Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015.

BACKGROUND: While the Affordable Care Act's Medicaid expansion improved healthcare coverage and access for millions of uninsured Americans, less is known about its effects on the overall accessibility and quality of care across all payers. Rapid volume increases of newly enrolled Medicaid patients might have unintentionally strained accessibility or quality of care. We assessed changes in physician office visits and high- and low-value care associated with Medicaid expansion across all payers. METHODS: Prespecified, quasi-experimental, difference-in-differences analysis pre and post Medicaid expansion (2012-2015) in 8 states that did and 5 that did not choose to expand Medicaid. Physician office visits sampled from the National Ambulatory Medical Care Survey, standardized with U.S. Census population estimates. Outcomes included visit rates per state population and rates of high or low-value service composites of 10 high-value measures and 7 low-value care measures respectively, stratified by year and insurance. RESULTS: We identified approximately 143 million adults utilizing 1.9 billion visits (mean age 56; 60% female) during 2012-2015. Medicaid visits increased in expansion states post-expansion compared to non-expansion states by 16.2 per 100 adults (p = 0.031 95% CI 1.5-31.0). New Medicaid visits increased by 3.1 per 100 adults (95% CI 0.9-5.3, p = 0.007). No changes were observed in Medicare or commercially-insured visit rates. High or low-value care did not change for any insurance type, except high-value care during new Medicaid visits, which increased by 4.3 services per 100 adults (95% CI 1.1-7.5, p = 0.009). CONCLUSIONS: Following Medicaid expansion, the U.S. healthcare system increased access to care and use of high-value services for millions of Medicaid enrollees, without observable reductions in access or quality for those enrolled in other insurance types. Provision of low-value care continued at similar rates post-expansion, informing future federal policies designed to improve the value of care.

A prognostic nomogram based on risk assessment for invasive micropapillary carcinoma of the breast after surgery.

PURPOSE: Invasive micropapillary carcinoma (IMPC) is one of the rare subtypes of breast cancer. This study aimed to explore a predictive nomogram model for IMPC prognosis. METHODS: A total of 1855 IMPC patients diagnosed after surgery between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results (SEER) database to build and validate nomogram. A nomogram was created based on univariate and multivariate Cox proportional hazards regression analysis. Receiver operating characteristic (ROC) curves were used to demonstrate the accuracy of the prognostic model. Decision curve analysis (DCA) was performed to evaluate the safety of the model in the range of clinical applications, while calibration curves were used to validate the prediction consistency. RESULTS: Cox regression analysis indicated that age ≥62 at diagnosis, negative ER status, and tumor stage were considered adverse independent factors for overall survival (OS), while patients who were married, white or of other races, received chemotherapy or radiotherapy, had a better postoperative prognosis. The nomogram accurately predicted OS with high internal and external validation consistency index (C index) (0.756 and 0.742, respectively). The areas under the ROC curve (AUCs) of the training group were 0.787, 0.774 and 0.764 for 3, 5 and 10 years, respectively, while those of the validation group were 0.756, 0.766 and 0.762, respectively. The results of both DCA and calibration curves demonstrated the good performance of the model. CONCLUSIONS: A nomogram for IMPC of the breast patients after surgery was developed to estimate 3, 5 and 10 years-OS based on independent risk factors. This model has good accuracy and consistency in predicting prognosis and has clinical application value.

Quantifying the Carbon Reduction Potential of Recycling Construction Waste Based on Life Cycle Assessment: A Case of Jiangsu Province.

