Expert consensus on difficulty assessment of endodontic therapy.

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

The impact of physical activity on household out-of-pocket medical expenditure among adults aged 45 and over in urban China: The mediating role of spousal health behaviour.

Background: Increasing medical expenditure is viewed as one of the critical challenges in the context of population ageing. Physical activity (PA), as a primary prevention strategy for promoting health, is considered as an effective way to curb the excessive growth in medical expenditure. This study aimed to analyze the association between PA and the household out-of-pocket medical expenditure (HOPME) among Chinese urban adults aged 45 and over, and to explore the mediating role of spousal health behaviour. Methods: This study analyzed a nationally longitudinal survey: 2014-2018 China Family Panel Studies (CFPS). Fixed effects regression model was applied to estimate the association between PA and annual HOPME. Sobel model was utilized to test the mediating effect. Results: (1) PA was negatively associated with the annual HOPME among urban resident aged 45 and over in China. Exercising 1-5 times per week and maintaining the duration of each exercise session at 31-60 min were effective in reducing annual HOPME. (2) Spousal PA played a significant mediating role in the relationship between respondent's PA and annual HOPME. (3) The negative association between the respondent's PA and HOPME were found among women and those aged between 45 and 65, so was the mediating effect of spouse's PA. Conclusion: Individual PA not only directly reduces HOPME but also indirectly contributes to this reduction by enhancing the PA levels of their spouses. To capitalize on these benefits, more actions should be taken to increase the availability of PA facilities, enhance the public awareness of PA's benefits, and encourage residents to consistently engage in regular PA.

Innovative accumulative risk assessment of co-exposure to Cd, As, and Pb in contaminated rice based on their in vivo bioavailability and in vitro bioaccessibility.

The consumption of cadmium (Cd), arsenic (As), and lead (Pb) co-contaminated rice exposes humans to multiple heavy metals simultaneously, with relative bioavailability (RBA) and bioaccessibility (BAc) being important determinants of potential health risks. This study evaluated the relationship between in vivo RBA and in vitro BAc of Cd, As, and Pb in rice and their cumulative risk to humans. A total of 110 rice samples were collected in Zhejiang Province, China, and 10 subsamples with varying concentration gradients were randomly selected to measure RBA using a mouse model (liver, kidney, femur, blood, and urine as endpoints) and BAc using four in vitro assays (PBET, UBM, SBRC, and IVG). Our results indicated that Cd-RBA varied from 21.2 % to 67.5 %, As-RBA varied from 23.2 % to 69.3 %, and Pb-RBA varied from 22.2 % to 68.9 % based on mouse liver plus kidneys. The BAc values for Cd, As, and Pb in rice varied according to the assay. Compared to Cd and As, Pb exhibited a lower BAc in the gastric (GP) and intestinal (IP) phases. According to the relationship between the BAc and RBA values, IVG-GP (R2 = 0.92), SBRC-IP (R2 = 0.73), and UBM-GP (R2 = 0.80) could be used as predictors of Cd-, As-, and Pb-RBA in rice, respectively. The health risks associated with co-exposure to Cd, As, and Pb in contaminated rice for both adults and children exceeded the acceptable threshold, with Cd and As being the primary risk factors. The noncarcinogenic and carcinogenic risks were markedly reduced when the RBA and BAc values were incorporated into the risk assessment. Due to the risk overestimation inherent in estimating the risk level based on total metal concentration, our study provides a realistic assessment of the cumulative health risks associated with co-exposure to Cd, As, and Pb in contaminated rice using in vivo RBA and in vitro BAc bioassays.

Agricultural carbon emissions in Zhejiang Province, China (2001-2020): changing trends, influencing factors, and has it achieved synergy with food security and economic development?

