A simple and economical method for unbiasedly quantifying the alveolar size of entire mouse lung tissue utilizing Hematoxylin and Eosin Staining.

Alveolar, the smallest structural and functional units within the respiratory system, play a crucial role in maintaining lung function. Alveolar damage is a typical pathological hallmark of respiratory diseases. Nevertheless, there is currently no simple, rapid, economical, and unbiased method for quantifying alveolar size for entire lung tissue. Here, firstly, we conducted lung sample slicing based on the size, shape, and distribution of airway branches of different lobes. Next, we performed HE staining on different slices. Then, we provided an unbiased quantification of alveolar size using free software ImageJ. Through this protocol, we demonstrated that C57Bl/6 mice exhibit varying alveolar sizes among different lobes. Collectively, we provided a simple and unbiased method for a more comprehensive quantification of alveolar size in mice, which holds promise for a broader range of respiratory research using mouse models.

Assessment of the plane of maximum curvature for patients with adolescent idiopathic scoliosis via computed tomography.

BACKGROUND: In the assessment of three-dimensional features of adolescent idiopathic scoliosis, the plane of maximum curvature was compared with the coronal Cobb angle. OBJECTIVES: To investigate the intrarater reliability, variability, and difference of the prone plane of maximum curvature measurements taken from computed tomography using the constrained and unconstrained Cobb methods; to assess the difference and correlation between the prone plane of maximum curvature measurements obtained using the constrained and unconstrained Cobb methods; and to examine differences and correlation between the prone plane of maximum curvature Cobb angle and coronal Cobb angle measurements. STUDY DESIGN: Retrospective study. METHODS: Records of 29 subjects with adolescent idiopathic scoliosis aged 15.8 ± 3.5 years were reviewed (25 thoracic and 24 thoracolumbar/lumbar curves). An experienced rater measured the plane of maximum curvature using the constrained and unconstrained Cobb methods, and the coronal Cobb angles using the conventional Cobb method on computed tomography images 3 times each with 1-week interval. The intraclass correlation coefficient (2,1), Pearson correlation coefficient (r), one-way repeated measures analysis of variance, and paired t test were applied for various analyses. RESULTS: The intraclass correlation coefficients for all intrarater reliability assessments were greater than 0.87. The plane of maximum curvature measurements of the two Cobb methods were excellently correlated (r ⩾ 0.97) with no significant difference (P > 0.05). The mean plane of maximum curvature Cobb angle was moderately correlated with (r > 0.72) but significantly greater (P < 0.001) than the mean coronal Cobb angle. CONCLUSION: The plane of maximum curvature measurements obtained from computed tomography were found to be reliable while the plane of maximum curvature measurements of the two Cobb methods were comparable. The mean plane of maximum curvature Cobb angle was moderately correlated with but significantly greater than the mean coronal Cobb angle. CLINICAL RELEVANCE: The plane of maximum curvature measurements taken from computed tomography was found to be reliable, hence it could be used as a supplement to the coronal Cobb angle in the assessment and management of adolescent idiopathic scoliosis. With technological advancement, the radiation dose of computed tomography can be further reduced to a safer level for a broader range of cases.

Assessment of a pro-healing stent in an animal model of early neoatherosclerosis.

BACKGROUND: Neoatherosclerosis represents an accelerated manifestation of atherosclerosis in nascent neointima after stenting, associated with adverse events. We investigated whether improved reendothelialization using RGD-coated stents results in diminished vascular permeability and reduced foam cell formation compared to standard DES in atherosclerotic rabbits. METHODS AND RESULTS: Neointimal foam cell formation was induced in rabbits (n = 7). Enhanced endothelial integrity in RGD-coated stents resulted in decreased vascular permeability relative to DES, which was further confirmed by SEM and TEM. Cell culture experiments examined the effect of everolimus on endothelial integrity. Increasing concentrations of everolimus resulted in a dose-dependent decrease of endothelial cell junctions and foam cell transformation of monocytes, confirming the relevance of endothelial integrity in preventing permeability of LDL. CONCLUSION: Incomplete endothelial integrity was confirmed as a key factor of neointimal foam cell formation following stent implantation. Pro-healing stent coatings may facilitate reendothelialization and reduce the risk of neoatherosclerosis.

Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services.