The recycling of construction waste is key to reducing waste generation and CO2 emissions. This study aimed to develop a quantitative model for analyzing the carbon reduction potential of recycling construction, demolition, and renovation waste (CDRW) in Jiangsu province. The waste generation rate calculation method and nonlinear autoregressive artificial neural network model were used to estimate and predict CDRW generation. The life cycle assessment was performed to calculate the carbon reduction potential of recycling CDRW. In quantifying the carbon reduction potential, not only construction and demolition waste, but also renovation waste was considered for the first time. The results showed that the total carbon reduction potential of recycling CDRW increased from 3.94 Mt CO2e in 2000 to 58.65 Mt CO2e in 2020. Steel and concrete were the main contributors. By scenario analysis, the carbon reduction potential of fully recycling CDRW in 2020 increased by 37.79 Mt CO2e, a growth rate of 64%. The study further predicts future CDRW generation and the corresponding carbon reduction potential. Our conclusions indicate that 245.45 Mt of CDRW will be generated in 2030, and carbon reduction potential may reach 82.36 Mt CO2e. These results will help the government manage construction waste better and reach early achievement of the carbon peak target.

Displaying Cost and Completion Time for Reference Laboratory Test Orders-A Randomized Controlled Trial.

OBJECTIVES: Reduction in unnecessary services is one strategy for increasing the value of health care. Reference laboratory, or send-out, tests are associated with considerable costs. We investigated whether displaying cost and turnaround time (TAT), or time-to-result, for reference laboratory tests at the time of order entry in the electronic health record (EHR) system would impact provider ordering practices. METHODS: Reference laboratory test cost and TAT data were randomized prior to the study and only displayed for the intervention group. A 24-month dataset composed of 12 months each for baseline and study periods was extracted from the clinical data mart. A difference-in-differences (DID) analysis was conducted using a linear mixed-effects model to estimate the association between the intervention and changes in test-ordering patterns. RESULTS: In the inpatient setting, the DIDs of aggregate test-order costs and volume were not different among the control and intervention groups (p = 0.31 and p = 0.26, respectively). In the ambulatory setting, the DIDs of aggregate test-order costs and volume were not different among the control and intervention groups (p = 0.82 and p = 0.51, respectively). For both inpatient and ambulatory settings, no significant difference was observed in the DID of aggregate test-order costs and volumes calculated in respect to stratified relative cost and TAT groups (p > 0.05). CONCLUSION: Lack of alternative tests, test orders placed at a late step in patient management, and orders facilitated by trainees or mid-level providers may have limited the efficacy of the intervention. Our randomized study demonstrated no significant association between the display of cost or TAT display and ordering frequency.

Convergence study of water pollution emission intensity in China: evidence from spatial effects.

One of the challenges that China currently faces is how to reduce the emissions of water pollution. However, the study of water pollution convergence has a certain policy significance for controlling the emissions of water pollution. This article firstly uses chemical oxygen demand (COD) and ammonia nitrogen (NH3-N) as indicators of water pollution. Due to the obvious spillover effect of water in space, this article adds a spatial effect to the convergence model. Based on panel data of 30 provinces and cities from 2006 to 2017, this article uses a dynamic spatial Dubin model to analyze the convergence of water pollution emission intensity to address the endogenous problem in the model. The empirical results of this paper show that there is absolute ß-convergence and conditional ß-convergence in the intensity of water pollution emissions. The spatial autocorrelation test shows that there is a positive spatial autocorrelation of water pollution emissions, which means that the pollution emissions in neighboring areas will affect the emissions in the local area. The industrial structure has a certain promoting effect on the emission of water pollution, which means that adjusting the industrial structure and alleviating the structure of the secondary industry is the trend of future development. Economic growth can curb the emissions of water pollution. The influences of urbanization and foreign investment on the emissions of the two pollutants are inconsistent, and policies can be formulated according to local conditions in the future.

Concentrations, distribution, and risk assessment of endosulfan residues in the cotton fields of northern Xinjiang, China.

