The role of segmental bioelectrical impedance technique in the assessment of intraperitoneal ultrafiltration volume with peritoneal dialysis patients.

OBJECTIVE: To investigate the role of segmental bioelectrical impedance technique (SBIA) in the assessment of intraperitoneal ultrafiltration volume with peritoneal dialysis patients. METHOD: We selected the patients at the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University and measured the segmental bioelectrical impedance by a German Fresenius body composition analyzer (the Fresenius whole body composition measurement (BCM) machine was used as a segmental machine in this study). An alternating current (5 kHz, 0.05-0.7 mA) was continuously released during the measurement. The released current penetrated the peritoneal cavity on both sides of the body, from which the segmental resistance at a frequency of 5 kHz was obtained from the multifrequency data (R5/Ω). Baseline BIA measurements were initiated after the patient entered the supine position for 5-10 min, then dialysate was instilled into the peritoneal cavity. BIA measurements were performed at 10-min intervals during the retention of dialysate in the abdomen and finally ended when dialysate drainage was complete. Real-time intraperitoneal volume estimated by SBIA (IPVSBIA)and ultrafiltration volume estimated by SBIA(UFVSBIA) was calculated. At the same time, the actual ultrafiltration volume at the end of peritoneal dialysis was weighed and measured (UFVMEA). RESULTS: A total of 30 patients were included in the study, 9 patients withdrew from the study due to subjective factors during the measurement process, and 21 patients completed the study. The correlation coefficient R2 of UFVSBIA and UFVMEA was 0.21 (p < 0.05). Bland-Altman analysis showed that the bias of UFVSBIA to the actual UFVMEA was 0.12 L, and the 95% agreement limit was between -0.5 L and 0.74 L, which confirmed that UFVSBIA measured by electrical impedance method and UFVMEA measured by weighing method were in good agreement. The time required to reach the maximum ultrafiltration volume (UFVSBIA) was 108 ± 68 min, and the mean value of the maximum ultrafiltration volume (Max UFVSBIA) was 1.16 ± 0.60 L. CONCLUSION: The segmental bioelectrical impedance technique can be used to assess the intraperitoneal ultrafiltration volume of peritoneal dialysis patients in real-time and effectively. This method may guide the dialysis fluid retention time and the maximum ultrafiltration volume in PD patients.

Seawater quality criteria derivation and ecological risk assessment for the neonicotinoid insecticide imidacloprid in China.

As a broad-spectrum nicotinoid insecticide, imidacloprid (IMI) has been frequently recorded in seawater environments. Water quality criteria (WQC) is the maximum concentration of chemicals, which will not pose harmful effects on aquatic species in the studied water body. Nevertheless, the WQC is not available for IMI in China, which hinders the risk assessment of this emerging pollutant. This study, therefore, aims to derive the WQC for IMI through the toxicity percentile rank (TPR) and species sensitivity distribution (SSD) methodology, and to assess its ecological risk in aquatic environments. Results showed that the recommended short-term water quality criterion (SWQC) and long-term criterion (LWQC) in seawater were derived as 0.8 µg/L and 0.056 µg/L, respectively. The ecological risk of IMI in seawater shows a wide range with hazard quotient (HQ) values of up to 11.4. The environmental monitoring, risk management and pollution control for IMI, therefore, warrant further study.

Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China.

BACKGROUND: A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. OBJECTIVE: To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific. METHODS: We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. RESULTS: Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows. CONCLUSIONS: The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows.

A new look at the racial differences in environmental attitudes: the roles of risk perception and group consciousness.

Racial minorities bear disproportionate share of pollution and environmental risk. A key solution to such disparities is to increase their participation in the environmental policymaking process. In this article, I test various theories of environmental attitudes and participation-with a special focus on risk perception and group consciousness-on Whites and Minorities and use them to explain the racial differences in environmental concern and participatory intentions. Using survey data, I find that risk perception is positively associated with environmental concern and participatory intentions for both Whites and Minorities. I also find that many theories of environmental attitudes apply to Whites and Minorities differently. While the traditional explanations of political orientation and social connectedness apply to Whites, their patterns are less clear for Minorities. Instead, group consciousness plays an exceptionally important role for racial minorities, and it accounts for much of racial minorities' higher levels of concern and participatory intentions compared with Whites. This study provides new perspectives to understand the racial differences in environmental concern and participation and has important implications for the environmental justice research and movement and environmental public policy.

Racial, ethnic, and income disparities in air pollution: A study of excess emissions in Texas.

