Clinical risk factors and Risk assessment model for Anastomotic leakage after Rectal cancer resection.

BACKGROUND: Anastomotic leakage (AL) is the most serious complication after rectal cancer surgery. Risk factors associated with AL have been documented in previous studies; however, the consensus is still lacking. In this retrospective study, we aimed to identify risk factors for AL after rectal cancer resection and to create an accurate and effective tool for predicting the risk of this complication. METHODS: The study cohort comprised of 276 patients with rectal cancer who had undergone anterior resection between 2015 and 2020. Twenty-four selected variables were assessed by univariate and multivariate logistic regression analyses to identify independent risk factors of AL. A risk assessment model for predicting the risk of AL was established on the basis of the regression coefficients of each identified independent risk factor. RESULTS: Anastomotic leakage occurred in 20 patients (7.2%, 20/276). Multivariate analysis identified the following variables as independent risk or protective factors of AL: perioperative ileus ( P < 0.001, odds ratio [OR] = 14.699), tumor size ≥5 cm ( P = 0.025, OR = 3.925), distance between tumor and anal verge <7.5 cm ( P = 0.045, OR = 3.512), obesity ( P = 0.032, OR = 7.256), and diverting stoma ( P = 0.008, OR = 0.143). A risk assessment model was constructed and patients were allocated to high-, medium-, and low-risk groups on the basis of risk model scores of 5-7, 2-4, and 0-1, respectively. The incidences of AL in these three groups were 61.5%, 11.9%, and 2.0%, respectively ( P < 0.001). CONCLUSIONS: Our risk assessment model accurately and effectively identified patients at high risk of AL and could be useful in aiding decision-making aimed at minimizing adverse outcomes associated with leakage.

Machine learning-assisted assessment of key meteorological and crop factors affecting historical mulch pollution in China.

Degraded mulch pollution is of a great concern for agricultural soils. Although numerous studies have examined this issue from an environmental perspective, there is a lack of research focusing on crop-specific factors such as crop type. This study aimed to explore the correlation between meteorological and crop factors and mulch contamination. The first step was to estimate the amounts of mulch-derived microplastics (MPs) and phthalic acid esters (PAEs) during the rapid expansion period (1993-2012) of mulch usage in China. Subsequently, the Elastic Net (EN) and Random Forest (RF) models were employed to process a dataset that included meteorological, crop, and estimation data. At the national level, the RF model suggested that coldness in fall was crucial for MPs generation, while vegetables acted as a key factor for PAEs release. On a regional scale, the EN results showed that crops like vegetables, cotton, and peanuts remained significantly involved in PAEs contamination. As for MPs generation, coldness prevailed over all regions. Aridity became more critical for southern regions compared to northern regions due to solar radiation. Lastly, each region possessed specific crop types that could potentially influence its MPs contamination levels and provide guidance for developing sustainable ways to manage mulch contamination.

Characteristics and economic burden of hospitalized patients with herpes zoster in China, before vaccination.

Herpes zoster (HZ) brings a significant economic burden. The HZ vaccine was introduced in China for the first time in 2020, and there is a lack of up-to-date information on the hospitalization costs and characteristics prior to vaccination. This study aimed to describe the characteristics and economic burden of HZ inpatients in Hunan Province, China, and analyze the factors influencing the length of stay (LOS) and costs. This was a retrospective study and we extracted information from the Chinese National Health Statistics Network Reporting System on HZ inpatients in Hunan Province, China from 2017 to 2019. Spatial join tools and Global or Local Moran's Index were used for the geographic analysis of hospitalized HZ incidence. Multivariate linear regression models were used to analyze the factors influencing LOS and costs. There were 44,311 HZ inpatients included in this study, incurring a total of $31,857,734 medical costs. These patients had a median LOS of 8 days and a median expenditure of $573.47. Older age, more comorbidities, and the presence of complications with nervous system involved were all significantly associated with longer LOS and higher costs. HZ infection resulted in a large direct medical cost and heavy disease burden, especially in patients with advanced age or underlying medical conditions. The HZ vaccine has the potential to effectively reduce the disease burden and should be widely popularized especially among high-risk groups.