Given the huge carbon footprint of agricultural activities, reduction in agricultural carbon emission (ACE) is important to achieve China's carbon peaking and carbon neutrality goals, but it may affect agricultural food security and economic development. Therefore, it is important for scientific carbon reduction measures to understand the multi-year trends and the influencing factors of ACE, and clarify whether the process of ACE affects food security and economic development. This study analyzed the trends of total ACE and ACE caused by different agricultural carbon sources (ACS) from 2001 to 2020 in Zhejiang Province, then we revealed the main influencing factors of ACE based on the logarithmic mean Divisia index (LMDI) model and dissected the relationship between ACE and food security and economic development. Results show that the total ACE fluctuated from 6.10 Mt in 2001 to 3.93 Mt in 2020, and the process included a decrease in 2001-2003 and 2005-2020 and an increase in 2003-2005. The decrease in ACE, from 2001 to 2014, was mainly due to the decline in rice acreage, which contributed 90.38%; from 2014 to 2020, it was by the reduction in the use of fertilizer, diesel, and pesticide, which contributed 83.9%. As drivers, agricultural economic development effect and total population size effect drove 4.25 and 1.54 Mt of ACE, respectively. As inhibitors, planting structure effect, technology development effect, and population structure effect inhibited 3.12, 2.11, and 2.74 Mt of ACE, respectively. With the reduction of ACE, the agricultural economy continued to grow, but the food security situation was pessimistic, indicating that ACE reduction has achieved synergy with economic development, but not with food security.

Application of Artificial Intelligence to Quantitative Assessment of Fundus Tessellated Density in Young Adults with Different Refractions.

INTRODUCTION: The aim of this study was to quantitatively assess fundus tessellated density (FTD) and associated factors by artificial intelligence (AI) in young adults. METHODS: A total of 1,084 undergraduates (age, 17-23 years old) were enrolled in November 2021. The students were divided into three groups according to axial length (AL): group 1 (AL <24.0 mm, n = 155), group 2 (24 mm ≤ AL <26 mm, n = 578), and group 3 (AL ≥26 mm, n = 269). FTD was calculated by extracting the fundus tessellations as the regions of interest (circle 1, diameter of 3.0 mm; circle 2, diameter of 6.0 mm) and then calculating the average exposed choroid area per unit area of fundus. RESULTS: Among 1,084 students, 1,002 (92.5%) students' FTDs were extracted. The mean FTD was 0.06 ± 0.06 (range, 0-0.40). In multivariate analysis, FTD was significantly associated with male sex, longer AL, thinner subfoveal choroid thickness (SFCT), increased choriocapillaris vessel density (VD), and decreased deeper choroidal VD (all p < 0.05). In circle 1 (diameter of 3.0 mm) and circle 2 (diameter of 6.0 mm), analysis of variance showed that the FTD of the nasal region (p < 0.05) was significantly larger than that of the superior, inferior, and temporal regions. CONCLUSION: AI-based imaging processing could improve the accuracy of fundus tessellation diagnosis. FTD was significantly associated with a longer AL, thinner SFCT, increased choriocapillaris VD, and decreased deeper choroidal VD.

Trust assessment for mobile crowdsensing via device fingerprinting.

Mobile crowdsensing leverages the ubiquitous sensors of smart devices to facilitate various sensing applications. Users who participate in contributing data usually get rewards from the task requester, while there is a potential risk that someone would preempt the task and provide a forged sensing report for seeking revenue with minimal effort. Thus, trust assessment is essential to identify those irregular sensing reports. The existing methods mainly consider users' reputations and estimate the trustworthiness upon the difference from the aggregated result. However, they still face a severe problem when a majority of reports are invalid or low-quality caused by the repeated submission, e.g., a user can switch multiple accounts on a single device to repeatedly submit forged reports. To tackle this problem, we design a trust assessment scheme with an enhanced device fingerprinting algorithm. Briefly, to reduce the influence of the repeated sensing reports, we first compute their unique fingerprints derived from the intrinsic characteristics of sensors and assign an initial trust weight for each report. Then, to improve the accuracy of the assessment, we further compute the similarity of the reports to obtain their final trust values. Extensive evaluations are conducted to justify the effectiveness of our proposed design.

