Safety assessment of tranexamic acid: real-world adverse event analysis from the FAERS database.

Background: In recent years, with the continuous expansion of the application scope of Tranexamic acid (TXA), its usage has surged. Despite numerous studies demonstrating its powerful efficacy, concerns regarding its adverse reactions persist, necessitating comprehensive safety assessment. This study analyzed real-world data from the U.S. Food and Drug Administration to investigate TXA-related adverse events, aiming to elucidate its safety and optimize patient treatment. Methods: The adverse drug event data concerning TXA from 2004 Q1 to 2023 Q3 were collected. Following data standardization, a variety of signal quantification techniques, including the reporting odds ratios, proportional reporting ratios, Bayesian confidence propagation neural network, and empirical Bayes geometric mean were used for analysis. Results: After analyzing 16,692,026 adverse event reports, a total of 1,574 cases of adverse events related to TXA were identified, spanning 23 system organ classes and 307 preferred terms. In addition to the common thrombosis-related Vascular disorders (n = 386) and Cardiac disorders (n = 377), adverse reactions in the Nervous system disorders category were also observed (n = 785), including Myoclonus (n = 70), Status epilepticus (n = 43), and Myoclonic epilepsy (n = 17). Furthermore, this study uncovered adverse effects such as Renal cortical necrosis, Hepatic cyst rupture, and Vascular stent stenosis, which were not previously mentioned in the instructions. Although these occurred infrequently, they exhibited high signal strength. Both Retinal artery occlusion and Vascular stent thrombosis disorder were frequent and exhibited high signal strength as well. It is worth noting that 78 cases of adverse reactions were caused by confusion between incorrect product administration. Conclusion: Our research suggests that TXA has some adverse reactions that are being overlooked. As a cornerstone medication in hemorrhage treatment, it's crucial to monitor, identify, and address these adverse reactions effectively.

The burden and predictors of 30-day unplanned readmission in patients with acute liver failure: a national representative database study.

BACKGROUND: Liver diseases were significant source of early readmission burden. This study aimed to evaluate the 30-day unplanned readmission rates, causes of readmissions, readmission costs, and predictors of readmission in patients with acute liver failure (ALF). METHODS: Patients admitted for ALF from 2019 National Readmission Database were enrolled. Weighted multivariable logistic regression models were applied and based on Directed Acyclic Graphs. Incidence, causes, cost, and predictors of 30-day unplanned readmissions were identified. RESULTS: A total of 3,281 patients with ALF were enrolled, of whom 600 (18.3%) were readmitted within 30 days. The mean time from discharge to early readmission was 12.6 days. The average hospital cost and charge of readmission were $19,629 and $86,228, respectively. The readmissions were mainly due to liver-related events (26.6%), followed by infection (20.9%). The predictive factors independently associated with readmissions were age, male sex (OR 1.227, 95% CI 1.023-1.472; P = 0.028), renal failure (OR 1.401, 95% CI 1.139-1.723; P = 0.001), diabetes with chronic complications (OR 1.327, 95% CI 1.053-1.672; P = 0.017), complicated hypertension (OR 1.436, 95% CI 1.111-1.857; P = 0.006), peritoneal drainage (OR 1.600, 95% CI 1.092-2.345; P = 0.016), etc. CONCLUSIONS: Patients with ALF are at relatively high risk of early readmission, which imposes a heavy medical and economic burden on society. We need to increase the emphasis placed on early readmission of patients with ALF and establish clinical strategies for their management.

The Fate of Heavy Metals and Risk Assessment of Heavy Metal in Pyrolysis Coupling with Acid Washing Treatment for Sewage Sludge.

Pyrolysis is an emerging and effective means for sludge disposal. Biochar derived from sludge has broad application prospects, however, is limited by heavy metals. In this study, the fate of heavy metals (HMs) in pyrolysis coupling with acid washing treatment for sewage sludge was comprehensively investigated for the first time. Most of the HMs redistributed in the pyrolyzed residues (biochar) after pyrolysis, and the enrichment order of the HMs was: Zn > Cu > Ni > Cr. Compared with various washing agents, phosphoric acid presented a superior washing effect on most heavy metals (Cu, Zn, and Cr) in biochars derived at low pyrolysis temperature and Ni in biochars derived at high pyrolysis temperature. The optimal washing conditions for heavy metals (including Cu, Zn, Cr, and Ni) removal by H3PO4 were obtained by batch washing experiments and the response surface methodology (RSM). The total maximum HM removal efficiency was 95.05% under the optimal washing specifications by H3PO4 (acid concentration of 2.47 mol/L, L/S of 9.85 mL/g, and a washing temperature of 71.18 °C). Kinetic results indicated that the washing process of heavy metals in sludge and biochars was controlled by a mixture of diffusion and surface chemical reactions. After phosphoric acid washing, the leaching concentrations of HMs in the solid residue were further reduced compared with that of biochar, which were below the USEPA limit value (5 mg/L). The solid residue after pyrolysis coupling with acid washing resulted in a low environmental risk for resource utilization (the values of the potential ecological risk index were lower than 20). This work provides an environmentally friendly alternative of pyrolysis coupling with acid washing treatment for sewage sludge from the viewpoint of the utilization of solid waste.