Refining health risk assessment of arsenic in wild edible boletus from typical high geochemical background areas: The role of As species, bioavailability, and enterotoxicity.

Arsenic (As) is easily accumulated in wild Boletus. However, the accurate health risks and adverse effects of As on humans were largely unknown. In this study, we analyzed the total concentration, bioavailability, and speciation of As in dried wild boletus from some typical high geochemical background areas using an in vitro digestion/Caco-2 model. The health risk assessment, enterotoxicity, and risk prevention strategy after consumption of As-contaminated wild Boletus were further investigated. The results showed that the average concentration of As was 3.41-95.87 mg/kg dw, being 1.29-56.3 folds of the Chinese food safety standard limit. DMA and MMA were the dominant chemical forms in raw and cooked boletus, while their total (3.76-281 mg/kg) and bioaccessible (0.69-153 mg/kg) concentrations decreased to 0.05-9.27 mg/kg and 0.01-2.38 mg/kg after cooking. The EDI value of total As was higher than the WHO/FAO limit value, while the bioaccessible or bioavailable EDI suggested no health risks. However, the intestinal extracts of raw wild boletus triggered cytotoxicity, inflammation, cell apoptosis, and DNA damage in Caco-2 cells, indicating existing health risk assessment models based on total, bioaccessible, or bioavailable As may be not accurate enough. Given that, the bioavailability, species, and cytotoxicity should be systematically considered in accurate risk assessment. In addition, cooking mitigated the enterotoxicity along with decreasing the total and bioavailable DMA and MMA in wild boletus, suggesting that cooking could be a simple and effective way to decrease the health risks of consumption of As-contaminated wild boletus.

Poly (Aryl Amino Ketone/Sulfones) with Obvious Electrochromic Effect Prepared by One-Step Low-Cost and Facile Synthesis.

High-performance donor-acceptor (D-A) polymers, as an important class of electrochromic (EC) materials, have attracted extensive attention. In this paper, a series of novel poly (aryl amino ketone) (PAAK) and poly (aryl amino sulfone) (PAAS) type high-performance polymers (HPP) with electrochromism were prepared by a simple C-N coupling reaction and were coated on an indium tin oxide (ITO) substrate as EC films. All four polymers were prepared by a nucleophilic substitution reaction using commercially purchased amine monomers with difluoride sulfone/ketone using potassium carbonate as a catalyst. A series of tests were performed to compare and analyze the effects of the different electron-withdrawing abilities of sulfone and carbonyl groups, and the different conjugation lengths of these two TPA structures were connected to the EC properties of the polymer. The different phenyl or biphenyl of the two TPA structures mainly affected the oxidation potential of the polymer, while the sulfone group and the carbonyl group, with a different electron absorption ability, had a greater influence on the energy band and cyclic stability. The optical contrast of PAAS-BT at 850 nm was up to 58% and maintained 450 cycles, indicating that this series of materials had a broad application prospect waiting for further research. In addition to the performance, the raw materials used in this work could be directly and commercially purchased for a low price; the two aniline monomers were priced at about $0.43 /g and $0.15 /g, respectively. This method significantly reduces the cost and provides a new idea for subsequent large-scale production and practical applications.

A Systematic Review of the Measurement Properties of Face, Legs, Activity, Cry and Consolability Scale for Pediatric Pain Assessment.

