Surface property and in vitro toxicity effect of insoluble particles given by protein corona: Implication for PM cytotoxicity assessment.

In vitro toxicological assessment helps explore key fractions of particulate matter (PM) in association with the toxic mechanism. Previous studies mainly discussed the toxicity effects of the water-soluble and organic-soluble fractions of PM. However, the toxicity of insoluble fractions is relatively poorly understood, and the adsorption of proteins is rarely considered. In this work, the formation of protein corona on the surface of insoluble particles during incubation in a culture medium was investigated. It was found that highly abundant proteins in fetal bovine serum were the main components of the protein corona. The adsorbed proteins increased the dispersion stability of insoluble particles. Meanwhile, the leaching concentrations of some metal elements (e.g., Cu, Zn, and Pb) from PM increased in the presence of proteins. The toxicity effects and potential mechanisms of the PM insoluble particle-protein corona complex on macrophage cells RAW264.7 were discussed. The results revealed that the PM insoluble particle-protein corona complex could influence the phagosome pathway in RAW264.7 cells. Thus, it promoted the intracellular reactive oxygen species generation and induced a greater degree of cell differentiation, significantly altering cell morphology. Consequently, this work sheds new light on the combination of insoluble particles and protein corona in terms of PM cytotoxicity assessment.

Footprints of total coliforms, faecal coliforms and E. coli in a wastewater treatment plant and the probabilistic assessment and reduction of E. coli infection risks.

Wastewater contains various pathogenic microorganisms, and the disease of workers caused by exposure to wastewater at the wastewater treatment plants (WWTPs) is a growing concern. The footprints of total coliforms (TC), faecal coliforms (FC) and Escherichia coli (E. coli) in a conventional activated sludge WWTP during 12 consecutive months were clarified. It was found that TC, FC and E.coli in influent were significantly removed (log 4.71, log 4.43 and log 4.62, respectively) by WWTP with sand filtration playing a key role, and excess sludge was a major potential pathway for them flowing to the environment. Through quantitative microbial risk assessment (QMRA), hand-to-mouth ingestion of untreated wastewater and wastewater in secondary/efficient sedimentation tanks, as well as accidental ingestion of sludge in dewatering workshop presented the highest infection risks of pathogenic E.coli in the WWTP, considerably exceeded the U.S. EPA benchmark (≤1 × 10-4 pppy). PPE application and E.coli concentration reduction in wastewater or sludge were recommended to reduce the infection risks at these stages. Further, partial ozonation and dissolved ozone flotation thickening were investigated able to reduce the infection risks at the stages of secondary and tertiary treatment of wastewater or sludge treatment by 90- 98 %. The findings of this study would assist in selecting appropriate processes for the further sanitation of WWTPs.

Differences in medical costs between TCM users and TCM nonusers in inpatients with thalassemia.

BACKGROUND: Thalassemia has brought serious health threats and economic burdens to patients worldwide. There is no sovereign remedy for thalassemia, both conventional and Traditional Medicine (TM) methods have certain effects on this disease. As typical of TM, Traditional Chinese Medicine (TCM) has been widely used in the treatment of thalassemia. Previous studies mainly focused on conventional treatments for thalassemia and patients' medical burden, but no research has examined the effects of TCM use on the economic burdens for thalassemia inpatients in mainland China. The main objective of this study is to compare the medical cost differences between TCM users and TCM nonusers, furtherly, we will discuss the role of TCM use in the treatment of thalassemia. METHODS: We employed the 2010-2016 Medicare claims database provided by the China Health Insurance Research Association (CHIRA). Chi-square and Mann-Whitney tests were used to analyze the differences between TCM users and TCM nonusers. Multiple regression analysis was performed using the ordinary least squares method to compare the TCM users' inpatient medical cost with TCM nonusers', and to further examine the correlation between TCM cost, conventional medication cost and nonpharmacy cost for TCM users. RESULTS: A total of 588 urban thalassemia inpatients were identified, including 222 TCM users and 366 TCM nonusers. The inpatient medical cost of TCM users was RMB10,048 (USD1,513), which was significantly higher than TCM nonusers (RMB1,816 (USD273)). Total inpatient cost for TCM users was 67.4% higher than those of TCM nonusers (P < 0.001). With confounding factors fixed, we found that the conventional medication cost and nonpharmacy cost were positively correlated with TCM cost. CONCLUSION: Total hospitalization expenses for TCM users were higher than TCM nonusers. Both the conventional medication cost and nonpharmacy cost of TCM users were all higher than TCM nonusers. We infer TCM plays a complementary role, rather than an alternative, in the treatment of thalassemia due to the lack of cooperative treatment guidelines. It is recommended that a cooperative diagnosis and treatment guidelines should be generated to balance the use of TCM and conventional medicine for treating thalassemia, so as to reduce the economic burdens on patients.