Environmental and economic assessment of advanced oxidation for the treatment of unsymmetrical dimethylhydrazine wastewater from a life cycle perspective.

As a high-performance liquid rocket fuel, unsymmetrical dimethylhydrazine (UDMH) will produce wastewater during transportation, storage and cleaning containers. The wastewater will have a bad impact on human health and ecological environment, and it must be properly handled. There are many reports about the technical feasibility of UDMH wastewater treatment. Less attention is paid to analyzing the impact on the environment during the treatment process. This paper quantifies the environmental impacts and economic benefits of four advanced oxidation processes for the treatment of UDMH wastewater based on life cycle assessment and life cycle costing methods. Taking the UDMH wastewater produced by an aerospace group of Tianjin, China as the research object, using Fenton method, UV-Fenton method, electro catalytic oxidation (EC) with ruthenium iridium titanium (Ti/TiO2-RuO2-IrO2) as electrode and electro catalytic oxidation with boron-doped diamond (BDD) as electrode as treatment methods, on the basis of the laboratory test, the industrialized device is adopted. The resource consumption, energy consumption, pollutant discharge and cost were compared when the TOC removal rate was the same, and a better method of treating unsymmetrical dimethyl hydrazine wastewater was discussed. The results show that the impact on most types of environments is as follows: UV-Fenton < Fenton < EC (BDD) < EC (Ti/TiO2-RuO2-IrO2), and the four advanced oxidation methods are all beneficial to reduce eutrophication. The life cycle cost of UV-Fenton is the lowest (US$1.53/m3). Combined with environmental and economic analysis, it can be seen that UV-Fenton is the best choice. Through sensitivity analysis, it can be seen that reducing chemical reagents and electricity consumption, and changing the way of generating electricity to renewable energy can significantly reduce the environmental and economic impact. The life cycle cost of EC(BDD) as the electrode is the highest (US$26.20/m3), but it can achieve a TOC removal rate of 97.75 %, so it is a better choice when only the removal rate is required regardless of cost.

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014-2019.

BACKGROUND: Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM). METHODS: We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference. RESULTS: Per 10 ug/m3 increase of particles with an aerodynamic diameter < 2.5 µm (PM2.5), particles with an aerodynamic diameter < 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbonic oxide (CO) and ozone (O3) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM2.5 and PM10) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m3 increase in PM2.5 and PM10, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM2.5 and PM10, respectively. Given WHO 2021 air quality guideline as the reference, PM2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM. CONCLUSION: PM2.5 and PM10 are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.

Utility of a fulcrum for positioning support during flexion-extension radiographs for assessment of lumbar instability in patients with degenerative lumbar spondylolisthesis.

OBJECTIVE: The authors investigated a new standardized technique for evaluating lumbar stability in lumbar lateral flexion-extension (LFE) radiographs. For patients with lumbar spondylolisthesis, a three-part fulcrum with a support platform that included a semiarc leaning tool with armrests, a lifting platform for height adjustment, and a base for stability were used. Standard functional radiographs were used for comparison to determine whether adequate flexion-extension was acquired through use of the fulcrum method. METHODS: A total of 67 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were enrolled in the study. The authors analyzed LFE radiographs taken with the patient supported by a fulcrum (LFEF) and without a fulcrum. Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), change in lumbar lordosis (CLL), and lumbar instability (LI) were measured for comparison using functional radiographs. RESULTS: The average value of SA was 5.76° ± 3.72° in LFE and 9.96° ± 4.00° in LFEF radiographs, with a significant difference between them (p < 0.05). ST and PO were also significantly greater in LFEF than in LFE. The detection rate of instability was 10.4% in LFE and 31.3% in LFEF, and the difference was significant. The CLL was 27.31° ± 11.96° in LFE and 37.07° ± 12.963.16° in LFEF, with a significant difference between these values (p < 0.05). CONCLUSIONS: Compared with traditional LFE radiographs, the LFEF radiographs significantly improved the detection rate of LI. In addition, this method may reduce patient discomfort during the process of obtaining radiographs.