In the current study, surface soil samples were collected from cotton fields in Shawan and Shihezi areas in northern Xinjiang and tested for endosulfan residues using gas chromatography-mass spectrometry. Results showed endosulfan sulfate was the predominant compound in the surface soil studied, followed by ß-endosulfan and α-endosulfan with detection rates of 86.9%, 55.7%, and 49.2%, respectively, for the 61 soil samples collected. The average concentrations of endosulfan sulfate, α-endosulfan, and ß-endosulfan were 0.743, 0.166, and 0.073 µg/kg, respectively. The ratios of α-/ß-endosulfan were below 2.33 in all samples tested, suggesting no new endosulfan was added to the soil and the presence of endosulfan residues in this region was due to historical application in the past. According to the health risk assessment model recommended by the USA Environmental Protection Agency, the health risk of endosulfan residues in the studied area was low, and the maximum values of noncarcinogenic risks for children and adults were 2.30 × 10-5 and 2.70 × 10-6, respectively. Folsomia candida was the most sensitive organism to total endosulfan residues, with 38% of the total sampling sites classified as high risk. For earthworms, the proportion of high risk site was 13%. Lactuca sativa was the most tolerant organism to ∑ESs, with all sampling sites identified as negligible risk. This study provided current status of endosulfan residues and related risk in cotton fields, which could be used to support decision makers to prepare relevant regulations.

Study on the impact of comprehensive urbanization on urban civil building CO2 emissions in China.

With the rapid development of China, urbanization has become an important research topic of China's CO2 emissions. To fill the gap in considering the spatial correlation of the comprehensive urbanization that includes multi-dimensional factors on CO2 emissions from urban civil buildings (UBEC), this study constructs a comprehensive evaluation indicator of urbanization from four aspects including population, economy, society, and land urbanization by using the entropy method. The spatial spillover effect of UBEC and the impact of comprehensive urbanization on UBEC are also studied by using the spatial panel model in this paper. This study finds out that UBEC has obvious spatial spillover effects. During the early years of the study period, the eastern coastal areas had greater carbon emissions, while in recent years, they have gradually transitioned to the northwestern regions. Comprehensive urbanization has a significant promotion effect on it. And foreign direct investment and per capita energy consumption also have positive impact on UBEC. This study provides a reference for measuring the effects of urbanization on sector-specific CO2 emissions and may be useful for energy efficiency and emission abatement efforts in China.

Assessment of liver fibrosis with liver and spleen stiffness measured by sound touch elastography, serum fibrosis markers in patients with chronic hepatitis B.

OBJECTIVES: To evaluate the performance of liver stiffness (LS) and spleen stiffness (SS) by using the sound touch elastography (STE) technique and compare with those of the splenic index, aspartate transaminase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) index, King's score and combined models for diagnosing and staging fibrosis in chronic hepatitis B (CHB). METHODS: One hundred patients with CHB underwent STE and serological tests. LS and SS values were measured with STE technique, and splenic index was calculated. Staging of fibrosis was determined with liver biopsy. Correlations between the individual parameters and the stage of fibrosis were evaluated with the Spearman correlation analysis. The area under the receiver operating characteristic curve (AUROC) was calculated to analyze the performance of all methods. RESULTS: Among all individual parameters, LS showed the highest AUROC for diagnosing fibrosis of ≥S2, ≥S3, and S4 stages (AUROC: 0.70, 0.86, and 0.96, respectively; all P < 0.05). The AUROC of combined model 1 (LS and SS) and 2 (LS, SS, APRI, FIB-4 index, King's score) for diagnosing ≥S2, ≥S3, and S4 fibrosis were 0.70, 0.86, 0.97, and 0.70, 0.86, 0.96, respectively, which were higher than those of APRI, FIB-4 index and the King's score (P < 0.05). No significant differences were found between two combined models and LS for staging fibrosis (P > 0.05). CONCLUSIONS: LS measurement is reliable for diagnosing and staging fibrosis in CHB, with a better performance than SS, splenic index and serum biomarkers. It is also comparable with the performance of combined models.

Performances of the Canadian Agility and Movement Skill Assessment (CAMSA), and validity of timing components in comparison with three commonly used agility tests in Chinese boys: an exploratory study.