Construction and validation of NSMC-ASIL, a predictive model for risk assessment of malignant hepatic nodules.

Most malignant hepatic nodules (MHNs) eventually progress to hepatocellular carcinoma (HCC). However, assessment of the risk of malignancy in high-risk groups of patients with hepatic nodules remains a challenge. This study aimed to develop and validate a simple scoring system to predict the risk of development of MHNs. 1144 patients with primary nodular lesions of hepatic were divided into training cohort and validation cohort. The nomogram model for predicting the risk of MHNs was established according to age, sex, nodule size, prothrombin time (PT), alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVKA-II), γ-glutamine acyltransferase isoenzyme (γ-GT), alanine aminotransferase (ALT), total bile acid (TBA), and total bilirubin (TBIL) in training cohort by logistic regression and validated in validation cohort. The area under receiver operating characteristic curve (AUC) of the predictive model for diagnosing MHNs in training cohort was 0.969 (95% CI: 0.959-0.979), with sensitivity 93.38% and specificity 90.75%, and the AUC in the validation cohort was 0.986 (95% CI: 0.975-0.996), with sensitivity 90.81% and specificity 94.26%. The AUC, sensitivity, and specificity of this model for the diagnosis of early-stage HCC were 0.942, 88.64% and 87.35% in training cohort, and 0.956, 87.04% and 91.85% in validation cohort, respectively. We established a nomogram model that used intuitive data for reliably predicting the risk of MHNs, and this model also showed good diagnostic accuracy in predicting early-stage HCC.

Corrigendum: Assessment of cerebral and cerebellar white matter microstructure in spinocerebellar ataxias 1, 2, 3, and 6 using diffusion MRI.

[This corrects the article DOI: 10.3389/fneur.2020.00411.].

DNA methylation subtypes guiding prognostic assessment and linking to responses the DNA methyltransferase inhibitor SGI-110 in urothelial carcinoma.

BACKGROUND: At present, the extent and clinical relevance of epigenetic differences between upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB) remain largely unknown. Here, we conducted a study to describe the global DNA methylation landscape of UTUC and UCB and to address the prognostic value of DNA methylation subtype and responses to the DNA methyltransferase inhibitor SGI-110 in urothelial carcinoma (UC). METHODS: Using whole-genome bisulfite sequencing (n = 49 samples), we analyzed epigenomic features and profiles of UTUC (n = 36) and UCB (n = 9). Next, we characterized potential links between DNA methylation, gene expression (n = 9 samples), and clinical outcomes. Then, we integrated an independent UTUC cohort (Fujii et al., n = 86) and UCB cohort (TCGA, n = 411) to validate the prognostic significance. Furthermore, we performed an integrative analysis of genome-wide DNA methylation and gene expression in two UC cell lines following transient DNA methyltransferase inhibitor SGI-110 treatment to identify potential epigenetic driver events that contribute to drug efficacy. RESULTS: We showed that UTUC and UCB have very similar DNA methylation profiles. Unsupervised DNA methylation classification identified two epi-clusters, Methy-High and Methy-Low, associated with distinct muscle-invasive statuses and patient outcomes. Methy-High samples were hypermethylated, immune-infiltrated, and enriched for exhausted T cells, with poor clinical outcome. SGI-110 inhibited the migration and invasion of Methy-High UC cell lines (UMUC-3 and T24) by upregulating multiple antitumor immune pathways. CONCLUSIONS: DNA methylation subtypes pave the way for predicting patient prognosis in UC. Our results provide mechanistic rationale for evaluating SGI-110 in treating UC patients in the clinic.

The Global Burden of Disease attributable to low physical activity and its trends from 1990 to 2019: An analysis of the Global Burden of Disease study.