Purpose: We performed this systematic review to summarize the psychometric properties of Face, Legs, Activity, Cry and Consolability (FLACC) scale in pediatric patients in different settings. Methods: Two investigators independently searched PubMed, EMBASE, OVID and China National Knowledge Infrastructure (CNKI) for eligible studies through July 2021. We assessed the psychometric properties using the modified critical appraisal tool (CAT). Finally, we systematically reviewed the results of the included studies. Results: A total of 15 studies were eventually included. The overall quality of each eligible study was low to moderate. The FLACC scale has been available in different versions and in different settings. Although eligible studies have demonstrated significant clinical benefit in assessing postoperative pain in pediatric patients aged 0 to 10 years from post-anesthetic care unit (PACU), pediatric intensive care unit (PICU) and inpatient unit, and in assessing procedural pain in pediatric patients aged 0.5 to 7 years from emergency unit, immunization center and PICU, mostly without test-retest analysis. Conclusion: Although the absence of a gold standard of pain assessment, the currently available data support the usefulness of the FLACC from the perspective of criterion validity. Therefore, the FLACC scale can be considered for measuring observational pain in infants and children. However, further studies are still needed to provide more robust evidence.

Quality assessment and its influencing factors of lung cancer clinical research registration: a cross-sectional analysis.

Background: A better understanding of the current features of lung cancer clinical research registration is important for improving registration quality and standardizing the registration. This study aimed to assess the registration quality of lung cancer studies on ClinicalTrials.gov and analyze the influencing factors. Methods: Lung cancer clinical researches registered in the ClinicalTrials.gov database were searched on 7 July 2021. The characteristics of trials that registered up to 7 July 2021 were assessed. The quality of completed and terminated lung cancer studies from 1 July 2007 to 7 July 2020 was assessed using a modified version of the World Health Organization (WHO) Trial Registration Data Set (TRDS, V.1.3.1). Multivariate logistic regression analysis was also used to analyze the factors influencing study registration quality. An above-average registration quality score represented a high registration quality. Results: A total of 6,448 clinical studies on lung cancer were used to summarise the registration characteristics. Most interventional studies were randomized (41.88%), single group (48.07%), and open-label (82.86%) studies, while most observational studies were cohort studies (59.08%). In total, 2,171 completed and terminated studies were assessed, with an average quality score (out of 54) of 36.76±5.69. None of the assessed studies had a 100% modified TRDS reporting rate, and missing summary results were the main factor affecting the quality scores. Multivariate logistic regression analyses showed that prospective registrations [adjusted odds ratio (aOR), 2.18; 95% confidence interval (CI), 1.79-2.65], multi-center studies (aOR, 1.73; 95% CI, 1.39-2.16), government-sponsored studies (aOR, 3.09; 95% CI, 1.48-6.42), and published studies (aOR, 1.43; 95% CI, 1.15-1.78) were more likely to be high quality research. Conclusions: To improve the quality of registration, awareness of prospective registration should be further improved and government investment should be increased. At the same time, more efficient and extensive data sharing after completion of the studies should be actively promoted.

QF-TraderNet: Intraday Trading via Deep Reinforcement With Quantum Price Levels Based Profit-And-Loss Control.

Reinforcement Learning (RL) based machine trading attracts a rich profusion of interest. However, in the existing research, RL in the day-trade task suffers from the noisy financial movement in the short time scale, difficulty in order settlement, and expensive action search in a continuous-value space. This paper introduced an end-to-end RL intraday trading agent, namely QF-TraderNet, based on the quantum finance theory (QFT) and deep reinforcement learning. We proposed a novel design for the intraday RL trader's action space, inspired by the Quantum Price Levels (QPLs). Our action space design also brings the model a learnable profit-and-loss control strategy. QF-TraderNet composes two neural networks: 1) A long short term memory networks for the feature learning of financial time series; 2) a policy generator network (PGN) for generating the distribution of actions. The profitability and robustness of QF-TraderNet have been verified in multi-type financial datasets, including FOREX, metals, crude oil, and financial indices. The experimental results demonstrate that QF-TraderNet outperforms other baselines in terms of cumulative price returns and Sharpe Ratio, and the robustness in the acceidential market shift.

Assessment of global asymptomatic SARS-CoV-2 infection and management practices from China.