Costs of traditional Chinese medicine treatment for inpatients with lung cancer in China: a national study.

BACKGROUND: Traditional Chinese Medicine (TCM) has long been a widely recognized medical approach and has been covered by China's basic medical insurance schemes to treat lung cancer. But there was a lack of nationwide research to illustrate the impact of the use of TCM on lung cancer patients' economic burden in mainland China. Therefore, we conduct a nationwide study to reveal whether the use of TCM could increase or decrease the medical expenditure of lung cancer inpatients in mainland China. METHODS: This is a 7-year cross-sectional study from 2010 to 2016. The data is a random sample of 5% from lung cancer claims data records of Chinese Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI). Mann-Whitney test was used to compare inpatient cost data with positive skewness. Ordinary least squares regression analysis was performed to compare the total TCM users' hospitalization cost with TCM nonusers', to examine whether TCM use is the key factor inducing relatively high medical expenditure. RESULT: A total of 47,393 lung cancer inpatients were included in this study, with 38,697 (81.7%) of them at least using one kind of TCM approach. The per inpatient medical cost of TCM users was RMB18,798 (USD2,830), which was 65.2% significantly higher than that of TCM nonusers (P < 0.001). The medication cost, conventional medication cost, and nonpharmacy cost of TCM users were all higher than TCM nonusers, illustrating the higher medical cost of TCM users was not induced by TCM only. With confounding factors fixed, there was a positive correlation between TCM cost and conventional medication cost, nonpharmacy cost (Coef. = 0.283 and 0.211, all P < 0.001), indicting synchronous increase of TCM costs and conventional medication cost for TCM users. CONCLUSION: The use of TCM could not offset the utilization of conventional medicine, demonstrating TCM mainly played a complementary role but not an alternative role in the inpatient treatment of lung cancer. A joint Clinical Guideline that could balance the use of TCM and Conventional medicine should be developed for the purpose of reducing economic burden for lung cancer inpatients.

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis.

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.

Life-cycle assessment of two sewage sludge-to-energy systems based on different sewage sludge characteristics: Energy balance and greenhouse gas-emission footprint analysis.

Anaerobic digestion and incineration are widely used sewage sludge (SS) treatment and disposal approaches to recovering energy from SS, but it is difficult to select a suitable technical process from the various technologies. In this study, life-cycle assessments were adopted to compare the energy- and greenhouse gas- (GHG) emission footprints of two sludge-to-energy systems. One system uses a combination of AD with incineration (the AI system), whereas the other was simplified by direct incineration (the DI system). Comparison between three SS feedstocks (VS/TS: 57.61 -73.1 ds.%) revealed that the AI system consistently outperformed the DI system. The results of sensitivity analyses showed that the energy and GHG emission performances were mainly affected by VS content of the SS, AD conversion efficiency, and the energy consumption of sludge drying. Furthermore, the energy and GHG emission credit of the two systems increased remarkably with the increase in the VS content of the SS. For the high-organic-content sludge (VS/TS: 55%-80%), the energy and GHG emission credit of the AI system increase with the increase of AD conversion efficiency. However, for the low organic content sludge (VS/TS: 30%-55%), it has the opposite effect. In terms of energy efficiency and GHG performance, the AI system is a good choice for the treatment of high-organic-content sludge (VS/TS>55%), but DI shows superiority over AI when dealing with low organic content sludge (VS/TS<55%).

