Differences in nutritional risk assessment between NRS2002, RFH-NPT and LDUST in cirrhotic patients.

Nutritional status is an independent predictor of outcome in cirrhosis patients. Nutritional Risk Screening 2002 (NRS2002), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), and Liver Disease Undernutrition Screening Tool (LDUST) were employed to detect cirrhosis with malnutrition risk in this work. Meanwhile, their diagnostic performances were compared to find the best screening method. This work aimed to establish the sarcopenia cut-off value of the transversal psoas thickness index (TPTI), and identify the risk factors for malnutrition. Cirrhosis patients who were admitted to Heibei Gerneral hospital from April 2021 to October 2021 and underwent abdominal CT examination were enrolled. 78 patients were assessed by NRS2002, RFH-NPT, and LDUST. The Global Leadership Initiative for Malnutrition (GLIM) criteria were selected as the gold standard for the diagnosis of malnutrition. Meanwhile the cut-off value of sarcopenia was established based on the TPTI of malnourished patients. Logistic regression analysis was adopted to assess the influencing factors of malnutrition risk and malnutrition. The prevalence of malnutrition was 42.31%. The prevalence of malnutrition risk was 32.1%, 61.5%, and 62.8% with NRS2002, RFH-NPT, and LDUST, respectively. NRS2002 presented the best specificity compared with the other methods, while RFH-NPT showed the highest sensitivity. The optimal gender-specific TPTI cut-off value for diagnosing sarcopenia was determined as TPTI < 14.56 mm/m (male) and TPTI < 8.34 mm/m (female). In the multivariate analysis, ascites was associated with malnutrition risk, while sarcopenia showed a significant risk for malnutrition. NRS2002 and RFH-NPT were superior to LDUST at detecting the malnutrition in cirrhosis patients diagnosed according to GLIM criteria. The gender-specific TPTI cut-off value was TPTI < 14.56 mm/m (male) and TPTI < 8.34 mm/m (female). Malnutrition risk should be screened for patients with ascites as soon as possible. In addition, it was important to evaluate malnutrition in sarcopenia patients in time.

Removal mechanisms of erythromycin by microalgae Chlorella pyrenoidosa and toxicity assessment during the treatment process.

Microalgae-based biotechnology for antibiotic removal has received increasing attention as an economical and green method. This study investigated the removal mechanism of erythromycin by Chlorella pyrenoidosa and its correlation with the ecotoxic responses of microalgae. The degradation products (DPs) were identified, and their toxicity was predicted. The results indicated that only 4.04 %, 6.28 % and 23.53 % of erythromycin were left after 21-day microalgae treatment in 0.1, 1.0 and 10 mg/L treatments, respectively. Biodegradation contributed 48.62-67.01 %, 16.67-52.32 % and 6.42-24.82 %, while abiotic degradation contributed 8.76-29.61 %, 5.19-41.39 %, and 16.55-51.22 % to erythromycin attenuation in 0.1, 1.0, and 10 mg/L treatments, respectively. The growth and physiological-biochemical parameters of microalgae were slightly affected in low concentration treatment, which may be the main reason that biodegradation was the prominent removal mechanism. By contrast, oxidative damage in high concentration treatment inhibited the cell growth and chlorophyll content of microalgae, which hindered erythromycin biodegradation. In addition, eleven erythromycin degradation products (DPs) were identified during microalgae treatment of 21 days. Seven DPs including DP717, DP715, DP701A, DP701B, DP657, DP643, and DP557, represented higher toxicity to aquatic organisms than erythromycin.

Global review of macrolide antibiotics in the aquatic environment: Sources, occurrence, fate, ecotoxicity, and risk assessment.