With ongoing research, it was found that asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was widespread in coronavirus disease 2019 (COVID-19) populations. Studies have confirmed asymptomatic patients with COVID-19 have potential infectivity, and most of the transmission occurred before symptoms appear. Asymptomatic infection rates varied widely in different countries and regions. Identifying the asymptomatic infected persons and cutting off the infection source is an effective way to prevent the spread of this disease. However, asymptomatic patients have hidden clinical symptoms, and screening based only on the clinical symptoms of COVID-19 can easily lead to a missed diagnosis. Therefore, determining asymptomatic infection patients by SARS-CoV-2 nucleic acid testing is the gold standard. A series of prevention and control measures adopted by the Chinese government, especially the "Four Early" policy, have achieved outstanding achievements, which are worth learning from by other countries.

Do Stairs Inhibit Seniors Who Live on Upper Floors From Going Out?

BACKGROUND: Walk-up buildings are common in China today since they were almost the only type of residential buildings constructed from the 1950s to the 1990s. OBJECTIVES: This study examined how a vertical mobility obstacle, that is, mandatory stair climbing in walk-up residential buildings, may impact whether seniors go outdoors. METHODS: We collected and examined 1,608 valid data records from 64 Chinese senior participants in Shanghai wearing Fitbit HR wristbands that tracked their mobility and physical activity for 31 consecutive days. Multilevel mixed-effects logistic regressions were performed on the binary leaving-home-or-not probability by the level of vertical obstacles controlled for physical-demographic factors, socioeconomic factors, outdoor activity habits, and weather. RESULTS: Our observations revealed that each floor above ground level reduced the likelihood of outdoor trips by approximately one third per floor. After controlling for the physical, demographic, and socioeconomic factors of the participants as well as weather and holidays, we found that significantly fewer going-out incidents were also associated with more frequent outdoor activities within the community, especially in paved areas, but no associations were observed with self-reported visit frequencies to green spaces, senior centers within the community, or other places outside the community. CONCLUSION: This study offered the in situ observation that seniors' probability of leaving their homes is correlated with the degree of vertical circulation as a mobility barrier (i.e., the number of stairs between their living space and access to the outdoors), which may impact policy making for regulations concerning elevators in residential codes and renovations.

The use of restricted mean time lost under competing risks data.

BACKGROUND: Under competing risks, the commonly used sub-distribution hazard ratio (SHR) is not easy to interpret clinically and is valid only under the proportional sub-distribution hazard (SDH) assumption. This paper introduces an alternative statistical measure: the restricted mean time lost (RMTL). METHODS: First, the definition and estimation methods of the measures are introduced. Second, based on the differences in RMTLs, a basic difference test (Diff) and a supremum difference test (sDiff) are constructed. Then, the corresponding sample size estimation method is proposed. The statistical properties of the methods and the estimated sample size are evaluated using Monte Carlo simulations, and these methods are also applied to two real examples. RESULTS: The simulation results show that sDiff performs well and has relatively high test efficiency in most situations. Regarding sample size calculation, sDiff exhibits good performance in various situations. The methods are illustrated using two examples. CONCLUSIONS: RMTL can meaningfully summarize treatment effects for clinical decision making, which can then be reported with the SDH ratio for competing risks data. The proposed sDiff test and the two calculated sample size formulas have wide applicability and can be considered in real data analysis and trial design.

Assessment of circulating tumor DNA in cerebrospinal fluid by whole exome sequencing to detect genomic alterations of glioblastoma.