Psychometric Assessment of the Chinese Version of the Indian Vision Functioning Questionnaire Based on the Method of Successive Dichotomizations.

Purpose: The purpose of this study was to assess whether a Chinese translated version of the 33-item Indian Vision Function Questionnaire (IND-VFQ-33) forms a valid measurement scale and to evaluate its psychometric properties based on the method of successive dichotomizations (MSD). Methods: The English version of the IND-VFQ-33 was translated, back translated, and cross-culturally adapted for use in China. It was interviewer administered to patients with cataracts. MSD, a polytomous Rasch model that estimates ordered thresholds, was used to assess and optimize psychometric properties of the overall scale and three subscales separately. Results: One hundred and seventy-nine patients provided complete responses. After the removal of 2 misfitting items, a revised 31-item overall scale demonstrated adequate precision (person reliability [PR] = 0.92) and no misfitting items. The general functioning subscale fit the MSD model well after removing two misfitting items. The psychosocial impact subscale and the visual symptoms subscale were not considered further due to poor measurement precision. After addressing psychometric deficiencies, a 31-item overall scale (IND-VFQ-31-CN) and a 19-item general functioning subscale (IND-VFQ-GF-19-CN) were developed. Conclusions: The original IND-VFQ-33 required re-engineering to form valid measures for use in China. The revised overall scale and general functioning subscale demonstrated adequate MSD based psychometric properties. Translational Relevance: The revised IND-VFQ-33 is a valid patient-reported outcome assessment for Chinese patients with cataract based on MSD analysis.

Clinical application of enhanced recovery after surgery in the treatment of choledocholithiasis by ERCP.

ABSTRACT: This study aims to investigate the effect of applying enhanced recovery after surgery methods (ERAS) in perioperative nursing of choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of biliary calculus.Clinical data from 161 patients who underwent ERCP surgery in Wuhan Union Hospital from January 2017 to December 2019 were retrospectively analyzed. A total of 78 patients received perioperative nursing using the ERAS concept (experimental group) and 83 patients received conventional perioperative nursing (control group). Group differences were compared for the time to first postoperative ambulation, exhausting time, time to first defecation and eating, intraoperative blood loss, postoperative complication incidence (pancreatitis, cholangitis, hemorrhage), white blood cell (WBC), and serum amylase (AMS) values at 24 hours, duration of nasobiliary duct indwelling, length of hospital stay, and hospitalization expenses.No significant between-group differences were noted for demographic characteristics (age, sex, BMI, ASA score, and comorbidity) (P > .05). Time to first ambulation, exhausting time, time to defecation and eating, and nasobiliary drainage time were shorter in the experimental group than the control group, and the differences were statistically significant (P < .05). There was no significant between-group difference in postoperative WBC values at 24 hours (P > .05), but the experimental group's AMS values at 24 hours postoperation were significantly lower than those of the controls (154.93 ±â€Š190.01 vs 241.97 ±â€Š482.64, P = .031). Postoperative complications incidence was 9.1% in the experimental group, which was significantly lower than the 20.4% in the control group, and this difference was statistically significant (P = .039). Compared with the control group, nasobiliary drainage time (26.53 ±â€Š7.43 hours vs 37.56 ±â€Š9.91 hours, P < .001), hospital stay (8.32 ±â€Š1.55 days vs 4.56 ±â€Š1.38 days, P < .001), and hospitalization expenses (36800 ±â€Š11900 Yuan vs 28900 ±â€Š6500 Yuan, P = .016) were significantly lower in the experimental group.ERAS is a safe and effective perioperative nursing application in ERCP for treating choledocholithiasis. It can effectively accelerate patients' recovery and reduce the incidence of complications; therefore, it is worthy of being applied and promoted in clinical nursing.

Assessment of Choroidal Vascularity and Choriocapillaris Blood Perfusion in Anisomyopic Adults by SS-OCT/OCTA.