The extensive use of macrolide antibiotics (MCLs) has led to their frequent detection in aquatic environments, affecting water quality and ecological health. In this study, the sources, global distribution, environmental fate, ecotoxicity and global risk assessment of MCLs were analyzed based on recently published literature. The results revealed that there are eight main sources of MCLs in the water environment. These pollution sources resulted in MCL detection at average or median concentrations of up to 3847 ng/L, and the most polluted water bodies were the receiving waters of wastewater treatment plants (WWTPs) and densely inhabited areas. Considering the environmental fate, adsorption, indirect photodegradation, and bioremoval may be the main attenuation mechanisms in natural water environments. N-demethylation, O-demethylation, sugar and side chain loss from MCL molecules were the main pathways of MCLs photodegradation. Demethylation, phosphorylation, N-oxidation, lactone ring hydrolysis, and sugar loss were the main biodegradation pathways. The median effective concentration values of MCLs for microalgae, crustaceans, fish, and invertebrates were 0.21, 39.30, 106.42, and 28.00 mg/L, respectively. MCLs induced the generation of reactive oxygen species, that caused oxidative stress to biomolecules, and affected gene expression related to photosynthesis, energy metabolism, DNA replication, and repair. Moreover, over 50% of the reported water bodies represented a medium to high risk to microalgae. Further studies on the development of tertiary treatment technologies for antibiotic removal in WWTPs, the combined ecotoxicity of antibiotic mixtures at environmental concentration levels, and the development of accurate ecological risk assessment models should be encouraged.

Utility of a Patient-Reported Symptom and Functioning Assessment Tool for Geriatric Oncology Care in China.

OBJECTIVES: Symptom and functional assessment is challenging in geriatric oncology care. This multicenter cross-sectional study examined the use of a multiple-symptom assessment tool, the MD Anderson Symptom Inventory (MDASI), on Chinese patients with cancer aged 65 years and older. METHODS: Patient-rated symptoms and functioning were assessed using MDASI and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire. RESULTS: The most severe symptoms were fatigue and poor appetite. The older group (75-84 years old, n = 224) reported a more severe difficulty remembering (effect size [ES] 0.32; P < .001), shortness of breath (ES 0.20; P = .020), and interference with general activity (ES 0.14; P = .027), with significantly worse physical functioning (ES -0.33; P < .001) and cognitive functioning on the European Organization for Research and Treatment of Cancer quality-of-life questionnaire (ES 0.20; P < .001) than the younger group (65-74 years old, n = 555). For MDASI measures of the core symptoms and total interference with daily activity, Cronbach α coefficients were 0.90 and 0.93, respectively, for the younger group; and 0.93 and 0.94 for the older group, respectively. Moderate to severe (score ≥4) interference with general activity and walking on MDASI accurately indicated poor performance status (area under the curve 0.8089 and 0.7969, respectively) and lack of independence status of Activities of Daily Living (area under the curve 0.7993 and 0.8304, respectively). CONCLUSIONS: MDASI is psychometrically reliable, valid, and clinically sensitive for the measuring symptom burden and functional status of Chinese patients with cancer aged 65 years and older. MDASI could be adopted to measure multiple symptoms and physical functioning outcomes in geriatric oncology practice as well as for research on treatment benefits.

State of the Science: Cancer Complementary and Alternative Medicine Therapeutics Research-NCI Strategic Workshop Highlights of Discussion Report.

In May 2016, the Office of Cancer Complementary and Alternative Medicine, Division of Cancer Diagnosis and Treatment, of the National Cancer Institute convened a special workshop focused on the State of the Science: Cancer Complementary and Alternative Medicine Therapeutics Research. The current state of the science, gaps, and future opportunities were reviewed and discussed by a distinguished panel of experts in this field of research, and the highlights of this meeting are reported herein.

The current status of heavy metal in lake sediments from China: Pollution and ecological risk assessment.

