Stroke Triage Using Administrative Data and Social Determinants of Health at Hospital Presentation: Retrospective Study.

BACKGROUND: The key to effective stroke management is timely diagnosis and triage. Machine learning (ML) methods developed to assist in detecting stroke have focused on interpreting detailed clinical data such as clinical notes and diagnostic imaging results. However, such information may not be readily available when patients are initially triaged, particularly in rural and underserved communities. OBJECTIVE: This study aimed to develop an ML stroke prediction algorithm based on data widely available at the time of patients' hospital presentations and assess the added value of social determinants of health (SDoH) in stroke prediction. METHODS: We conducted a retrospective study of the emergency department and hospitalization records from 2012 to 2014 from all the acute care hospitals in the state of Florida, merged with the SDoH data from the American Community Survey. A case-control design was adopted to construct stroke and stroke mimic cohorts. We compared the algorithm performance and feature importance measures of the ML models (ie, gradient boosting machine and random forest) with those of the logistic regression model based on 3 sets of predictors. To provide insights into the prediction and ultimately assist care providers in decision-making, we used TreeSHAP for tree-based ML models to explain the stroke prediction. RESULTS: Our analysis included 143,203 hospital visits of unique patients, and it was confirmed based on the principal diagnosis at discharge that 73% (n=104,662) of these patients had a stroke. The approach proposed in this study has high sensitivity and is particularly effective at reducing the misdiagnosis of dangerous stroke chameleons (false-negative rate <4%). ML classifiers consistently outperformed the benchmark logistic regression in all 3 input combinations. We found significant consistency across the models in the features that explain their performance. The most important features are age, the number of chronic conditions on admission, and primary payer (eg, Medicare or private insurance). Although both the individual- and community-level SDoH features helped improve the predictive performance of the models, the inclusion of the individual-level SDoH features led to a much larger improvement (area under the receiver operating characteristic curve increased from 0.694 to 0.823) than the inclusion of the community-level SDoH features (area under the receiver operating characteristic curve increased from 0.823 to 0.829). CONCLUSIONS: Using data widely available at the time of patients' hospital presentations, we developed a stroke prediction model with high sensitivity and reasonable specificity. The prediction algorithm uses variables that are routinely collected by providers and payers and might be useful in underresourced hospitals with limited availability of sensitive diagnostic tools or incomplete data-gathering capabilities.

COVID-19 infection rate but not severity is associated with availability of greenness in the United States.

Human exposure to greenness is associated with COVID-19 prevalence and severity, but most relevant research has focused on the relationships between greenness and COVID-19 infection rates. In contrast, relatively little is known about the associations between greenness and COVID-19 hospitalizations and deaths, which are important for risk assessment, resource allocation, and intervention strategies. Moreover, it is unclear whether greenness could help reduce health inequities by offering more benefits to disadvantaged populations. Here, we estimated the associations between availability of greenness (expressed as population-density-weighted normalized difference vegetation index) and COVID-19 outcomes across the urban-rural continuum gradient in the United States using generalized additive models with a negative binomial distribution. We aggregated individual COVID-19 records at the county level, which includes 3,040 counties for COVID-19 case infection rates, 1,397 counties for case hospitalization rates, and 1,305 counties for case fatality rates. Our area-level ecological study suggests that although availability of greenness shows null relationships with COVID-19 case hospitalization and fatality rates, COVID-19 infection rate is statistically significant and negatively associated with more greenness availability. When performing stratified analyses by different sociodemographic groups, availability of greenness shows stronger negative associations for men than for women, and for adults than for the elderly. This indicates that greenness might have greater health benefits for the former than the latter, and thus has limited effects for ameliorating COVID-19 related inequity. The revealed greenness-COVID-19 links across different space, time and sociodemographic groups provide working hypotheses for the targeted design of nature-based interventions and greening policies to benefit human well-being and reduce health inequity. This has important implications for the post-pandemic recovery and future public health crises.

A PETAR method for risk assessment of human health and environment on the regional scale.