BACKGROUND: The practical application of the Canadian Agility and Movement Skill Assessment (CAMSA) has been reported in some Western countries. However, a few studies reported the application of the CAMSA in Chinese children. In addition, given that the CAMSA was designing to incorporate both movement skills and agility assessment, the value and validity of the timing component of the CAMSA are worth discussing. METHODS: By choosing the Illinois Agility Test, Repeated Side Step-1 m distance, and the newly designed Repeated Side Step-half of height as the benchmark, we evaluate the performance of the CAMSA, further establish the concurrent validity of the CAMSA timing components (completion time and time score). In total, 149 male children (mean age 9.0 ± 0.8 years) from public schools in Shanghai, China, participated in the study. RESULTS: The mean CAMSA completion time was 19.3 ± 5.3 (s), and mean time score was 8.7 ± 3.9 (range of 1-14) for all participants (n = 149). After adjusted the sprint speed, older age was positively associated with the performance of the CAMSA. Being overweight was not associated with the performance of the CAMSA comparing with healthy body mass children, however, being obese was negatively associated with the CAMSA timing components and total score. Children having extracurricular sports activities (e.g., athletic experiences), mostly soccer, were more likely to demonstrated better performances of the CAMSA completion time, time score and total score. However, overweight and obese, also athletic experiences were not significantly contributed to the CAMSA skill score, although the association was slight (Adj R 2 = 0.13). Besides, the CAMSA completion time has a strong correlation with the IAT, r = 0.77; RSS-1MD, r =  - 0.76; and RSS-HHD, r =  - 0.77, p < 0.01. The same pattern of correlation was also found between the CAMSA time score and three agility tests: IAT, r =  - 0.79; RSS-1MD, r = 0.76; RSS-HHD, r = 0.78, p < 0.01. DISCUSSION: Overall, a few participants in the study were able to reach the recommended level of the total CAMSA score referring to the Canadian criterion. The strong concurrent validity was found between the CAMSA timing components and three selected agility tests, respectively.

[Contamination and dietary exposure assessment of fatty acid esters of chloropropanediols in vegetable oil and fat-rich food in Shaanxi Province].

OBJECTIVE: To investigate the contamination of chloropropanediols in fat-rich food in Shaanxi Province, and to assess the dietary chloropropanediols exposure and the health risk of intaking chloropropanediols from fat-rich food for Shaanxi residents. METHODS: In 2015-2016, three kinds of food including vegetable oil, fried food and baked food were collected randomly from ten cities of Shaanxi Province, and determined by gas chromatography. Dietary intake assessment of human exposure to 3-monochloropropane-1, 2-diol ester(3-MCPD ester) was carried out in combination of food consumption data with concentration of chloropropanediols. RESULTS: A total of 203 samples were detected, the total detection rates of 3-MCPD ester and 2-monochloropropane-1, 3-diol ester(2-MCPD ester) were 31.53% and 12.30%, respectively, with the mean values of 0.22 and 0.02 mg/kg.Among all food samples, baked food were more seriously polluted than other kinds of foods with 3-MCPD ester, its detection rate was 47.06%. The highest detection rate of 2-MCPD ester was fried food with 20.00% detection rate. Getting rid of rapeseed oil, olive oil, pastries and biscuits, and 2-MCPD esters were detected in the rest. The ratio of the average exposure and high-end exposure to the maximum daily tolerance of 3-MCPD ester in the three fatty foods were less than 100%. CONCLUSION: The overall level of 3-MCPD esters contamination in fat-rich food is common in Shaanxi Province. The risk assessment result suggests that the current dietary intake of 3-MCPD esters from fried food in Shaanxi Province has acceptable effect on health.

The Construction and Optimization of Ecological Security Pattern in the Harbin-Changchun Urban Agglomeration, China.