Assessment of choroidal structural changes in patients with pre- and early-stage clinical diabetic retinopathy using wide-field SS-OCTA.

Purpose: To investigate the micro-vascular changes in choroidal structures in patients with pre- and early-stage clinical diabetic retinopathy (DR) using wide-field Swept-Source Optical Coherence Tomography Angiography (SS-OCTA). Method: This observational cross-sectional study included 131 eyes of 68 subjects that were divided into healthy controls (group 1, n = 46), pre-DR (group 2, n = 43), early-stage DR (group 3, n = 42) cohorts. All participants that underwent SS-OCTA examination were inpatients in the department of Ophthalmology and the department of Endocrinology, Qilu Hospital, Shandong University, and Department of Ophthalmology, Aier Eye Hospital, Jinan, from July 11, 2021 to March 17, 2022. The choroidal vascularity index (CVI), choroidal thickness (ChT) and central macular thickness (CMT) in the whole area (diameter of 12 mm) and concentric rings with different ranges (0-3, 3-6, 6-9, and 9-12 mm) were recorded and analyzed from the OCTA image. Result: Compared with healthy eyes, decreases in CVI and ChT were found in the eyes of patients with pre-or early-stage DR. The changes were more significant in the peripheral choroid, with the most prominent abnormalities in the 9-12mm area (P < 0.001). However, there was no obvious difference in the average CMT value. Furthermore, CVI and ChT were significantly correlated with the duration of diabetes in the range of 6-9 and 9-12 mm (Ps < 0.05; Correlation coefficient = -0.549, -0.395, respectively), with the strongest correlation (Ps < 0.01; Correlation coefficient = -0.597, -0.413, respectively) observed at 9-12 mm. Conclusion: The CVI and ChT values of diabetic patients are significantly lower than in healthy controls, especially in patients with early-stage DR. In addition, the peripheral choroidal capillaries are more susceptible to early DM-induced injury than in the central area.

Assessment on the Impact on Human Health, Environment, Water and Soil by Disposing Household Expired Drugs: A Cross-Sectional Study in China.

BACKGROUND: The household expired drugs disposal has been a huge public issue in many countries, including China, which may affect various side and toxic effects on human health and environment, water resources, and soil too. This paper explores the knowledge, attitude, and practice of Guangzhou city residents regarding household expired drugs and their effect on human health and provided the scientific pieces of evidence to carry out the long-term recovery mechanism for expired medicines. METHODS: An observational, cross-sectional study was conducted using a self-structured questionnaire. Descriptive analysis, including univariate and unconditional logistic regression models, was carried out to analyze the data. RESULTS: A total of 613 community residents with a 99.4% response rate enrolled for the study. More than half 60.2% of residents stated that expired drugs pollute the environment, soil, and water resources, where 81.2% of respondents knew that it would produce side effects or toxic effects. However, still, 71.6% of respondents disposed of directly into the trash bin or sink, and, only 24.8% had good practice that they use a designed recycling bin. Likewise, only 8.3% of respondents placed expired drugs into collection points nearly 3-5 times in a year, while 65.1% of participants never disposed of in the collection point, which found a worse practice. CONCLUSION: Overall, the knowledge, attitude, and practice of Guangzhou residents regarding household expired drugs disposal were not ideal. To improve the resident's awareness about family expired drugs disposal, ensure the financial support for the recycling process, establish an accessible and acceptable recycling point, and introduce relevant laws and regulations for the long-term mechanism.

[Assessment of ecological environment effects of coastal development in Hebei Province, China].

Through the analysis of the development activities and the ecological environment in coastal of Hebei Province, China, an index system for evaluating the ecological environment effect, composed of 28 indices, was set up by the pressure, state and response subsystems. Using the comprehensive index evaluation method, the integrated effects of ecological environment index (EI) was calculated and its grading criterion was founded. The results showed that the ecological environment effect of Hebei Province coastal development varied from being relatively small, normal and then relatively large from 1984 to 2010, and its acceptance degree evolved from being acceptable to being unacceptable. Because the resource and environment pressures caused by coastal development were serious and a delay existed in the state relative to the response, the improvement of various measures in the response subsystem did not show a positive effect on the state, and the environmental quality of ocean showed a degrading trend. Due to the differences in coastal development pattern and strength, the ecological environment effect of development activities showed some spatial differences. The ecological environment effect of Qinhuangdao coastal development was the minimum, followed by Cangzhou and Tangshan. Cangzhou and Tangshan had reached unacceptable levels and needed to further strengthen the restoration and protection of ecological environment.