BACKGROUND AND PURPOSE: South Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic factors play important roles in access to healthcare and may be crucial in the success of time-critical acute stroke intervention. The aim of this study was to examine the trends in the delayed presentation to emergency department (ED) and identify factors associated with prehospital delay for an acute stroke/transient ischaemic attack (TIA) at a comprehensive stroke centre. METHODS: Patient health-related data were extracted for stroke/TIA discharges for the period 2009-2017. Electronic medical record data were used to determine sociodemographic characteristics and prehospital factors, and their associations with delayed presentation≥4.5 hours from stroke onset were studied. RESULTS: During the 9-year period, population-adjusted stroke/TIA discharge rates increased from 540 to 676 per 100 000. A significant reduction in the proportion of patients presenting to ED<4.5 hours (56% in 2009 versus 46% in 2017, p<0.001) was observed. Younger patients aged 55-64 and 65-74 years, those belonging to Polynesia, South Asia and Mainland Southeast Asia, and those not using state ambulance as the mode of arrival to the hospital were at increased risk of prehospital delay. CONCLUSIONS: Comprehensive reappraisal of educational programmes for early stroke recognition is required in our region due to delayed ED presentations of younger and specific CALD communities of stroke/TIA patients.

[Assessment of the Speciation and Pollution of Heavy Metals in Paddy Soils from the Jiulong River Basin].

Speciation characteristics of twelve heavy metals in 71 paddy soils from the Jiulong River Basin were analyzed using inductively coupled plasma mass spectrometry (ICP-MS) and the modified BCR protocol. The risk assessment coding method (RAC), ratio of secondary phase and primary phase (RSP), and geoaccumulation index (Igeo) were applied to evaluate the pollution degree of heavy metals in the area. The results show that most of these elements are abundant in the paddy soils and the speciation characteristics of different heavy metals vary. The elements Cd and Mn mainly exist as acid soluble fractions in the soils, with a mean proportion of 46.2% and 35.2%, respectively; Fe and Pb mainly exist as reducible fractions in the soils, with a mean proportion of 64.5% and 41.5%, respectively; and V, Cr, Ni, As, Co, Sr, Zn, and Cu mainly exist as residual fractions in the soils, with a mean proportion of 79.6%, 78.4%, 73.1%, 67.7%, 51.9%, 49.7%, 45.3%, and 38.4%, respectively. The three pollution assessment methods focus on the acid-soluble phase, secondary phase, and total amount of heavy metals, respectively. All have their own application value and disadvantages of incompletion. The comprehensive analysis of these three pollution assessment methods helps to more accurately and comprehensively assess the pollution characteristics of the heavy metals. The results show that the paddy soils are moderately to severely polluted with Cd; the Mn and Sr pollution is mild to severe; the Zn, Pb, Cu, and Co pollution is mild to moderate; the As and Ni pollution is absent or moderate; and V, Fe, and Cr pollution is non-existent or mild.

[Three-dimensional Ultrasound Assessment on Apical Vertebral Rotation in Patients with Adolescent Idiopathic Scoliosis:Reliability and Validity Analyses].

OBJECTIVE: To assess reliability and validity of the three-dimensional (3-D) ultrasound measurement of apical vertebral rotation in patients with adolescent idiopathic scoliosis (AIS). METHODS: Sixteen female AIS patients were recruited. Ultrasound examinations were performed using a 3-D ultrasound unit with a SonixGPS system,which were compared with magnetic resonance imaging (MRI) examinations conducted on the same day. Two raters performed 3-D ultrasound scanning in supine position on angle measurements for vertebral rotation in the transverse plane three times,respectively. The center of laminae (COL) method was used to measure apical vertebral rotation in the 3-D ultrasound image,compared with the Aaro-Dahlborn results of MRI. Reliability of the 3-D ultrasound measurements was assessed using intra-class correlation coefficients (ICC),mean absolute deviation (MAD),standard deviation (SD) and standard error of measurement (SEM). Validity of the 3-D ultrasound measurements was assessed using paired Student t-tests,Bland-Altman statistics and Pearson correlation coefficients. The level of significance was set as 0.05. RESULTS: 3-D ultrasound had high intra- and inter-rater reliabilities (ICC [2,k]>0.9,P<0.05) for assessing vertebral rotation. There was no significant difference between the Aaro-Dahlborn results in MRI and the COL Results in 3-D ultrasound (P>0.05). High consistencies (Bland-Altman) and correlations (Pearson) were demonstrated between the two methods. CONCLUSION: Radiation-free 3-D ultrasound is a reliable and valid method for measuring apical vertebral rotation in the transverse plane of patients with AIS.

[Socio-economic Factors Influencing the Spatial Distribution of PM2.5 Concentrations in China: An Exploratory Analysis].