Urban agglomerations have become a new geographical unit in China, breaking the administrative fortresses between cities, which means that the population and economic activities between cities will become more intensive in the future. Constructing and optimizing the ecological security pattern of urban agglomerations is important for promoting harmonious social-economic development and ecological protection. Using the Harbin-Changchun urban agglomeration as a case study, we have identified ecological sources based on the evaluation of ecosystem functions. Based on the resistance surface modified by nighttime light (NTL) data, the potential ecological corridors were identified using the least-cost path method, and key ecological corridors were extracted using the gravity model. By combining 15 ecological sources, 119 corridors, 3 buffer zones, and 77 ecological nodes, the ecological security pattern (ESP) was constructed. The main land-use types composed of ecological sources and corridors are forest land, cultivated land, grassland, and water areas. Some ecological sources are occupied by construction, while unused land has the potential for ecological development. The ecological corridors in the central region are distributed circularly and extend to southeast side in the form of tree branches with the Songhua River as the central axis. Finally, this study proposes an optimizing pattern with "four belts, four zones, one axis, nine corridors, ten clusters and multi-centers" to provide decision makers with spatial strategies with respect to the conflicts between urban development and ecological protection during rapid urbanization.

[Assessment on exposure of dietary aluminium among residents in Shaanxi Province during 2013-2015].

OBJECTIVE: To investigate the contamination condition of the aluminium in commercial foods in Shaanxi Province, and evaluate aluminium dietary intake level in Shaanxi population and its potential health risks. METHODS: 1331 samples in Shaanxi Province were collected from 2013 to 2015. The aluminium contents were detected by National Food Contamination and Harmful Factors in Risk Monitoring Manual, and data of total diet study in Shaanxi Province in 2007, to calculate dietary intake of aluminium in Shaanxi population. RESULTS: Average dietary intake of aluminium was 0. 358 mg/( kg·d), accounted for 125% of PTWI. The dietary intake of aluminium in children aged 2 to7 years old was highest, followed children aged 8 to 12 years old and men aged 13 to 19 years old. Grain products and potato products were the main sources of aluminium exposure compared with others. CONCLUSION: The dietary intake of aluminium in Shaanxi population is more than the PTWI. The children aged 2 to 7 years old, children aged 8 to12 years old and men aged 13 to 19 years old is high. Grain products and potato products are the main sources of aluminium exposure in Shaanxi population. The effective measureto control the intake of aluminium is to normalize and rationalize the use of additives containing aluminium.

[Analysis on contamination of zearalenone and dietary exposure assessment in food samples of Shaanxi Province in 2013-2016].

OBJECTIVE: To investigate the contamination of zearalenone in food in Shaanxi Province, and to assess the dietary zearalenone exposure and the health risk of intaking zearalenone from corn products for Shaanxi residents. METHODS: In 2013-2016, samples of five kinds of food including grains, vegetable oil, liquor and infants' food were collected randomly from ten cities, and determined with ultra-performance liquid chromatography. Dietary intake assessment of human exposure to zearalenone was carried out in combination of food consumption data with concentration of zearalenone. RESULTS: 1193 samples were detected zearalenone and the total detection rate was 17. 27%, with the mean value of 13. 5 µg/kg. Among all food samples, oil products were more seriously polluted than other kinds of foods, its detection rate was 79. 37%. And 12 samples of grain products exceed the standard, the exceeding standard rate was 1. 64%, which were all corn products. The level of zearalenone detected in wheat flour, rice, millet, beer and bakery products was low. CONCLUSION: The overall level of zearalenone contamination inmarket food is common, but corn products may be the severely contaminated foods with zearalenone in Shaanxi Province. The risk assessmentresult suggests that the current dietary intake of zearalenone from corn products in Shaanxi Province has no appreciable effect on health, however, the concentrations of zearalenone in corn products are relatively high, and need to be monitored in the future.

[Dietary exposure and health risk assessment of heavy metal in grains of Shaanxi Province].