BACKGROUND: Cerebrospinal fluid (CSF) has been demonstrated as a better source of circulating tumor DNA (ctDNA) than plasma for brain tumors. However, it is unclear whether whole exome sequencing (WES) is qualified for detection of ctDNA in CSF. The aim of this study was to determine if assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma. METHODS: CSFs of ten glioblastoma patients were collected pre-operatively at the Department of Neurosurgery, Sun Yat-sen University Cancer Center. ctDNA in CSF and genome DNA in the resected tumor were extracted and subjected to WES. The identified glioblastoma-associated mutations from ctDNA in CSF and genome DNA in the resected tumor were compared. RESULTS: Due to the ctDNA in CSF was unqualified for exome sequencing for one patient, nine patients were included into the final analysis. More glioblastoma-associated mutations tended to be detected in CSF compared with the corresponding tumor tissue samples (3.56 ±â€Š0.75 vs. 2.22 ±â€Š0.32, P = 0.097), while the statistical significance was limited by the small sample size. The average mutation frequencies were similar in CSF and tumor tissue samples (74.1% ±â€Š6.0% vs. 73.8% ±â€Š6.0%, P = 0.924). The R132H mutation of isocitrate dehydrogenase 1 and the G34V mutation of H3 histone, family 3A (H3F3A) which had been reported in the pathological diagnoses were also detected from ctDNA in CSF by WES. Patients who received temozolomide chemotherapy previously or those whose tumor involved subventricular zone tended to harbor more mutations in their CSF. CONCLUSION: Assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma, which may provide useful information for the decision of treatment strategy.

Comparison of two treatments in the presence of competing risks.

Competing risks data arise frequently in clinical trials, and a common problem encountered is the overall homogeneity between two groups. In competing risks analysis, when the proportional subdistribution hazard assumption is violated or two cumulative incidence function (CIF) curves cross; currently, the most commonly used testing methods, for example, the Gray test and the Pepe and Mori test, may lead to a significant loss of statistical testing power. In this article, we propose a testing method based on the area between the CIF curves (ABC). The ABC test captures the difference over the whole time interval for which survival information is available for both groups and is not based on any special assumptions regarding the underlying distributions. The ABC test was also extended to test short-term and long-term effects. We also consider a combined test and a two-stage procedure based on this new method, and a bootstrap resampling procedure is suggested in practice to approximate the limiting distribution of the combined test and two-stage test. An extensive series of Monte Carlo simulations is conducted to investigate the power and the type I error rate of the methods. In addition, based on our simulations, our proposed TS, Comb, and ABC tests have a relatively high power in most situations. In addition, the methods are illustrated using two different datasets with different CIF situations.

METTL3 is essential for postnatal development of brown adipose tissue and energy expenditure in mice.

Brown adipose tissue (BAT) undergoes rapid postnatal development and then protects against cold and obesity into adulthood. However, the molecular mechanism that determines postnatal development and maturation of BAT is largely unknown. Here we show that METTL3 (a key RNA methyltransferase) expression increases significantly in interscapular brown adipose tissue (iBAT) after birth and plays an essential role in the postnatal development and maturation of iBAT. BAT-specific deletion of Mettl3 severely impairs maturation of BAT in vivo by decreasing m6A modification and expression of Prdm16, Pparg, and Ucp1 transcripts, which leads to a marked reduction in BAT-mediated adaptive thermogenesis and promotes high-fat diet (HFD)-induced obesity and systemic insulin resistance. These data demonstrate that METTL3 is an essential regulator that controls iBAT postnatal development and energy homeostasis.

In Vivo Assessment of Potential Therapeutic Approaches for USH2A-Associated Diseases.

Mutations in USH2A gene account for most cases of Usher syndrome type II (USH2), characterized by a combination of congenital hearing loss and progressive vision loss. In particular, approximately 30% of USH2A patients harbor a single base pair deletion, c.2299delG, in exon 13 that creates a frameshift and premature stop codon, leading to a nonfunctional USH2A protein. The USH2A protein, also known as usherin, is an extremely large transmembrane protein (5202 aa), which limits the use of conventional AAV-mediated gene therapy; thus development of alternative approaches is required for the treatment of USH2A patients. As usherin contains multiple repetitive domains, we hypothesize that removal of one or more of those domains encoded by mutant exon(s) in the USH2A gene may reconstitute the reading frame and restore the production of a shortened yet adequately functional protein. In this study, we deleted the exon 12 of mouse Ush2a gene (corresponding to exon 13 of human USH2A) using CRISPR/Cas9-based exon-skipping approach and revealed that a shortened form of Ush2a that lacks exon 12 (Ush2a-∆Ex12) is produced and localized correctly in the cochlea. When the Ush2a-∆Ex12 allele is expressed on an Ush2a null background, the Ush2a-∆Ex12 protein can successfully restore the impaired hair cell structure and the auditory function in the Ush2a-/- mice. These results demonstrate that CRISPR/Cas9-based exon-skipping strategy holds a great therapeutic potential for the treatment of USH2A patients.