In recent years, the PM2.5 pollution in China has become a top environmental and health concern, involving the characterization of healthy effects over a broad spatial area with uneven geographical distribution. This research aims to explore the influential factors for the PM2.5 distribution from a socio-economic perspective, based on the observations from China's 1497 monitoring sites in 2015. First, the Moran's I index and the local indicators of spatial association (LISA) were computed to outline the distribution of PM2.5 on a national scale using provincial-level divisions. Second, the correlation between the spatial distribution of PM2.5 and socio-economic factors were analyzed by ordinary least squares (OLS) and geo-weighted regression (GWR) models. The results indicated that the GWR model explained the causal relationships better. Generally, Beijing, Tianjin, and Hebei had peak levels of PM2.5, while Guangxi, Sichuan, and several other southern provinces had the lowest levels. Particularly, forest coverage rate and electricity consumption per capita were negatively correlated with the concentration of PM2.5. In this study, the vehicle ownership per capita proved to be the most significant factor that positively contributed to the concentration.

Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis.

BACKGROUND: Endoscopic therapy and surgery are both conventional treatments to remove pancreatic duct stones that developed during the natural course of chronic pancreatitis. However, few studies comparing the effect and safety between surgery drainage and endoscopic drainage (plus Extracorporeal Shock Wave Lithotripsy, ESWL).The aim of this study was to compare the benefits between endoscopic and surgical drainage of the pancreatic duct for patients with calcified chronic pancreatitis. METHODS: A total of 86 patients were classified into endoscopic/ESWL (n = 40) or surgical (n = 46) treatment groups. The medical records of these patients were retrospectively analyzed. RESULTS: Pain recurrence and hospital stays were similar between the endoscopic/ESWL treatment and surgery group. However, endoscopic/ESWL treatment yielded significantly lower medical expense and less complications compared with the surgical treatment. CONCLUSIONS: In selective patients, endoscopic/ESWL treatment could achieve comparable efficacy to the surgical treatment. With lower medical expense and less complications, endoscopic/ESWL treatment would be much preferred to be the initial treatment of choice for patients with calcified chronic pancreatitis.

HIV testing in nonhealthcare facilities among adolescent MSM.

OBJECTIVES: To describe the extent to which Centers for Disease Control and Prevention (CDC)-funded HIV testing in nonhealthcare facilities reaches adolescent MSM, identifies new HIV infections, and links those newly diagnosed to medical care. METHODS/DESIGN: We describe HIV testing, newly diagnosed positivity, and linkage to medical care for adolescent MSM who received a CDC-funded HIV test in a nonhealthcare facility in 2015. We assess outcomes by race/ethnicity, HIV-related risk behaviors, and US geographical region. RESULTS: Of the 703 890 CDC-funded HIV testing events conducted in nonhealthcare facilities in 2015, 6848 (0.9%) were provided to adolescent MSM aged 13-19 years. Among those tested, 1.8% were newly diagnosed with HIV, compared with 0.7% among total tests provided in nonhealthcare facilities regardless of age and sex. The odds of testing positive among black adolescent MSM were nearly four times that of white adolescent MSM in multivariable analysis (odds ratio = 3.97, P < 0.001). Among adolescent MSM newly diagnosed with HIV, 67% were linked to HIV medical care. Linkage was lower among black (59%) and Hispanic/Latino adolescent MSM (71%) compared with white adolescent MSM (88%). CONCLUSION: CDC-funded nonhealthcare facilities can reach and provide HIV tests to adolescent MSM and identify new HIV infections; however, given the low rate of HIV testing overall and high engagement in HIV-related risk behaviors, there are opportunities to increase access to HIV testing and linkage to care for HIV-positive adolescent MSM. Efforts are needed to identify and address the barriers that prevent black and Hispanic/Latino adolescent MSM from being linked to HIV medical care in a timely manner.

An Evaluation of Mpowerment on Individual-Level HIV Risk Behavior, Testing, and Psychosocial Factors Among Young MSM of Color: The Monitoring and Evaluation of MP (MEM) Project.