Heavy metal contamination in lake sediments is a serious problem, particularly in developing countries such as China. To evaluate heavy metal pollution and risk of contamination in lake sediments on a national scale in China, we collated available data in the literature of the last 10 years on lake sediments polluted with heavy metals from 24 provinces in China. Based on these data, we used sediment quality guidelines, geoaccumulation index, and potential ecological risk index to assess potential ecological risk levels. The results showed that approximately 20.6% of the lakes studied exceeded grade II level in Chinese soil quality standards for As, 31.3% for Cd, 4.6% for Cu, 20.8% for Ni, 2.8% for Zn, and 11.1% for Hg, respectively. Besides, the mean concentrations for As in 10.3% of lakes, Hg in 11.9% of lakes, and Ni in 31.3% of lakes surpassed the probable effect level. The potential ecological risk for toxic metals decreased in the order of Cd > Hg > As > Cu > Pb > Ni > Cr > Zn, and there were 21.8% of the lakes studied in the state of moderate risk, 10.9% in high risk, and 12.7% in very high risk. It can be concluded that Chinese lake sediments are polluted by heavy metals to varying degrees. In order to provide key management targets for relevant administrative agencies, based on the results of the pollution and ecological risk assessments, Cd, Hg, As, Cu, and Ni were selected as the priority control heavy metals, and the eastern coastal provinces and Hunan province were selected as the priority control provinces. This article, therefore, provides a comprehensive assessment of heavy metal pollution in lake sediments in China, while providing a reference for the development of lake sediment quality standards.

Effects of China's New Rural Cooperative Medical Scheme on reducing medical impoverishment in rural Yanbian: An alternative approach.

BACKGROUD: This study aimed to measure the poverty head count ratio and poverty gap of rural Yanbian in order to examine whether China's New Rural Cooperative Medical Scheme has alleviated its medical impoverishment and to compare the results of this alternative approach with those of a World Bank approach. METHODS: This cross-sectional study was based on a stratified random sample survey of 1,987 households and 6,135 individuals conducted in 2008 across eight counties in Yanbian Korean Autonomous Prefecture, Jilin province, China. A new approach was developed to define and identify medical impoverishment. The poverty head count ratio, relative poverty gap, and average poverty gap were used to measure medical impoverishment. Changes in medical impoverishment after the reimbursement under the New Rural Cooperative Medical Scheme were also examined. RESULTS: The government-run New Rural Cooperative Medical Scheme reduced the number of medically impoverished households by 24.6 %, as well as the relative and average gaps by 37.3 % and 38.9 %, respectively. CONCLUSIONS: China's New Rural Cooperative Medical Scheme has certain positive but limited effects on alleviating medical impoverishment in rural Yanbian regardless of how medical impoverishment is defined and measured. More governmental and private-sector efforts should therefore be encouraged to further improve the system in terms of financing, operation, and reimbursement policy.

Current Development in Elderly Comprehensive Assessment and Research Methods.

Comprehensive geriatric assessment (CGA) is a core and an essential part of the comprehensive care of the aging population. CGA uses specific tools to summarize elderly status in several domains that may influence the general health and outcomes of diseases of elderly patients, including assessment of medical, physical, psychological, mental, nutritional, cognitive, social, economic, and environmental status. Here, in this paper, we review different assessment tools used in elderly patients with chronic diseases. The development of comprehensive assessment tools and single assessment tools specially used in a dimension of CGA was discussed. CGA provides substantial insight into the comprehensive management of elderly patients. Developing concise and effective assessment instruments is helpful to carry out CGA widely to create a higher clinical value.

Comprehensive geriatric assessment and traditional Chinese medicine intervention benefit symptom control in elderly patients with advanced non-small cell lung cancer.

The aim of this study was to observe the symptom improvement and clinical benefit in elderly patients with advanced non-small cell lung cancer (NSCLC) stratified on the basis of CGA findings after treatment with a combination of traditional Chinese medicine and Western medicine. Twenty-four elderly advanced NSCLC patients with a mean age of 73.0 ± 5.3 (65-83) years were categorized into three stratifications according to CGA results, namely function independent, mildly function impaired, and function dependent. They received standardized therapy, individualized therapy, and best supportive care, respectively. The patients receiving standardized therapy and individualized therapy were randomized into two groups, with or without traditional Chinese medicine for symptom control, while for all the patients receiving best supportive care, traditional Chinese medicine was administered. Nine non-elderly NSCLC patients (<65 years old) were enrolled as control and treated in accordance with NCCN NSCLC treatment guidelines. EORTC QLQ-C30 core scale, LC13 scale, and MDASI-TCM scale were used to assess relevant symptoms before and after treatment. After treatment for 3 weeks, it was shown by QLQ-C30+LC13 scales, for function-dependent patients, that the physical and role performances and the global health status were improved and the symptoms of fatigue and cough were alleviated; by MDASI-TCM scale, the symptoms of fatigue, cough, and expectoration were improved. In function-independent and mildly function-impaired elderly patients, there were no significant changes in functional status and symptoms. But in non-elderly patients, the physical and social performances were lowered, and the symptoms of fatigue, constipation, and poor appetite were aggravated. The elderly patients with advanced NSCLC were categorized on the basis of CGA findings, and traditional Chinese medicine may be beneficial to symptom control of function-dependent patients.