OBJECTIVE: Excess emissions are pollutant releases that occur during periods of startups, shutdowns or malfunctions and are considered violations of the U.S. Clean Air Act. They are an important, but understudied and under-regulated, category of pollution releases given their frequency and magnitude. In this paper, we examine the demographic correlates of excess emissions, using data from industrial sources in Texas. METHODS: We conduct two complementary sets of analyses: one at the census tract level and one at the facility level. At the census tract level, we use a multinomial logit model to examine the relationships between racial, ethnic, and income characteristics and the incidence of excess emissions. At the facility level, we first estimate a logit model to examine whether these characteristics are associated with facilities that emit excess emissions, and then, conditional on the presence of excess emissions, we use ordinary least square regression to estimate their correlation with the magnitude of releases. RESULTS: Across our analyses, we find that the percentage of Black population and median household income are positively associated with excess emissions; percentage of college graduate, population density, median housing value, and percentage of owner-occupied housing unit are negatively associated with excess emissions. We, however, have not found a clear and significant relationship between the percentage of Hispanic population and excess emissions.

Water quality criteria derivation and ecological risk assessment for triphenyltin in China.

Triphenyltin (TPT) is one of the most toxic chemicals artificially discharged into aquatic environment with human activities. Due to its intensive use in antifouling paints and adverse effects on non-target species, TPT has aroused wide concern in both saltwater and freshwater environment. Nevertheless, the water quality criteria (WQC) are not available in China, which impedes the risk assessment for this emerging pollutant. This study aims to establish the WQC of TPT for both freshwater and saltwater ecosystems. With the derived WQC, a four-level tiered ecological risk assessment (ERA) approach was employed to assess the ecological risks of this emerging pollutant in Chinese waters. Through the species sensitivity distribution (SSD) methodology, the freshwater criterion maximum concentration (CMC) and criterion continuous concentration (CCC) were derived as 396 ng Sn L-1 and 5.60 ng Sn L-1, respectively, whereas the saltwater CMC and CCC were 66.5 ng Sn L-1 and 4.11 ng Sn L-1, respectively. The ecological risk assessment for TPT demonstrated that the acute risk was negligible whereas the chronic risk was significant with HQ (Hazard Quotient) values of up to 5.669 and 57.1% of coastal waters in China facing clear risk. TPT contamination in coastal environment, therefore, warrants further concern.

Enhanced Recovery After Surgery Programs for Laparoscopic Abdominal Surgery: A Systematic Review and Meta-analysis.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols or laparoscopic technique has been applied in various surgical procedures. However, the clinical efficacy of combination of the two methods still remains unclear. Thus, our aim was to assess the role of ERAS protocols in laparoscopic abdominal surgery. METHODS: We performed a systematic literature search in various databases from January 1990 to October 2017. The results were analyzed according to predefined criteria. RESULTS: In the present meta-analysis, the outcomes of 34 comparative studies (15 randomized controlled studies and 19 non-randomized controlled studies) enrolling 3615 patients (1749 in the ERAS group and 1866 in the control group) were pooled. ERAS group was associated with shorter hospital stay (WMD - 2.37 days; 95% CI - 3.00 to - 1.73; P 0.000) and earlier time to first flatus (WMD - 0.63 days; 95% CI - 0.90 to - 0.36; P 0.000). Meanwhile, lower overall postoperative complication rate (OR 0.62; 95% CI 0.51-0.76; P 0.000) and less hospital cost (WMD 801.52 US dollar; 95% CI - 918.15 to - 684.89; P 0.000) were observed in ERAS group. Similar readmission rate (OR 0.73, 95% CI 0.52-1.03, P 0.070) and perioperative mortality (OR 1.33; 95% CI 0.53-3.34; P 0.549) were found between the two groups. CONCLUSIONS: ERAS protocol for laparoscopic abdominal surgery is safe and effective. ERAS combined with laparoscopic technique is associated with faster postoperative recovery without increasing readmission rate and perioperative mortality.

A study on the information-motivation-behavioural skills model among Chinese adults with peritoneal dialysis.

AIM AND OBJECTIVE: To examine whether the information-motivation-behavioural skills model could predict self-care behaviour among Chinese peritoneal dialysis patients. BACKGROUND: Peritoneal dialysis is a treatment performed by patients or their caregivers in their own home. It is important to implement theory-based projects to increase the self-care of patients with peritoneal dialysis. The information-motivation-behavioural model has been verified in diverse populations as a comprehensive, effective model to guide the design, implementation and evaluation of self-care programmes. DESIGN: A cross-sectional, observational study. METHODS: A total of 201 adults with peritoneal dialysis were recruited at a 3A grade hospital in China. Participant data were collected on demographics, self-care information (knowledge), social support (social motivation), self-care attitude (personal motivation), self-efficacy (behaviour skills) and self-care behaviour. We also collected data on whether the recruited patients had peritoneal dialysis-associated peritonitis from electronic medical records. Measured variable path analysis was performed using mplus 7.4 to identify the information-motivation-behavioural model. RESULTS: Self-efficacy, information and social motivation predict peritoneal dialysis self-care behaviour directly. Information and personal support affect self-care behaviour through self-efficacy, whereas peritoneal dialysis self-care behaviour has a direct effect on the prevention of peritoneal dialysis-associated peritonitis. CONCLUSIONS: The information-motivation-behavioural model is an appropriate and applicable model to explain and predict the self-care behaviour of Chinese peritoneal dialysis patients. Poor self-care behaviour among peritoneal dialysis patients results in peritoneal dialysis-associated peritonitis. RELEVANCE TO CLINICAL PRACTICE: The findings suggest that self-care education programmes for peritoneal dialysis patients should include strategies based on the information-motivation-behavioural model to enhance knowledge, motivation and behaviour skills to change or maintain self-care behaviour.

Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials.

BACKGROUND: This meta-analysis is aimed to evaluate the feasibility and safety of enhanced recovery after surgery (ERAS) programs in gastric cancer patients undergoing laparoscopy-assisted gastrectomy (LAG). METHODS: We performed a meta-analysis of randomized control trials involving either enhanced recovery after surgery (ERAS)/fast track surgery (FTS) for patients underwent LAG. EMBASE, Pubmed, Web of science, and Cochrane Library were searched. Primary outcomes included the length of postoperative hospital stay, cost of hospitalization, postoperative complications, and readmission rate. RESULTS: Five randomized control trials were eligible for analysis. There were 159 cases in FTS group and 156 cases in conventional care group. Compared with conventional care group, FTS group relates to shorter postoperative hospital stay (WMD - 2.16; 95% CI - 3.05 to - 1.26, P < 0.00001), less cost of hospitalization (WMD - 4.72; 95% CI - 6.88 to - 2.55, P < 0.00001), shorter time to first flatus (WMD - 9.72; 95% CI - 13.75 to - 5.81, P < 0.00001), lower level of C-reaction protein on postoperative days 3 or 4 (WMD - 19.66; 95% CI - 28.98 to - 10.34, P < 0.00001), higher level of albumin on postoperative day 4 (WMD 3.45; 95% CI 2.01 to 4.89, P < 0.00001), and postoperative day 7 (WMD 5.63; 95% CI 1.01 to 10.24, P = 0.02). Regarding postoperative complications, no significant differences were observed between FTS group and conventional care group (OR 0.63, 95% CI 0.37 to 1.09, P = 0.10). The readmission rate of FTS group was comparable to conventional care group (WMD 3.14; 95% CI 0.12 to 81.35, P = 0.49). CONCLUSIONS: Among patients undergoing LAG, FTS is associated with shorter postoperative hospital stay, rapid postoperative recovery, and decreased cost without increasing complications or readmission rate. The combined effects of the two methods could further accelerate clinical recovery of gastric cancer patients.

Ecological risk assessment of bisphenol A in surface waters of China based on both traditional and reproductive endpoints.

Bisphenol A (BPA) occurs widely in natural waters with both traditional and reproductive toxicity to various aquatic species. The water quality criteria (WQC), however, have not been established in China, which hinders the ecological risk assessment for the pollutant. This study therefore aims to derive the water quality criteria for BPA based on both acute and chronic toxicity endpoints and to assess the ecological risk in surface waters of China. A total of 15 acute toxicity values tested with aquatic species resident in China were found in published literature, which were simulated with the species sensitivity distribution (SSD) model for the derivation of criterion maximum concentration (CMC). 18 chronic toxicity values with traditional endpoints were simulated for the derivation of traditional criterion continuous concentration (CCC) and 12 chronic toxicity values with reproductive endpoints were for reproductive CCC. Based on the derived WQC, the ecological risk of BPA in surface waters of China was assessed with risk quotient (RQ) method. The results showed that the CMC, traditional CCC and reproductive CCC were 1518µgL(-1), 2.19µgL(-1) and 0.86µgL(-1), respectively. The acute risk of BPA was negligible with RQ values much lower than 0.1. The chronic risk was however much higher with RQ values of between 0.01-3.76 and 0.03-9.57 based on traditional and reproductive CCC, respectively. The chronic RQ values on reproductive endpoints were about threefold as high as those on traditional endpoints, indicating that ecological risk assessment based on traditional effects may not guarantee the safety of aquatic biota.

Correlation analysis of computed tomography imaging score with the presence of acute kidney injury in severe acute pancreatitis.