Young men who have sex with men (MSM) of color are at increased risk for HIV infection. Mpowerment (MP) is an intervention designed to reduce risky sexual behavior and increase HIV testing among young MSM ages 18-29. From 2009 to 2012, three community-based organizations with support from the U.S. Centers for Disease Control and Prevention evaluated MP among N = 298 participants. Following a repeated measures design, data from 3- and 6-month follow-ups were compared to baseline. HIV testing and self-efficacy for safer sex increased at both follow-up time points; self-acceptance as an MSM was higher at follow-up 2. Condomless anal/vaginal sex was lower at follow-up 1 only. Frequency of exchange of safer sex messages among gay/bisexual/transgender friends was lower at follow-up 1, but similar to baseline at follow-up 2. Exposure to MP was associated with improved perceived positive social norms about safer sex and safer sex messages among gay/bisexual/transgender friends.

[Fractionation and Contamination Assessment of Metal Elements in the Surface Sediments of Yundang Lagoon in Xiamen].

Total concentrations of 15 metal elements in the surface sediments of Yundang Lagoon in Xiamen were determined using ICP-MS. The fractions were extracted by a modified BCR method. The results indicated that in different areas of Yundang Lagoon, the order of the concentrations of Cd, Cu, Sr, Pb, Zn and U was:outer lagoon > ditch > inner lagoon, the order for Cr, Co, Ni, V, Fe, Li, Rb and Mn was:inner lake > outer lake > ditch. Cu, Zn and Pb were mainly in the reducible phase; Cd was mainly in the acid soluble-extractable and reducible phases; Co, Ni, U, Fe and Mn were mainly in the reducible and residual phases; Li, V, Cr, Rb and Ba were dominated by residual phase. The potential ecological risk of metal elements suggested that V, Cr, Co, Ni, Zn, Cu, Cd and Pb were at a low potential ecological risk level. The results of ratio of secondary phase to primary phase (RSP) assessment indicated that Cu, Cd and Zn showed high pollution level; Pb showed moderate pollution level; Co, Mn, Sr and U were in a low polluted condition; Ni, Fe, Cr, V, Li, Ba and Rb showed no pollution. In general, Yundang Lagoon was in a low potential ecological risk.

[Functional Outcome Assessment in Patients with Pelvic Fracture after Lushan Earthquake: a Punt Study using ICF-based Tool].

OBJECTIVE: The purpose of this pilot study was to assess the functional outcome of patients with pelvic fracture after Lushan earthquake using a newly developed tool based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Ten patients diagnosed as pelvic fracture were recruited in this study from April 20th to 30th, 2013 in West China Hospital, Sichuan University. Data were collected using the international comprehensive version of ICF Core Set for patients with musculoskeletal conditions. Descriptive statistics analysis were used. RESULTS: Pelvic fracture caused by Lushan earthquake lead to a series of severe injuries complicated with multiple organ dysfunction. In the assessment of body functions, almost all the patients with pelvic fracture showed impairments including energy and drive, sleep, sensation of pain, mobility and repair function of skin. In the assessment of body structures, the damages were mainly distributed in pelvic region, lower extremity, trunk as well as areas of skin. In the assessment of activities and participations, limitations and restrictions were related to changing and maintaining basic body position, transferring, walking andself-care. CONCLUSION: ICF Core Set could provide a comprehensive, systematic and evidence-based assessments from the perspective of body function, body structure as well as activities and participations for patients with pelvic fracture after Lushan earthquake. Future study with large sample size is needed to validate the assessment of ICF Core Set for patients with musculoskeletal injuries after earthquake and other natural disasters.

[Risk assessment and analysis of polycyclic aromatic hydrocarbons in the surface sediments of Xinglin Bay Suburb Rivers of Xiamen].

The concentrations of 16 polycyclic aromatic hydrocarbons (PAHs), declared as carcinogens by USEPA, were measured in the sediment samples (n = 19) collected along Xinglin Bay rivers/canals present in Xiamen. PAHs were extracted using accelerated solvent extraction system and analyzed using gas chromatography-mass spectrometry (GC-MS). The possible sources of PAHs and their health risk were investigated. Among selected PAHs, 13 PAHs were detected in the surface sediments. Total concentrations of PAHs in the surface sediments ranged from 413.00 to 2748.81 ng x g(-1), with a mean value of 949.56 ng x g(-1). The mean concentration of highly carcinogenic compounds such as benzo [k] fluoranthene (BkF) and benzo [g, h, i] perylene (BghiP) were 69.15 ng x g(-1) and 49.86 ng x g(-1), respectively and counted for 73.68% out of the total samples. The dominant PAH compounds were 2, 3 and 4 rings and counted for 61.03% and 23.53% , respectively; while 5-6 rings containing PAHs were accounted for 15.82%. According to the results, 68.42% of samples were moderately contaminated, while 31.58% were highly contaminated with PAHs. Based on the ratios of Ant/(Ant + Phe) and Fla/(Fla + Pyr), it cleared that PAHs in surface sediments were mainly derived from fossil fuel and combustion products. Principal component analysis results and sediment quality benchmarks (mSQG-Q) were used for risk assessment of these PAH contaminated sediments. The risk SQG-Q of 16 PAHs were less than 0.50. Comprehensive content, composition and SQG-Q showed that a certain degree of ecological risks of PAH pollution existed in the surface sediments, particularly in the sites close to Xinglin Industrial Zone (2, 3, 5 and 9) and Gangtou(13), which need further research work and proper attentions.