Introduction: Low physical activity (LPA) is associated with several major non-communicable diseases (NCDs) and premature mortality. In this study, we aimed to assess the global burden and trends in disease attributable to LPA (DALPA) from 1990 to 2019. Methods: Annual age-standardized disability-adjusted life years (DALYs) and death rates of DALPA [all-cause and five specific causes (ischaemic heart disease, diabetes mellitus, stroke, colon and rectal cancer, and breast cancer)] by sex, age, geographical region and social deprivation index (SDI) score from 1990 to 2019 were available from the Global Burden of Disease (GBD) study 2019. The estimated annual percentage changes (EAPCs) were calculated to quantify the changing trend. A generalized linear model (GLM) was used to explore the relationship between DALYs/death rates of DALPA and sociodemographic factors. Results: Globally, in 2019, the age-standardized DALYs and death rates of DALPA were 198.42/100,000 (95% UI: 108.16/100,000-360.32/100,000) and 11.10/100,000 (95% UI: 5.66/100,000-19.51/100,000), respectively. There were 15.74 million (8.51-28.61) DALYs and 0.83 million (0.43-1.47) deaths attributable to LPA. Overall, age-standardized DALYs and death rates presented significant downward trends with EAPCs [-0.68% (95% CI: -0.85- -0.50%) for DALYs and -1.00% (95% CI: -1.13- -0.86%) for deaths] from 1990 to 2019. However, age-standardized DALYs and death rates of diabetes mellitus attributable to LPA were substantially increased [EAPC: 0.76% (95% CI: 0.70-0.82%) for DALYs and 0.33% (95% CI: 0.21-0.51%) for deaths]. In the 15-49 age group, DALPA presented significant upward trends [EAPC: 0.74% (95% CI: 0.58-0.91%) for DALYs and 0.31% (95% CI: 0.1-0.51%) for deaths]. The GLM revealed that higher gross domestic product and current health expenditure (% of GDP) were negatively associated with DALYs and death rates of DALPA. Conclusion: Although global age-standardized DALYs and death rates of DALPA presented downward trends, they still cause a heavy burden worldwide. These rates showed upward trends in the diabetic and 15-49 age groups, which need more attention and health interventions.

Residual characteristics and potential integrated risk assessment of synthetic pyrethroids in leafy vegetables from Zhejiang in China - Based on a 3-year investigation.

Leafy vegetables have high nutritional value and are very popular in China. However, the long-term variation in residues and integrated risks of synthetic pyrethroids (SPs) in these vegetables have not been well examined. In this study, a total of 1005 samples were collected from 55 markets during 2017-2019. The cumulative exposure to nine kinds of SPs in Zhejiang, China, through the consumption of nine leafy vegetables was analyzed, and the potential integrated risk was assessed by the relative potency factor. A total of 191 samples were detected with SPs residues. The most frequently detected SPs were λ-cyhalothrin and cypermethrin. The integrated risk assessment results revealed that the dietary risk for these SPs via leafy vegetable exposure is acceptable for children, adults and elderly individuals. The data provided here will be helpful for the government to formulate food policies in China.

Adding high-sensitivity C-reactive protein to frailty assessment to predict mortality and cardiovascular events in elderly inpatients with cardiovascular disease.