Purpose: To explore the association of choroidal vascularity and choriocapillaris blood perfusion with myopic severity in anisomyopes. Methods: Refractive error, axial length (AL), and other biometric parameters were measured in 34 anisomyopic young adults. Macular choroidal thickness (ChT) and choroidal vascularity, including total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI), were determined from swept-source optical coherence tomography (SS-OCT) vertical and horizontal B-scans. The percentage of choriocapillaris flow voids (FV%) was obtained from en face SS-OCT-angiography. Results: The spherical equivalent refraction (SER) was -3.35 ± 1.25 diopters in the more myopic eyes and -1.25 ± 1.17 diopters in the less myopic eyes (P < 0.001). The interocular difference in SER was highly correlated with that in AL (P < 0.001). The macular ChT, TCA, LA, and SA were smaller in the more myopic eyes than in the less myopic eyes in both vertical and horizontal scans (all P < 0.001). Importantly, the CVIs in vertical and horizontal scans were smaller and the FV% was greater in the more myopic eyes (P < 0.05). In vertical scans, the interocular difference in CVIs was correlated with that in the SER, AL, and ChT (all P < 0.05). The interocular difference in FV% was correlated with that in SER, AL, and vertical and horizontal ChTs (all P < 0.05). Conclusions: Choroidal vascularity and choriocapillaris blood perfusion were lower in the more myopic eyes of anisomyopic adults. These changes were correlated with the severity of myopia and choroidal thinning, indicating that choroidal blood flow is disturbed in human myopia.

Assessment of heavy metals in water, sediment and shellfish organisms in typical areas of the Yangtze River Estuary, China.

Identifying the transformations of heavy metal in different media is a scientific issue, and geographical detector is applied to evaluate the spatiotemporal stratified heterogeneity mechanisms for heavy metals in the Yangtze River Estuary. Heavy metal concentrations in water and sediment were consistent with lognormal distributions. Their concentrations were organized into four classes. Class 1 included concentrations that were less than or equal to 25%, Class 2 included those between 25%-50%, Class 3 concentrations were between 50%-75% and Class 4 were >75%, which were based on their lognormal distributions. In water and sediment, the mean heavy metal concentrations yearly decreased from 2012 to 2016. The Chongming area was significantly lower than those found in the other areas, which is the least affected area by anthropogenic activities. The explanatory power of sediment to spatiotemporal stratified heterogeneity of heavy metals in shellfish organisms was much greater than that of water.

Comprehensive assessment of T-cell repertoire following autologous hematopoietic stem cell transplantation for treatment of type 1 diabetes using high-throughput sequencing.

OBJECTIVE: We aimed to investigate T-cell receptor (TCR) repertoires in type 1 diabetes (T1D) patients receiving autologous hematopoietic stem cell transplantation (AHSCT) treatment. METHODS: High-throughput deep TCR beta (TCRB) chain sequencing was performed to assess millions of individual TCRs in five T1D patients receiving AHSCT treatment and another five patients receiving insulin treatment during 12 months of follow-up. RESULTS: No significant changes in TCRB sequence reads, complementarity-determining region 3 (CDR3) sequences, or the usage of TCRB VJ gene-segments were observed at 12 months after AHSCT. Compared with the baseline, the usage of TCRB VJ gene-segments at 12 months decreased in the insulin treatment group (1836.4 ± 437.7 vs 2763.6 ± 390.6, P = 0.015), and the change rates were larger than those undergoing AHSCT (-0.62 ± 0.16 vs 0.06 ± 0.45, P = 0.002). Changes in the TCR repertoire were smaller after AHSCT than those with insulin treatment (P = 2.2*10-32 ). TCRBV 7-7/TCRBJ 2-5 was depleted after AHSCT while expanded with insulin treatment. TCRBV 12-4, TCRBV 10-3, TCRBV 12-3/TCRBJ 1-2 were expanded after AHSCT while ablated with insulin treatment. CONCLUSIONS: We found that AHSCT is safe without reduction in the diversity of TCR repertoires and TCR repertoires tend to be more stable after AHSCT. Furthermore, these four candidate TCRBV/TCRBJ gene usages on CDR3 regions may act as therapeutic targets and biomarkers.