Assessment of ctDNA in CSF may be a more rapid means of assessing surgical outcomes than plasma ctDNA in glioblastoma.

We aimed to develop a high-throughput deep DNA sequencing assay of cerebrospinal fluid (CSF) to identify clinically relevant oncogenic mutations that contribute to the development of glioblastoma (GBM) and serve as biomarkers to predict patients' responses to surgery. For this purpose, we recruited five patients diagnosed with highly suspicious GBM according to preoperative magnet resonance imaging. Subsequently, patients were histologically diagnosed with GBM. CSF was obtained through routine lumbar puncture, and plasma from peripheral blood was collected before surgery and 7 days after. Fresh tumor samples were collected using routine surgical procedures. Targeted deep sequencing was used to characterize the genomic landscape and identify mutational profile that differed between pre-surgical and post-surgical samples. Sequence analysis was designed to detect protein-coding exons, exon-intron boundaries, and the untranslated regions of 50 genes associated with cancers of the central nervous system. Circulating tumor DNAs (ctDNAs) were prepared from the CSF and plasma from peripheral blood. For comparison, DNA was isolated from fresh tumor tissues. Non-silent coding variants were detected in CSF and plasma ctDNAs, and the overall minor allele frequency (MAF) of the former corresponded to an earlier disease stage compared with that of plasma when the tumor burden was released (surgical removal). Gene mutation loads of GBMs significantly correlated with overall survival (OS, days) (Pearson correlation = -0.95, P = 0.01). We conclude that CSF ctDNAs better reflected the sequential mutational changes of driver genes compared with those of plasma ctDNAs. Deep sequencing of the CSF of patients with GBM may therefore serve as an alternative clinical assay to improve patients' outcomes.

Nutrient Supplement Use among the Chinese Population: A Cross-Sectional Study of the 2010⁻2012 China Nutrition and Health Surveillance.

Nutrient supplements play a key role in managing malnutrition/chronic diseases and are commonly used in the world, but few studies described the prevalence of nutrient supplement use at the national level in China. To our knowledge, this study provides the first detailed investigation of nutrient supplement use in a nationally representative sample of the Chinese population. This study aimed to describe the prevalence of the nutrient supplement use among the Chinese population aged 6 years or older in 2010⁻2012. A stratified multistage cluster sampling method was conducted to recruit participants from 150 surveillance sites. The demographic characteristics and information about nutrient supplement use were collected through an interview-administrative questionnaire. A total of 74,501 children and adults (excluding the pregnant women) were included in the study (mean age, 35.7 years; male, 47.0%, female, 53.5%). Only 0.71% of the participants reported using nutrient supplements in the previous month. Participants aged 6⁻11 years and 60 years and above, female, living in large urban, with higher education level and higher family incomes were more likely to use nutrient supplements than their counterparts (p < 0.05). The prevalence of nutrient supplement use increased with age in Chinese adults. The highest usage among the nutrient supplements was multi-vitamins and minerals with 0.37%. More females used single vitamin, multi-mineral, multi-vitamins and minerals than males (p < 0.05). The nutrient supplement use proportion was highest amongst the participants with a health problem, and the participants who had no idea about their health conditions were the least likely to use the nutrient supplements (p < 0.05). The prevalence of nutrient supplement use was low among the Chinese population in 2010⁻2012. Further research is required to understand the social cognition, usage reasons, dosage and consumption motivation of NS, and the relationships with health effects, to ensure that the nutrient supplements can be appropriately promoted in China.

Age at natural menopause and associated factors in adult women: Findings from the China Kadoorie Biobank study in Zhejiang rural area.