Anatomic assessment of sympathetic peri-arterial renal nerves in man.

BACKGROUND: Although renal sympathetic denervation therapy has shown promising results in patients with resistant hypertension, the human anatomy of peri-arterial renal nerves is poorly understood. OBJECTIVES: The aim of our study was to investigate the anatomic distribution of peri-arterial sympathetic nerves around human renal arteries. METHODS: Bilateral renal arteries were collected from human autopsy subjects, and peri-arterial renal nerve anatomy was examined by using morphometric software. The ratio of afferent to efferent nerve fibers was investigated by dual immunofluorescence staining using antibodies targeted for anti-tyrosine hydroxylase and anti-calcitonin gene-related peptide. RESULTS: A total of 10,329 nerves were identified from 20 (12 hypertensive and 8 nonhypertensive) patients. The mean individual number of nerves in the proximal and middle segments was similar (39.6 ± 16.7 per section and 39.9 ± 1 3.9 per section), whereas the distal segment showed fewer nerves (33.6 ± 13.1 per section) (p = 0.01). Mean subject-specific nerve distance to arterial lumen was greatest in proximal segments (3.40 ± 0.78 mm), followed by middle segments (3.10 ± 0.69 mm), and least in distal segments (2.60 ± 0.77 mm) (p < 0.001). The mean number of nerves in the ventral region (11.0 ± 3.5 per section) was greater compared with the dorsal region (6.2 ± 3.0 per section) (p < 0.001). Efferent nerve fibers were predominant (tyrosine hydroxylase/calcitonin gene-related peptide ratio 25.1 ± 33.4; p < 0.0001). Nerve anatomy in hypertensive patients was not considerably different compared with nonhypertensive patients. CONCLUSIONS: The density of peri-arterial renal sympathetic nerve fibers is lower in distal segments and dorsal locations. There is a clear predominance of efferent nerve fibers, with decreasing prevalence of afferent nerves from proximal to distal peri-arterial and renal parenchyma. Understanding these anatomic patterns is important for refinement of renal denervation procedures.

Cognitive impairment and the associated risk factors among the elderly in the Shanghai urban area: a pilot study from China.

OBJECTIVES: Our study aimed to investigate the prevalence of cognitive impairment(CI) and the associated risk factors among elderly people in Shanghai urban area, China. METHODS: A population-based survey was conducted among people aged 55 years or older in urban areas of Shanghai. Face-to-face interviews were carried out to collect information including demographic characteristics, medical history, and medication use, etc. The validated Chinese version of the Mini-Mental State Examination(MMSE) was used to screen subjects with CI, and the criteria of CI were adjusted for education levels. RESULTS: A total of 3,176 home-living residents (≥55 years old) were included in the study. Among them, 266 people (102 men and 164 women) were identified as cognition impaired, with a prevalence of 8.38% (266/3,176, 95% CI: (8.26, 8.49)) for both genders, 9.21% (102/1,107,95% CI: (9.18, 9.33)) for men and 7.93% (164/2,069, 95% CI: (7.80, 8.09)) for women, respectively. Furthermore, we found that several significant risk factors, including social factors(education, number of children, marriage status, and family structure), physiological factors (age, blood glucose level, and obesity), factors on living styles(physical exercise, diet & chronic diseases), and genetic factor(ApoE), associated with CI onset. CONCLUSIONS: This study confirms the high prevalence of CI among the elderly population in the Shanghai urban in China, similar to previous epidemiologic studies in Western countries. The putative risk factors associated with CI merit further investigated.

[Systematic assessment of acupoint stimulating therapy for deglutition disorders after apoplexy].