OBJECTIVES: The aim of the study is to investigate the CT imaging findings of severe acute pancreatitis (SAP) complicated with acute kidney injury (AKI) and evaluate the correlation between the CT imaging score and the presence of AKI in SAP. MATERIALS AND METHODS: Contrast-enhanced CT scanning was performed for all 145 patients. Related CT indices such as Balthazar CT grading, CTSI and EPIC scores were calculated. Clinical data, including APACHE II, Ranson scores, serum creatinine levels, urine output, and mortality, were then collected and compared with CT indices. RESULTS: The EPIC score showed a larger area under the receiver operating characteristic curve than either of the CTSI or Balthazar score. However, the change of APACHE II score, but not EPIC score, was significantly associated with the prognosis of AKI and eventual clinical outcome. In addition, the CT manifestation of fluid encapsulation was a good predictor of recovery from AKI. CONCLUSIONS: Among the CT indices, the EPIC score, which possessed a good correlation with both APACHE II and Ranson scores, provided a better prediction of AKI in SAP patients than CTSI and Balthazar scores. Encapsulation of inflammatory exudates might be used in the future as imaging-based prognostic criteria of recovering from AKI in patients with SAP.

Ecological risk assessment of nonylphenol in coastal waters of China based on species sensitivity distribution model.

Nonylphenol (NP) is an endocrine disruptor and causes feminization and carcinogenesis in various organisms. Consequently, the environmental distribution and ecological risks of NP have received wide concern. China accounts for approximately 10% of the total NP usage in the world, but the water quality criteria of NP have not been established in China and the ecological risks of this pollutant cannot be properly assessed. This study thus aims to determine the predicted no effect concentration (PNEC) of NP and to assess the ecological risks of NP in coastal waters of China with the PNEC as water quality criteria. To obtain the HC5 (hazardous concentration for 5% of biological species) and PNEC estimates, the species sensitivity distributions (SSDs) models were built with chronic toxicity data of NP on aquatic organisms screened from the US Environmental Protection Agency (USEPA) ECOTOX database. The results showed that the PNEC for NP in freshwater and seawater was 0.48 µg L(-1) and 0.28 µg L(-1), respectively. The RQ (risk quotient) values of NP in coastal waters of China ranged from 0.01 to 69.7. About 60% of the reported areas showed a high ecological risk with an RQ value ≥ 1.00. NP therefore exists ubiquitously in coastal waters of China and it poses various risks to aquatic ecosystems in the country. This study demonstrates that the SSD methodology can provide a feasible tool for the establishment of water quality criteria for emergent new pollutants when sufficient toxicity data is available.

Comprehensive analysis of an ecological risk assessment of the Daliao River estuary, China.

At present, most estuarine ecological risk studies are based on terrestrial ecosystem models, which ignore spatial heterogeneity. The Daliao River estuary has representative characteristics of many estuaries in China, and we used this estuary as the study area to formulate an estuarine ecological risk evaluation model. Targeting the estuary's special hydrodynamic condition, this model incorporated variables that were under the influence of human activities and used them as the major factors for partitioning sections of the river according to risk values. It also explored the spatial and temporal distribution laws of estuarine ecological risk. The results showed that, on the whole, the ecological risk of the Daliao River estuary area was relatively high. At a temporal level, runoff was the main factor resulting in differences in ecological risk, while at the spatial level, the ecological risk index was affected by pollutants carried by runoff from upstream, as well as downstream pollution emissions and dilution by seawater at the mouth of the sea. The characteristics of this model make it possible to simulate the spatial and temporal risk distribution in different regions and under different rainfall regimes. This model can thus be applied in other estuarine areas and provides some technical support for analysis and control of ecological destruction in estuary areas.

[Pollution assessment in the intertidal zone of Beibu Gulf using multi-biomarker pollution index].

This paper assessed the coastal environmental quality along the Beibu Gulf using a statistical approach, multi-biomarker pollution index (MPI). Samples of clam (Paphia undulata) and sediment were collected at nine sites from the intertidal zone of Beibu Gulf in April 2011. Nine biomarkers of response were measured both in gill and digestive gland in Paphia undulata, and twelve kinds of contaminants were measured in different sediment samples. According to the Pearson' s correlation coefficients between biomarker responses in Paphia undulata and contaminant levels in sediments, five biomarkers either in gill for oxidized glutathione (GSSG), reduced glutathione (GSH), glutathione S-transferase (GST) or in digestive gland for thiobarbituric acid reactive substances (TBARS) and glutathione peroxidase (GPx) were selected for MPI calculation. For each biomarker at each site, a response index was allocated, and the MPI value of this site was calculated as the sum of the response index of the five biomarkers. The results of the calculation (MPI values from 18 to 39) showed significant differences among sampling sites. The environmental quality of all sites ranged from class 1 (clean) to class 3 (lightly contaminated), and no site fell into class 4 (contaminated) or class 5 (heavily contaminated), indicating a good environmental quality in the intertidal zone of Beibu Gulf. However, the environmental quality at some sites (S1, S3, 54 and S7) fell into class 3 (lightly contaminated), indicating mild interference from human activities has occurred.