OBJECTIVE: To investigate heavy metal contamination of grains, and to assess the health risk of the contamination on local inhabitants. METHODS: The contents of 6 heavy metals of grains were detected, according to the food contamination monitor plan of Shaanxi Province. The levels of heavy metal contamination on grains were evaluated by pollution indices. Health risks associated with the daily dietary intake of heavy metals were assessed using USEPA health risk assessment model. RESULTS: 562 grain samples were randomly collected from 94 representative sites in Shaanxi Province. The contaminations of Cd and Pb were more seriously than the other metals. The pollution indices of Cd, As, Cr, Hg, Ni and Pb in 4 kinds of grains were less than 0.7, they were safe to eat. The dietary expose doses of Cd, As, Cr, Hg, Ni and Pb were also at the level of safety. The individual health risk of heavy metal pollution was 3.08 x 10(-4)/year for Cr, which was exceed the standard (5.0 x 10(-5)/year) of Inernational Commission on Radiological Protection (ICRP). The individual health risks of the other five metals were lower than the standard of ICRP. CONCLUSION: The most of grains are considered safe to eat for consumers, excepting a few samples are polluted by lead and cadmium. The individual health risk of Cr is higher than the standand of ICRP.

[Contamination status and risk assessment of lead in the foods and drinking water in Shaanxi Province].

OBJECTIVE: To understand the contamination level of lead in foods and drinking water, and to assess the daily intake of lead and the possible adverse health impact. METHODS: The concentrations of lead in 4612 samples of foods and 58 samples of drinking water were measured. National standard were used to evaluate the degree of pollution, and provisional tolerable weekly intake( PTWI) and margin of exposure( MOE)were used to estimate lead reveals amounts, and carcinogenic risks was used to evaluate the health risk, respectively. RESULTS: The average content of foods and drinking water were0. 0461 mg/kg and 0. 0005 mg/L, respectively, while the violation rates were 2. 18% and0%. The average weekly exposed levels of lead of Shaanxi Province residents were4. 45µg/( kg BW), which accounted for 17. 80% of provisional tolerable weekly intake( PTWI). And the mean MOE value of lead was 1. 89. The main sources of dietary lead were cereals, vegetables and condiment, which covering 88. 32% of total lead. The individual health risk of lead was 6. 49×10~(-5)( a~(-1)), which higher than the standard of ICRP( 5×10~(-5)a~(-1)). CONCLUSION: There is certain degree lead pollution in foods in Shaanxi Province. The exposed levels of lead through foods of Shaanxi Province residentsare safety, but the health risk is high.

The basic social medical insurance is associated with clinical outcomes in the patients with ST-elevation myocardial infarction: a retrospective study from Shanghai, China.

OBJECTIVE: Several social economic factors play important roles in treatments of ST-elevation myocardial infarction (STEMI) and finally influence the clinical outcomes. The basic social medical insurance (BSMI) is an important economic factor in China's medical system. However, the impact of BSMI on clinical outcomes in STEMI patients has not been explored yet. The aim of this study is to investigate whether BSMI is a predictor of clinical outcomes in the patients with STEMI in Shanghai, China. MATERIAL AND METHODS: In this retrospective study, 681 STEMI patients from different areas in Shanghai were classified into four groups: new rural cooperative medical scheme (NCMS) group, urban resident basic medical insurance scheme (URBMI) group, urban employee basic medical insurance scheme (UEBMI) group and UNINSURED group, major adverse events (cardiac death, nonfatal reinfarction, clinically driven target lesion revascularization/target vessel revascularization, stroke, heart failure) were regarded as study endpoints to determine whether BSMI was a prognostic factor. RESULTS: During a mean follow-up of 36 months, the incidence of major adverse events was significantly higher in NCMS patients (64; 38.8%) compared with the other groups: URBMI (47; 24.6%); UEBMI (28; 15.6%); UNISURED (40; 27.6%). Similarly, cardiac mortality was also higher in NCMS group (19; 11.5%). A Kaplan-Meier survival analysis revealed significantly lower event-free survival rate for major adverse events (p < 0.001) and cardiac mortality (p = 0.01) in NCMS group. Multivariate Cox regression analysis revealed that BSMI was an important prognostic factor in STEMI patients. CONCLUSION: These results demonstrate that BSMI is closely associated with the major adverse events-free survival rate at 36-month follow-up in the STEMI patients under the current policies in Shanghai, China.