OBJECTIVES: To investigate the factors associated with age at natural menopause in a large population of Chinese adult women. METHODS: This cross-sectional study was part of the baseline survey of China Kadoorie Biobank in Zhejiang Province. A total of 17,076 postmenopausal women were included in the present study. Relevant data of socio-demographic, lifestyle, dietary and reproductive characteristics were collected. Multinomial logistic regression models were used to examine the associated factors of age at natural menopause with adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were reported. RESULTS: The mean age at natural menopause was 48.94 years, with 3.40% of the women experienced premature menopause and 6.75% early menopause. Younger age, higher education, consumption of meat (1-3 days per week) and increased parity were associated with late menopause. Current smoking, underweight, higher physical activity, consumption of sea food (1-3 days per week), fresh eggs (≥4 days per week), fresh fruits (≥1 day per week), taking vitamins, experiencing severe food shortage, earlier age at menarche and older age at first birth were associated with earlier age at natural menopause. CONCLUSIONS: These results suggest that certain factors involved with socio-demographic, lifestyle, dietary and reproductive characteristics are related to the age at natural menopause in Chinese women.

Evaluation of KIM-1 and NGAL as Early Indicators for Assessment of Gentamycin-Induced Nephrotoxicity In Vivo and In Vitro.

BACKGROUND/AIMS: The aminolycoside Gentamicin is a widely used antibiotic, applied in equine medicine. Despite its clinical use, concerns remain regarding the potential toxic side-effects, such as nephrotoxicity. Early detection of renal damage is critical in preclinical drug development. This study was aimed to determine whether kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) may be early indicators in the assessment of Gentamycin-induced nephrotoxicity. METHODS: In our study, a model of Gentamicin-induced nephrotoxicity in male Sprague Dawley rats treated for up to 7 days at 50 or 100mg/kg/day was used to monitor the expressions of novel biomarkers of renal toxicity during the progression of acute kidney injury (AKI). Additionally, biomarkers were assessed in human kidney proximal epithelial cells (HK-2) treated with Gentamicin for 2, 6, 12, 24, 36 or 48h in vitro. RESULTS: Repeated administration of Gentamicin to rats for 1, 3, or 7 days resulted in a dose- and time-dependent increase in the expression of KIM-1 and NGAL. The expressions of the two biomarkers changed prior to renal tubule damage and increases in serum creatinine (SCr) and blood urea nitrogen (BUN) levels, suggesting their usefulness for predicting Gentamicin-induced acute kidney injury (AKI) in vivo. CONCLUSIONS: In contrast, no significant increase in the expression of the biomarker genes and proteins were evident in HK-2 cells after treated by Gentamycin for up to 48h, suggesting that they may not be suitable endpoints for sensitive detection of nephrotoxic effects in vitro.

The Centers for Disease Control and Prevention System in China: Trends From 2002-2012.

OBJECTIVES: To assess the improvements of the Chinese Centers for Disease Control and Prevention (CDCs) system between 2002 and 2012, and problems the system has encountered. METHODS: We obtained data from 2 national cross-sectional surveys in 2006 and 2013, including 32 provincial, 139 municipal, and 489 county-level CDCs throughout China. We performed a pre-post comparative analysis to determine trends in resource allocation and service delivery. RESULTS: The overall completeness of public health services significantly increased from 47.4% to 76.6%. Furthermore, the proportion of CDC staff with bachelor's or higher degrees increased from 14.6% to 32.6%, and governmental funding per CDC increased 5.3-fold (1.283-8.098 million yuan). The working area per CDC staff increased from 37.9 square meters to 63.3 square meters, and configuration rate of type A devices increased from 28.1% to 65.0%. Remaining problems included an 11.9% reduction in staff and the fact that financial investments covered only 71.1% of actual expenditures. CONCLUSIONS: China's CDC system has progressed remarkably, enabling quicker responses to emergent epidemics. Future challenges include establishing a sustainable financing mechanism and retaining a well-educated, adequately sized public health workforce.