OBJECTIVE: Chronic inflammation is associated with major adverse cardiovascular events (MACEs), mortality, and frailty. Our aim was to add high-sensitivity C-reactive protein (hsCRP) to the frailty assessment to predict its association with prognosis of older adults with cardiovascular disease (CVD). METHODS: A comprehensive geriatric assessment was conducted at baseline in 720 in-patients aged ≥65 years with CVD. We divided the population into frailty and non-frailty groups according to the Fried phenotype, and hsCRP was further combined with frailty to stratify all patients into c-frailty and non-c-frailty groups. Predictive validity was tested using Cox proportional hazards regression model analysis and the discriminative ability was evaluated by receiver operating characteristic (ROC) curves. RESULTS: Of all the subjects enrolled, 51.0% were male and the mean age was 75.32 ± 6.52 years. The all-cause death and MACE rate was 6.4% at the 1-year follow-up. Frailty and c-frailty were independent predictors of all-cause death and MACE (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.35-4.83, p = 0.004; HR: 3.67, 95% CI: 1.83-7.39, p < 0.001). Adding hsCRP to the frailty model resulted in a significant increase in the area under the ROC curve from 0.74 (95% CI: 0.70-0.77) to 0.77 (95% CI: 0.71-0.84) (p = 0.0132) and a net reclassification index of 7.9% (95% CI: 1.96%-12.56%, p = 0.012). CONCLUSION: Adding hsCRP to the frailty assessment is helpful to identify a subgroup of older CVD patients with a higher risk of death and MACE over a period of 1 year. TRIAL REGISTRATION: ChiCTR1800017204; date of registration: 07/18/2018. URL: http://www.chictr.org.cn/showproj.aspx?proj=28931.

The efficacy assessment of convalescent plasma therapy for COVID-19 patients: a multi-center case series.

Convalescent plasma (CP) transfusion has been indicated as a promising therapy in the treatment for other emerging viral infections. However, the quality control of CP and individual variation in patients in different studies make it rather difficult to evaluate the efficacy and risk of CP therapy for coronavirus disease 2019 (COVID-19). We aimed to explore the potential efficacy of CP therapy, and to assess the possible factors associated with its efficacy. We enrolled eight critical or severe COVID-19 patients from four centers. Each patient was transfused with 200-400 mL of CP from seven recovered donors. The primary indicators for clinical efficacy assessment were the changes of clinical symptoms, laboratory parameters, and radiological image after CP transfusion. CP donors had a wide range of antibody levels measured by serology tests which were to some degree correlated with the neutralizing antibody (NAb) level. No adverse events were observed during and after CP transfusion. Following CP transfusion, six out of eight patients showed improved oxygen support status; chest CT indicated varying degrees of absorption of pulmonary lesions in six patients within 8 days; the viral load was decreased to a negative level in five patients who had the previous viremia; other laboratory parameters also tended to improve, including increased lymphocyte counts, decreased C-reactive protein, procalcitonin, and indicators for liver function. The clinical efficacy might be associated with CP transfusion time, transfused dose, and the NAb levels of CP. This study indicated that CP might be a potential therapy for severe patients with COVID-19.

Health risk assessment of heavy metal pollution in a soil-rice system: a case study in the Jin-Qu Basin of China.

A regional field survey of a total of 109 pairs of soil and rice samples was conducted to evaluate the health risks posed by heavy metals in the Jin-Qu Basin, China. The studied soils are characterized by acid (pH in mean level of 5.5), carbon rich (soil organic matter in mean of 33.6 g kg-1) and mainly contaminated by Cd (42.2% samples exceeded the standard value of 0.3 mg kg-1 (GB15618-2018)). The spatial distributions of Cd, Pb and Zn exhibited similar geographic trends. 34% and 30% of the rice samples containing Cd and Pb exceeded the threshold value of 0.2 mg kg-1 (GB2762-2017), respectively. The risk estimation of dietary intake had a target hazard quotient value of Cd of 0.918 and a hazard index value for rice consumption of 2.141. Totally, Cd and Pb were found to be the main components contributing to the potential health risks posed by non-carcinogenic effects for local inhabitants.

Assessment of Cerebral and Cerebellar White Matter Microstructure in Spinocerebellar Ataxias 1, 2, 3, and 6 Using Diffusion MRI.