Fluorogenic resveratrol-confined graphene oxide for economic and rapid detection of Alzheimer's disease.

Developing an effective means for the real-time probing of amyloid ß (Aß) that is closely implicated in Alzheimer's disease (AD) could help better understand and monitor the disease. Here we describe an economic approach based on the simple composition of a natural product, resveratrol (Res), with graphene oxide (GO) for the rapid, fluorogenic recognition of Aß. The Res@GO composite has proved specific for Aß over a range of proteins and ions, and could sensitively capture both Aß monomers and fibers in a physiological buffer solution within only 3 min. The composite can also fluorescently image amyloid deposits in a mouse brain section within 30 min. This new protocol is much cheaper and more timesaving than the conventional immunofluorescence staining technique employed clinically, providing an economic tool for the concise detection of AD.

Unsedated versus sedated gastrointestinal endoscopy: a questionnaire investigation in Wuhan, central China.

National data show that in China mainland unsedated gastrointestinal (GI) endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own decisions: the unsedated group (n=1000) and the sedated group (n=800). After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unsedated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference (P<0.01). Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% between the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% patients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure (P<0.01). In China, unsedated GI endoscopy is now widely accepted by the majority of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people's living standard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually accepted by more patients.

Maternal hypoxia increases the susceptibility of adult rat male offspring to high-fat diet-induced nonalcoholic fatty liver disease.

Exposure to an adverse intrauterine environment increases the risk for adult metabolic syndrome. However, the influence of prenatal hypoxia on the risk of fatty liver disease in offspring is unclear. The purpose of the present study was to evaluate the role of reduced fetal oxygen on the development and severity of high-fat (HF) diet-induced nonalcoholic fatty liver disease (NAFLD). Based on design implicating 2 factors, ie, maternal hypoxia (MH) and postnatal HF diet, blood lipid and insulin levels, hepatic histology, and potential molecular targets were evaluated in male Sprague Dawley rat offspring. MH associated with postnatal HF diet caused a significant increase in plasma concentration of triglycerides, free fatty acids, low-density lipoprotein cholesterol, and insulin. Histologically, a more severe form of NAFLD with hepatic inflammation, hepatic resident macrophage infiltration, and progression toward nonalcoholic steatohepatitis was observed. The lipid homeostasis changes and insulin resistance caused by MH plus HF were accompanied by a significant down-regulation of insulin receptor substrate 2 (IRS-2), phosphoinositide-3 kinase p110 catalytic subunit, and protein kinase B. In MH rats, insulin-stimulated IRS-2 and protein kinase B (AKT) phosphorylation were significantly blunted as well as insulin suppression of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase. Meanwhile, a significant up-regulation of lipogenic pathways was noticed, including sterol-regulatory element-binding protein-1 and fatty acid synthase in liver. Our results indicate that maternal hypoxia enhances dysmetabolic liver injury in response to an HF diet. Therefore, the offspring born in the context of maternal hypoxia may require special attention and follow-up to prevent the early development of NAFLD.

Fluorogenic probing of specific recognitions between sugar ligands and glycoprotein receptors on cancer cells by an economic graphene nanocomposite.

Economical nanocomposites based on π-stacking of N-acetyl glycosyl rhodamine B to graphene oxide (GO) are simply prepared. These "sweet" GO-materials are proven to be admirable for the fluorogenic recognition of specific intercellular sugar-based ligand-glycoprotein receptor interactions of interest.