A high-precision prediction for spatiotemporal distribution and risk assessment of antibiotics in an urban watershed using a hydrodynamic model.

A methodology for the high-precision prediction and risk assessment of antibiotics at the watershed scale was established. Antibiotic emission inventory and attenuation processes were integrated into the MIKE 11 model to predict the spatiotemporal distribution of norfloxacin, ofloxacin, enrofloxacin, erythromycin, roxithromycin, and sulfamethoxazole in the Nanfei River watershed, China. Considering the variations in antibiotic removal in sewage treatment plants, manure composting, and lagoon systems, the high, medium, and low removal efficiencies of selected antibiotics across China were obtained and used as the best, expected, and worst scenarios, respectively, to evaluate the uncertainty of antibiotic emissions. The predicted concentrations were comparable to antibiotic measurements after flow calibration. The prediction results showed that the highest concentration exposures were mainly concentrated in urban areas with a dense population. Flow variations controlled the temporal distribution characteristics of antibiotics via the dilution effect, and the concentrations of antibiotics in the dry season were 3.1 times higher than those in the wet season. The median concentrations of norfloxacin and erythromycin ranged from 111.36 ng/L to 592.33 ng/L and 106.63 ng/L to 563.01 ng/L, respectively, which both posed a high risk to cyanobacteria and a medium risk to spreading antibiotic resistance. Scenario analysis further demonstrated that high removal efficiencies of these antibiotics can considerably reduce the potential ecotoxicity risks and bacterial resistance selection. The developed methodology for predicting the distribution and risk of antibiotics was suitable for the risk assessment and control strategy of human- and livestock-sourced pollutants.

Comprehensive insights into the occurrence, source, distribution and risk assessment of polycyclic aromatic hydrocarbons in a large drinking reservoir system.

The resource, environment, and ecological value of drinking reservoirs have received widespread concerns due to the pollution of persistent organic pollutants such as polycyclic aromatic hydrocarbons (PAHs). Therefore, we comprehensively studied the occurrence, source, distribution, and risk assessment of representative PAHs in Fengshuba Reservoir (FSBR) (large drinking reservoir, China). The total concentrations of 16 USEPA PAHs in the water phase, porewater phase, sediment phase, and soil phase were in ranges of 109.72-393.19 ng/L, 5.75-35.15 µg/L, 364.4-743.71 µg/kg, and 367.81-639.89 µg/kg, respectively. The naphthalene (Nap) was the dominant PAHs in the water phase, while it was Nap and phenanthrene (Phe) in porewater, sediment, and soil phase. The main sources of PAHs in FSBR were biomass combustion. Redundancy analysis indicated that the NTU, NO2-, NH4+, Chl-α, and IC were the dominant factors influencing the PAH distribution in water phase, and the PAHs in sediment phase was affected by T and NO3-. Pseudo-partitioning coefficients indicated that the PAHs in the porewater phase were more likely to migrate to the sediment phase. Risk assessment indicated that the PAHs both in the water and sediment phases were generally in a low-risk state, while the PAHs in the soil phase were in a moderate-risk state, and the Nap was in a high-risk state, and exposure to the PAHs in FSBR through drinking and skin exposure had little impact on consumers' health. In summary, Nap could be used as a key indicator to evaluate the existence and potential risk of PAHs in FSBR.

Real-world cost-effectiveness analysis of the fracture liaison services model of care for hip fracture in Taiwan.

BACKGROUND: This study was to perform an economic evaluation to understand clinical outcomes and health resource use between hip fracture patients receiving hospital-based postfracture fracture liaison service (FLS) care and those receiving usual care (UC) in Taiwan. METHODS: This cohort study included hospital-based data of 174 hip fracture patients who received FLS care (FLS group) from National Taiwan University Hospital, and 1697 propensity score-matched patients who received UC (UC group) of National Health Insurance claim-based data. Two groups had similar baseline characteristics but differed in hip fracture care after propensity score matching. Clinical outcomes included refracture-free survival (RFS), hip-refracture-free survival (HRFS), and overall survival (OS). Health resource use included inpatient, outpatient, and pharmacy costs within 2 years follow-up after the index of hip fracture. The economic evaluation of the FLS model was analyzed using the net monetary benefit regression framework based on the National Health Insurance perspective. RESULTS: The FLS group had longer RFS than the UC group, with an adjusted difference of 44.3 days (95% confidence interval: 7.2-81.4 days). Two groups did not differ in inpatient and outpatient costs during follow-up, but the FLS group had a higher expenditure than the UC group on osteoporosis-related medication. The probability of FLS being cost-effective was >80% and of increasing RFS, HRFS, and OS was 95%, 81%, and 80%, respectively, when the willingness-to-pay threshold was >USD 65/gross domestic product per day. CONCLUSION: FLS care was cost-effective in reducing refracture occurrence days for patients initially diagnosed with hip fractures.