Characteristics and treatment options of elderly Chinese patients with cancer as determined by Comprehensive Geriatric Assessment (CGA).

OBJECTIVE: China is experiencing a rapid increase in cancer incidence in elderly patients. In order to better understand this group, a large study of patients from multiple tertiary centers in the Beijing area was designed. This study was designed to provide insight into their unique treatment preferences, including the use of traditional Chinese medicine (TCM). MATERIALS AND METHODS: 803 patients from nine hospitals in the Beijing area were enrolled into this study. The inclusion criteria were patients who were 65 years or older and had a diagnosis of cancer at any stage. The CGA questionnaire used with these patients included the Chinese translation of the Gero-Oncology Health and Quality of Life Assessment tool. The questionnaire was provided to patients by a research nurse and was administered in Mandarin. RESULTS: The mean age of the patients was 72 years (range 65-94). The patients were mainly male (59.8%) and of Han ethnicity (95.4%). About 45% of these patients also had concurrent TCM in addition to their other cancer treatments. About 70% were able to manage their activities of daily living without assistance. Patients on TCM were more likely to have higher number of co-morbidities compared to their counterparts. CONCLUSION: This is the largest prospective study of CGA assessments done on elderly patients with cancer in Asia. The study demonstrates that CGA provides insights into understanding the needs of elderly Chinese patients with cancer. TCM is used frequently in China, and its impact on quality of life needs further investigation.

Thermal stability of liquid antioxidative extracts from pomegranate peel.

BACKGROUND: Liquid extracts from pomegranate peel have the potential for use as natural antioxidant products. This study investigates the quality changes of liquid extracts before and after thermal treatment during sterilization and storage. Liquid pomegranate peel extracts were prepared, sterilized under ultra-high temperature (UHT) at 121 °C for 10 s and then stored at three temperatures (4, 25 and 37 °C) for up to 180 days. The industrial, color, UV-visible spectrum profile and antioxidant (phenolics) characteristics were measured. RESULTS: Thermal sterilization treatment had no negative effects on the industrial, color, spectral and antioxidant characteristics of the extracts. After 180 days, the extracts stored at 4 °C retained 67% of the initial total soluble phenolic content and 58% of the original scavenging activity. The major antioxidant components in the extracts (stored at 4 °C for 180 days) were gallic acid, punicalagin A, punicalagin B and ellagic acid having concentrations of 19.3, 197.2, 221.1 and 92.4 mg L⁻¹, respectively. CONCLUSION: The results show that liquid pomegranate peel extracts had acceptable thermal stability after sterilization and storage. The recommended storage condition of this product was low temperature.

Assessment of shikonin for potential estrogenic activity by dual-luciferase reporter based bioluminescent measurements in vitro.

Shikonin, an active component of Lithospermum erythrorhizon Sieb. et Zucc., shows multiple pharmacological properties. However, the estrogenic activity of shikonin is remaining unclear. We assessed the potential estrogenic activity of shikonin with dual-luciferase reporter assay and bioluminescent measurements, by using transient cotransfection with estrogen dependent plasmid pERE-TK-Luc and internal control plasmid pRL-TK in MCF-7 cells. Estrogenic activity of shikonin, even at high concentration did not alter significantly compared to negative control (p > 0.05) and were significantly lower than those with E2 (p < 0.01). Concluding, shikonin demonstrates no estrogenic activity in vitro.