OBJECTIVE: To assess the therapeutic effect of acupoint stimulating therapy on deglutition disorders after apoplexy, so as to provide basis for clinical treatment and further study. METHODS: According to Cochrane systematic assessment method of evidence-based medicine, Meta analysis on randomized controlled trials or half randomized controlled trials of acupoint stimulating therapy for deglutition disorders after apoplexy were made. RESULTS: In 37 Chinese literatures, 3 697 patients in total were enrolled, and the results indicated that the effective rate of acupoint stimulating therapy on deglutition disorders after apoplexy was better than that in the control group [RR was 1.38, 95% CI (1.28, 1.49), Z = 8.38, P < 0.01]; and the cured rate also was better than that of the control group [RR was 2.56, 95% CI (2.15, 3.04), Z = 10.70, P < 0.01]. CONCLUSION: The therapeutic effect of acupoint stimulating therapy on deglutition disorders after apoplexy is better than that of the control group, but more randomized, double blind, controlled trials with good designs are needed to confirm this result.

The metric properties of Zarit caregiver burden scale: validation study of a Chinese version.

PURPOSE: To evaluate the Chinese version of the Zarit Burden Interview (ZBI) as an instrument for measuring strain in Chinese caregivers of elderly people with dementia. DESIGN AND METHODS: The objective of the present study was to carry out a metric analysis of a Chinese version of ZBI using a cross-sectional study. Patients and their caregivers completed a variety of questionnaires, including the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), the Geriatric Depression Scale (GDS), and the Hamilton Anxiety Scale (HAMA). Cronbach alpha coefficient was used to assess inter-item consistency, and a split half correlation coefficient was used to determine the internal consistency of the ZBI. Correlations between the ZBI and GDS, and the ZBI and HAMA were assessed for convergent validity. Correlations of the ZBI and MMSE, the ZBI and NPI were also calculated to evaluate the possible correlation of caregiver burden with the severity of cognitive impairment and neuropsychiatric symptoms. RESULTS: There were 42 patients with dementia in the study. The intraclass correlation coefficient was 0.89 and the split half correlation coefficient was 0.87. The mean ZBI score was 24.40+/-14.68. Item-total (corrected) correlation showed significant coefficients (rs>0.33, P<0.05) for most items. There was a significant correlation between the ZBI and GDS (rs=0.57, P<0.001), and between the ZBI and HAMA (rs=0.44, P=0.003). Furthermore, there was a significant positive correlation between the ZBI and NPI, the ZBI and the agitation score, the ZBI and the apathy score, and the ZBI and MMSE. CONCLUSIONS: The Chinese version of ZBI meets some of the basic reliability and validity standards required for health status measures. Further studies could lead to a better understanding of the difficulties experienced by caregivers of patients suffering from dementia in China.

Economic impact of dementia in developing countries: an evaluation of Alzheimer-type dementia in Shanghai, China.

The main objective of this study was to assess the economic cost of Alzheimer's disease (AD) in Shanghai, China, as a pilot study for future evaluations. Sixty-seven patients with AD were interviewed, and the information of the AD-related cost and resources used was collected from October 2005 to September 2006. By retrospective analysis, annual costs were calculated and expressed in Chinese renminbi (RMB). Direct cost per patient per year averaged approximately 8,432 RMB (1,058 USD), indirect cost per patient per year was 10,568 RMB (1,326 USD), and annual costs were 19,001 RMB (2,384 USD) per patient per year in this investigation. Total cost was significantly associated with the degree of severity including cognitive function (MMSE) and activity of daily living (ADL). With the increase in the number of persons at risk for developing AD, the economic burden of AD patients in China is significantly heavy.

Economic burden of Parkinson's disease in a developing country: a retrospective cost analysis in Shanghai, China.

We investigated economic costs from patients with Parkinson's disease (PD) in Shanghai, China, which could be used as a baseline for future evaluations. Data were collected from 190 patients by interview during 1-year period. Direct medical care costs averaged approximately Chinese yuan, renminbi (RMB) 4,305 (USD 519, or EUR 410) per year per patient, of which drugs (RMB 2,677) accounted for the major costly component. Nonmedical direct costs were much less than direct health care costs, averaging approximately RMB 3,301 (USD 398, or EUR 314). Costs due to loss of productivity averaged approximately RMB 73 (USD 8.8, or EUR 7.0) per patient per year. Taken together, the overall mean annual cost for PD in our series was approximately RMB 7,679 (USD 925, or EUR 731), and these costs accounted for around half of the mean annual income. Total cost was significantly associated with the disease severity and the frequency of outpatient visits. In addition, levodopa equivalent dose (LED) and the number of drugs being taken were also closely related with the drug cost. The results indicate that the economic burden of Chinese PD patients is heavy.