Risk assessments are necessary to effectively reveal the state of the degradation of living environments on a regional scale. However, risk assessments are often limited by time, cost, and technology, which make conducting effective evaluations difficult. Thus, in this study, the procedure for ecological tiered assessment of risk (PETAR) method was used to analyze the human health and environmental risks in Daye, China. This method first used the United States Environmental Protection Agency's risk assessment approach to qualitatively determine the risk sources, pressures, receptors, and effect endpoints and constructed a conceptual model of threats to the human living environment. Each risk-prone subregion was then evaluated using the fuzzy logic method. Next, a quantitative assessment was conducted for the subregions with the most serious environmental degradation. Finally, quantitative analyses were performed to verify the original hypotheses. The results showed that the high-risk areas were distributed in the industrial regions of Daye, wherein mining and processing clusters and mining settlements are widespread and confirmed the locations of the particular subregions with the most serious human health and environmental risks. This study also validated the practicality of the PETAR method for human health risk assessments in mining areas with large-scale, multifactor, and multihazard paths. Integr Environ Assess Manag 2023;19:239-253. © 2022 SETAC.

Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study.

Background: Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients. Methods: We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups. Results: Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001). Conclusion: Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.

Potential productivity loss from uncorrected and under-corrected presbyopia in low- and middle-income countries: A life table modeling study.

Objective: To estimate the burden of potential productivity losses due to uncorrected and under-corrected presbyopia in LMICs among the working-age population in both the cross-sectional and longitudinal manner. Methods: We extracted data for the prevalence of presbyopia from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019. Data for the gross domestic product (GDP) per capita were extracted from the World Bank database and Central Intelligence Agency's World Factbook. We introduced life table models to construct age cohorts (in 5-year age groups) of the working-age population (aged from 40 to 64 years old) in LMICs, with simulated follow-up until 65 years old in people with and without uncorrected presbyopia. The differences in productivity-adjusted life years (PALYs) lived and productivity between these two cohorts were calculated. The potential productivity loss was estimated based on GDP per capita. The WHO standard 3% annual discount rate was applied to all years of life and PALYs lived. Results: In 2019, there were 238.40 million (95% confidence interval [CI]: 150.92-346.78 million) uncorrected and under-corrected presbyopia cases in LMICs, resulting in 54.13 billion (current US dollars) (95% confidence interval [CI]: 34.34-79.02 billion) potential productivity losses. With simulated follow-up until retirement, those with uncorrected and under-corrected presbyopia were predicted to experience an additional loss of 155 million PALYs (an average loss of 0.7 PALYs per case), which was equivalent to a total loss of US$ 315 billion (an average loss of US$ 1453.72 per person). Conclusions: Our findings highlight the considerable productivity losses due to uncorrected and under-corrected presbyopia in LMICs, especially in a longitudinal manner. There is a great need for the development of enabling eye care policies and programs to create access to eye care services, and more healthcare investment in the correction of presbyopia in the working-age population in LMICs. This study could provide evidences for some potential health-related strategies for socio-economic development.

External Assessment of the Anti-N-Methyl-D-Aspartate Receptor Encephalitis One-Year Functional Status Score in Chinese Pediatric Patients.

Objective: to assess the performance of the Anti-N-Methyl-D-Aspartate Receptor encephalitis (NMDAR) One-Year Functional Status (NEOS) score in predicting one-year functional outcome in Chinese children with anti-NMDAR encephalitis. Methods: children with anti-NMDAR encephalitis at the Children's Hospital of Chongqing Medical University were retrospectively enrolled from January 2014 to December 2020. Patients were categorized into two groups based on the modified Rankin Scale (mRS) at one-year follow-up. Discrimination of the NEOS score was assessed by the area under curve (AUC) of the receiver operating characteristic curve. Calibration of the NEOS score was assessed by comparing predicted probabilities with observed probabilities using a calibration curve and the Hosmer-Lemeshow test. The clinical practicability of the NEOS score was evaluated by performing a decision curve analysis. Results: one hundred seventy-five children (101 females and 74 males) with anti-NMDAR encephalitis and a median age of 7.7 years were enrolled. Of those, 149 (85.1%) had a good outcome at 1 year (mRS ≤ 2), and the remaining 26 (14.9%) had a poor outcome (mRS > 2). Patients with a higher NEOS score had a significantly higher mRS at one-year follow-up [Spearman r = 0.3878, 95% confidence interval (CI): 0.2500-0.5103, P < 0.001]. The AUC of the NEOS score was 0.870 (95% CI: 0.801-0.938, P < 0.001). The observed probability and predicted probability showed moderate consistency in the calibration curve and the Hosmer-Lemeshow test (P = 0.912). The decision curve analysis showed that using the NEOS score to predict one-year outcomes could provide additional net benefit during clinical practice. Conclusions: the NEOS score is a potentially reliable model to predict the one-year functional outcome in Chinese children with anti-NMDAR encephalitis.