Development of imaging biomarkers for rare neurodegenerative diseases such as spinocerebellar ataxia (SCA) is important to non-invasively track progression of disease pathology and monitor response to interventions. Diffusion MRI (dMRI) has been shown to identify cross-sectional degeneration of white matter (WM) microstructure and connectivity between healthy controls and patients with SCAs, using various analysis methods. In this paper, we present dMRI data in SCAs type 1, 2, 3, and 6 and matched controls, including longitudinal acquisitions at 12-24-month intervals in a subset of the cohort, with up to 5 visits. The SCA1 cohort also contained 3 premanifest patients at baseline, with 2 showing ataxia symptoms at the time of the follow-up scans. We focused on two aspects: first, multimodal evaluation of the dMRI data in a cross-sectional approach, and second, longitudinal trends in dMRI data in SCAs. Three different pipelines were used to perform cross-sectional analyses in WM: region of interest (ROI), tract-based spatial statistics (TBSS), and fixel-based analysis (FBA). We further analyzed longitudinal changes in dMRI metrics throughout the brain using ROI-based analysis. Both ROI and TBSS analyses identified higher mean (MD), axial (AD), and radial (RD) diffusivity and lower fractional anisotropy (FA) in the cerebellum for all SCAs compared to controls, as well as some cerebral alterations in SCA1, 2, and 3. FBA showed lower fiber density (FD) and fiber crossing (FC) regions similar to those identified by ROI and TBSS analyses. FBA also highlighted corticospinal tract (CST) abnormalities, which was not detected by the other two pipelines. Longitudinal ROI-based analysis showed significant increase in AD in the middle cerebellar peduncle (MCP) for patients with SCA1, suggesting that the MCP may be a good candidate region to monitor disease progression. The patient who remained symptom-free throughout the study displayed no microstructural abnormalities. On the other hand, the two patients who were at the premanifest stage at baseline, and showed ataxia symptoms in their follow-up visits, displayed AD values in the MCP that were already in the range of symptomatic patients with SCA1 at their baseline visit, demonstrating that microstructural abnormalities are detectable prior to the onset of ataxia.

Comprehensive Quantitative Assessment of Lung Liquid Clearance by Lung Ultrasound Score in Neonates with No Lung Disease during the First 24 Hours.

OBJECTIVES: To comprehensively and quantitatively assess the process of lung liquid clearance using the lung ultrasound score. This study is to evaluate the whole healthy lungs of neonates during the first 24 h. METHODS: Lung ultrasound was performed in neonates with no respiratory symptoms within 3 h after birth, and scans were then repeated at 6 hours and 24 hours, respectively. The entire chest wall was divided into 12 regions. The lung ultrasound scores of the anterior, posterior, upper, and lower regions and sum of all regions were calculated according to the ultrasound pattern of each region examined. RESULTS: The total lung ultrasound score decreased gradually during the first 24 h, with the total lung ultrasound score at 6 h being significantly lower than that at <3 h (P < 0.05). At <3 h, B-lines were more abundant in the posterior chest than in the anterior chest (P < 0.05). At <3 h, B-lines were more abundant in the posterior chest than in the anterior chest (P < 0.05). At <3 h, B-lines were more abundant in the posterior chest than in the anterior chest (. CONCLUSION: Changes in the lung ultrasound score may quantitatively reflect the characteristics of different regions and processes of lung liquid clearance during the first 24 h.

Inequality in the health services utilization in rural and urban china: A horizontal inequality analysis.

BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality. METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method. RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area. CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.

[Pollution Condition and Health Risk Assessment of VOCs in Fermentation Exhaust from Penicillin Production].