Comprehensive Assessment of Right Ventricular Function by Three-Dimensional Speckle-Tracking Echocardiography: Comparisons with Cardiac Magnetic Resonance Imaging.

BACKGROUND: Three-dimensional speckle-tracking echocardiography (3D-STE) has been increasingly used to quantify right ventricular (RV) function. However, direct comparisons of 3D-STE with cardiac magnetic resonance (CMR) imaging for evaluation of RV function are limited. This study aimed to test the feasibility and accuracy of 3D-STE for the quantification of RV volumes, ejection fraction (EF), and longitudinal strain in comparison with CMR imaging and to determine whether 3D-STE for RV strain is superior to two-dimensional (2D) STE in comparison with CMR imaging. METHODS: A total of 195 consecutive patients referred for both CMR imaging and echocardiography were studied. Right ventricular end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RVEF, and 3D RV longitudinal strain (3D-RVLS) of the free wall by 3D-STE and 2D-RVLS of the free wall by 2D-STE, were compared with CMR measurements. Pearson correlation and Bland-Altman analyses were used to assess the intertechnique agreement. RESULTS: Right ventricular 3D-STE was feasible in 174 patients (89%). Right ventricular volumes and EF determined by 3D-STE strongly correlated with CMR values (RVEDV, r = 0.94; RVESV, r = 0.96; RVEF, r = 0.91; all P < .001). Three-dimensional STE slightly underestimated the RV volumes and longitudinal strain and overestimated the RVEF. The 3D-RVLS values correlated better than 2D-RVLS values with CMR values (0.85 vs 0.64, P < .001) with smaller bias and narrower limits of agreement (bias: 2.0 and 2.6; limits of agreement: 8.5 and 12.5, respectively). The bias and limits of agreement for 3D-STE-obtained RVLS were increased in patients with RV dilation, RVEF < 45%, or lower frame rate compared with those with normal RV size, RVEF ≥ 45%, or higher frame rate, respectively. Right ventricular 3D-STE measurements were highly reproducible. CONCLUSIONS: The 3D-STE measurements of RV volumes, EF, and longitudinal strain are highly feasible and reproducible, and data measured by 3D-STE correlate strongly with those determined using CMR imaging. Thus, 3D-STE may be a valid alternative to CMR imaging for the quantification of RV function in everyday clinical practice.

Multi-phase distribution, spatiotemporal variation and risk assessment of antibiotics in a typical urban-rural watershed.

The widespread consumption and continuous discharge of antibiotics have threatened the ecological health of urban-rural watershed. In this study, multi-phase distribution, spatiotemporal variation and ecological risk of 18 antibiotics in rivers and lakes from Suzhou City were investigated based on urban-rural gradient. The total antibiotic concentration in surface water, suspended particulate matter (SPM) and sediments was 39.28-2578 ng/L, 6.16-171.09 ng/L and 12.67-2249 ng/g, respectively. High detection frequency (>76%) and concentration of antibiotics in multi-phase suggested universal pollution. Quinolones (QNs) and tetracycline (TCs) were the dominant antibiotics detected. The partitioning coefficient (KP) value of SPM-water was 1.43-29.93 times larger than sediment-water, indicating that SPM can greatly affect the fate and distribution of antibiotics. Significant positive correlations between antibiotics and environmental parameters (e.g. TOC, TP and TN) revealed combined contamination and similar pollution sources. Antibiotic pollution exhibited evident spatiotemporal variation. For spatial variation, urban area showed more serious antibiotic pollution and greater ecological risk than rural and suburb areas, especially for sediments. Besides, antibiotic level and risk in rivers were higher than lakes. For seasonal variation, in case of surface water, rural area exhibited higher content in winter, while greater content was detected in autumn and spring in urban and suburb areas, respectively. The highest antibiotic content in SPM and sediments was all measured in winter owing to weak degradation ability. Ecological risk assessment based on risk quotients (RQs) indicated that norfloxacin (NFX), ciprofloxacin (CFX) and anhydroerythromycin (ETM-H2O) in surface water presented medium to high risk throughout the entire year, while sulfadiazine (SDZ) and enrofloxacin (EFX) in sediments showed higher accumulation potential. Thus, these five antibiotics were selected as the priority antibiotics for pollution control. In short, this study improves the understanding of antibiotic fates in the urban-rural watershed and provides scientific basis for the authorities to regulate antibiotic pollution.