Penicillin is the most widely used and longest-lived antibiotic in the pharmaceutical industry. It belongs to the bio-fermentation chass of drugs, with a large amount of fermentation exhaust containing volatile organic compounds (VOCs) generated during the process of penicillin production, which have a serious impact on the environment. In this study, the pollution characteristics of the fermented exhaust are studied by using investigation and testing the souces of the pollution and via a health risk assessment model. The main results show that 23 kinds of VOCs were detected in the penicillin fermentation exhaust. The main pollutants included vinyl acetate trifluorotrichloroethane, dichlorotetrafluoroethane, and methylene chloride. In the heating stage, holding stage, cooling stage, and fermentation stage, the proportion of chlorinated hydrocarbons was the highest, followed by esters, and the total amount of these two kinds of substances accounted for more than 90% of total volatile organic compounds (TVOCs). Using the model of health risk assessment, the noncarcinogenic risk value of the total fermented exhaust was 4.98×10-5, which estimating the risk value by concentration gradient expansion is much lower than the maximum acceptable level (5×10-5 a-1) recommended by the International Commission on Radiation Protection (ICRP), which will not cause certain non-carcinogenic risk to the exposed population. VOCs in fermentation exhaust also have carcinogenic effects on human beings. The main health hazards to humans are 1,3-butadiene, dichloromethane, methyl chloride, carbon tetrachloride, benzene, and 1,1-dichloroethane.

Efficiency of Emission Control Measures on Particulate Matter-Related Health Impacts and Economic Cost during the 2014 Asia-Pacific Economic Cooperation Meeting in Beijing.

Background: The Asia-Pacific Economic Cooperation (APEC) meeting was held from 5 November to 11 November 2014 in Beijing, and comprehensive emission control measures were implemented. The efficiency of these measures on particulate matter-related health impacts and economic cost need to be evaluated. Methods: The influences of emission control measures during APEC on particulate matter were evaluated, and health economic effects were assessed. Results: Average concentrations of PM2.5 and PM10 during APEC were reduced by 57.0%, and 50.6% respectively, compared with pre-APEC period. However, the concentrations of particulate matter rebounded after APEC. Compared with the pre-APEC and post-APEC periods, the estimated number of deaths caused by non-accidental, cardiovascular and respiratory diseases that could be attributed to PM2.5 and PM10 during the APEC were the lowest. The economic cost associated with mortality caused by PM2.5 and PM10 during the APEC were reduced by (61.3% and 66.6%) and (50.3% and 60.8%) respectively, compared with pre-APEC and post-APEC. Conclusions: The emission control measures were effective in improving short term air quality and reducing health risks and medical expenses during 2014 APEC, but more efforts is needed for long term and continuous air quality improvement and health protection.

The effect of the National Essential Medicines Policy on health expenditures and service delivery in Chinese township health centres: evidence from a longitudinal study.

OBJECTIVES: The government of China has introduced a National Essential Medicines Policy (NEMP) in the new round of health system reform. The objective of this paper is to analyse whether the NEMP can play a role in curbing the rise of medical expenditures without disrupting the availability of healthcare services at township hospitals in China. DESIGN: This study adopted a pre-post treatment-control study design. A difference-in-differences method and fixed-effects model for panel data were employed to estimate the effect of the NEMP. SETTING: Chongqing, Jiangsu and Henan Province, in China, in 2009 and 2010. PARTICIPANTS: 296 township health centres. OUTCOME MEASURES: Outcomes for health expenditures were average outpatient drug expenses per visit, average inpatient drug expenses per discharged patient, average outpatient expenses per visit and average inpatient expenses per discharged patient. Outcomes for care delivery were the numbers of visits per certified doctor per day and the numbers of hospitalised patients per certified doctor per day. RESULTS: The township health centres that were enrolled in the NEMP reported 26% (p<0.01) lower drug expenditures for inpatient care. An 11% (p<0.05) decrease in average inpatient expenditures per discharged patient was found following the implementation of the NEMP. The impacts of the NEMP on average outpatient expenditures and outpatient drug expenditures were not statistically significant at the 5% level. No statistically significant associations were found between the NEMP and reduction in quantity of health service delivery. CONCLUSIONS: The NEMP was significant in its effect in reducing inpatient medication and health service expenditures. This study shows no evidence that the quantity of healthcare service declined significantly after introduction of the NEMP over the study period, which suggests that if appropriate matching policies are introduced, the side effects of the NEMP can be counteracted to some degree. Further research including a long-term follow-up study is needed.