Comprehensive insights into the occurrence, distribution, risk assessment and indicator screening of antibiotics in a large drinking reservoir system.

Drinking water reservoir is threatened globally due to anthropogenic contamination and thus in need of more attention. Here, we comprehensively investigated the occurrence, distribution and risk assessment of representative antibiotics in a large drinking water reservoir (Fengshuba Reservoir, China). The total concentrations of antibiotics in the water phase, porewater phase, sediment phase and soil phase (drawdown area) were in the ranges of 195-569 ng/L, 47.1-333 ng/L, 114-272 µg/kg and 2.84-77.2 µg/kg, respectively. The dominant antibiotic was CIP in both the water and porewater phases, while it was OTC in the sediment phase. For the water phase, seasonal factor consisting hydrologic condition and pattern of antibiotic use could influence the occurrence level and environmental fate of antibiotics. In contrast, exogenous particles derived from the soils that had used manures during the spring planting season coupled with heavy rainfall was responsible for the occurrence level and composition of antibiotics in the sediment phase. Moreover, Chl-α, NO3-, TP and EC were the most dominant factor influencing the antibiotic distributions in the water phase, porewater phase, sediment phase and soil phase, respectively. Pseudo-partitioning coefficients indicated that PENV and PENG might accumulate more easily into the sediments from the aqueous phase compared with other antibiotics. Risk assessments suggested that TC might pose high risks to the aquatic ecosystem, but the antibiotics presented no risk to the health of consumers. Generally, TC could be used as a promising indicator for evaluating the occurrence and potential risk of antibiotics in Fengshuba Reservoir.

Occurrence, distribution and risk assessment of pesticides in a river-reservoir system.

The water environment from river to reservoir has been considered as a hybrid river-reservoir system due to pronounced environmental properties. This study investigated the distribution and potential environmental behavior of pesticides in river-reservoir system, examining 31 target pesticides in water phase from a key drinking water source (Dongjiang River). The concentrations of ∑8OCPs, ∑16OPPs and ∑7SPs with the corresponding occurrence were in the range of 107.57-340.35 ng/L (moderate level), 232.65-1197.95 ng/L (moderate level) and 125.23-245.09 ng/L (low level), respectively. Ecological risk assessments indicated that most of the pesticides posed a high level of risk to the aquatic organisms. Moreover, seasonal agricultural application, rainfall and temperature could influence the levels and compositions of ∑8OCPs, ∑16OPPs and ∑7SPs in the river system, while seasonal hydrological processes could only influence their compositions in the reservoir system. In the wet season, the levels of ∑8OCPs and ∑7SPs decreased from the river system to reservoir system probably via biogeochemical processes, while the level of ∑16OPPs decreased along the environmental gradient probably via dilution process. Additionally, longer hydraulic retention time of the reservoir system could contribute to the biogeochemical processes for OPPs and SPs exported from the river system, but it might fail to facilitate this process for OCPs. Taken together, this study highlighted that the distributions and environmental behavior of pesticides in river-reservoir system varied seasonally from river system to reservoir system.

Comparison of Uterine Receptivity between Fertile and Unexplained Infertile Women by Assessment of Endometrial and Subendometrial Perfusion Using Contrast-Enhanced Ultrasound: Which Index is Better--Peak Intensity or Area under the Curve?

The goal of this study was to compare uterine receptivity between women with normal fertility and those with unexplained infertility during natural cycles by assessment of endometrial and subendometrial perfusion using contrast-enhanced ultrasound (CEUS). We wanted to determine the better index: peak intensity (PI) or area under the curve (AUC). Thirty women with unexplained infertility were recruited into the study group, and 30 women with normal fertility were recruited into the control group. All women underwent CEUS during the late proliferative phase, ovulation phase, and implantation window of a menstrual cycle. Endometrial PI, endometrial AUC, subendometrial PI and subendometrial AUC were analyzed. In the late proliferative phase, the control group had a significantly higher endometrial PI (p < 0.001) as well as subendometrial PI (p < 0.001) and AUC (p = 0.004) than the study group. In the ovulation phase, the control group had a significantly higher endometrial PI (p < 0.001) and AUC (p = 0.021), as well as subendometrial PI (p < 0.001) and AUC (p = 0.003). During the implantation window, there were no significant differences between the two groups. Only subendometrial PI underwent a significant periodic change during the menstrual cycle in both groups. This finding was further confirmed by evaluation of the microvessel density of endometria. In conclusion, CEUS can be used to assess endometrial and subendometrial perfusion to evaluate uterine receptivity. Subendometrial PI was the most sensitive index compared with endometrial PI, endometrial AUC and subendometrial AUC.