Assessment of fish protein hydrolysate as a substitute for fish meal in white shrimp diets: Impact on growth, immune response, and resistance against Vibrio parahaemolyticus infection.

This study investigated the effects of fish protein hydrolysate derived from barramundi on growth performance, muscle composition, immune response, disease resistance, histology and gene expression in white shrimp (Penaeus vannamei). In vitro studies demonstrated FPH enhanced mRNA expressions of key immune-related genes and stimulated reactive oxygen species (ROS) production and phagocytic activity in shrimp hemocytes. To evaluate the effects of substituting fish meal with FPH in vivo, four isoproteic (43 %), isolipidic (6 %), and isoenergetic diets (489 kcal/100 g) were formulated with fish meal substitution levels of 0 % (control), 30 % (FPH30), 65 % (FPH65), and 100 % (FPH100). After 8-week feeding, the growth performance of FPH65 and FPH100 were significantly lower than that of control and FPH30 (p < 0.05). Similarly, the midgut histological examination revealed the wall thickness and villi height of FPH100 were significantly lower than those of control (p < 0.05). The shrimps were received the challenge of AHPND + Vibrio parahaemolyticus at week 4 and 8. All FPH-fed groups significantly enhanced resistance against Vibrio parahaemolyticus at week 4 (p < 0.05). However, this protective effect diminished after long-period feeding. No significant difference of survival rate was observed among all groups at week 8 (p > 0.05). The expressions of immune-related genes were analyzed at week 4 before and after challenge. In control group, V. parahaemolyticus significantly elevated SOD in hepatopancreas and Muc 19, trypsin, Midline-fas, and GPx in foregut (p < 0.05). Moreover, hepatopancreatic SOD of FPH65 and FPH100 were significantly higher than that of control before challenge (p < 0.05). Immune parameters were measured at week 8. Compared with control, the phagocytic index of FPH 30 was significantly higher (p < 0.05). However, dietary FPH did not alter ROS production, phenoloxidase activity, phagocytic rate, and total hemocyte count (p > 0.05). These findings suggest that FPH30 holds promise as a feed without adverse impacts on growth performance while enhancing the immunological response of white shrimp.

Non-target and target screening and risk assessment of per- and polyfluoroalkyl substances in textile wastewater and receiving river.

Textile industry uses varieties of chemicals including per- and polyfluoroalkyl substances (PFAS). PFAS are known to be persistent and incompletely removed in wastewater treatment plants (WWTPs). So far, little is known about what types of PFAS are used in the textile industry and their potential risks. Here we investigated PFAS in two WWTPs and a receiving river of a textile industrial park in Guangxi, China, by using both target and non-target analyses over a two-year period. The target analysis identified 11 specific PFAS, while the non-target analysis revealed a list of 648 different PFAS, including both legacy and emerging substances. Notably, perfluorooctanoic acid (PFOA) was still the most prevalent compound detected. Of particular concern was the finding that the investigated WWTPs, which employs an A/O (Anaerobic/Aerobic) process, exhibited a poor removal efficiency for PFAS. The average removal rate was only 22.0 %, indicating that the current treatment processes are inadequate in effectively mitigating PFAS contamination. Correlation analysis further highlighted the potential for PFAS to be transported from WWTPs to the receiving river, revealing a significant and strong positive correlation between the PFAS in the WWTP effluent and those of the river. Perfluorooctanesulfonic acid (PFOS) and two emerging PFAS (DTXSID30240816 and DTXSID90240817) were identified to have high ecological risks in the receiving river. Notably, these two emerging PFAS are homologues, and their presence in WWTPs has been poorly reported. The findings highlight the wide use and persistence of PFAS in current textile WWTPs, indicating potential long term risks to the receiving environment.

Comprehensive geriatric assessment to predict adverse events in elderly patients undergoing posterior lumbar fusion surgery.

PURPOSE: Although comprehensive geriatric assessment (CGA) has been used widely, its impact on adverse events in elderly patients has not been fully examined. The present study aimed to investigate the relationships between subcomponents of CGA and adverse events (AEs) in elderly patients undergoing posterior lumbar fusion surgery. METHODS: A total of 242 eligible elderly patients enrolled. Our CGA included activities of daily living, instrumental activities of daily living, nutritional status, cardiac function, pulmonary function, renal function, frailty, cognition, anxiety, depression, delirium, chronic pain score, comorbidity and polypharmacy. Comprehensive complication index was used to summarize postoperative complications and its severity. Logistic regression was performed to determine the relationships between subcomponents of a CGA and postoperative AEs. RESULTS: Present study found that female were more vulnerable to have AEs. Postoperative major AEs were associated with delirium (odds ratio (OR): 4.302, 95% confidence interval (CI) 1.720-10.761, p = 0.002), nutritional status (OR: 3.030, 95%CI 1.218-7.541, p = 0.017), cognitive impairment (OR: 4.122, 95%CI 1.179-14.407, p = 0.027), Charlson comorbidity index (CCI) (OR: 4.800, 95%CI 1.852-12.440, p = 0.001) and severe dependent (OR: 3.772, 95%CI 1.116-9.841, p = 0.007). Further analysis showed that delirium (OR: 2.824, 95%CI 1.068-7.467, p = 0.036) and CCI (OR: 3.221, 95%CI 1.184-8.766, p = 0.022) were independently related to major AEs. CONCLUSIONS: These results indicate that preoperative screening preoperative delirium, cognitive, nutrition and CCI are essential to prevent postoperative major AEs of the surgical elderly.

The value of Demetics ultrasound-assisted diagnosis system in diagnosis of breast lesions and in assessment Ki-67 status of breast cancer.

PURPOSE: This study aims to explore the diagnostic efficiency of the Demetics for breast lesions and assessment of Ki-67 status. MATERIAL: This retrospective study included 291 patients. Three combined methods (method 1: upgraded BI-RADS when Demetics classified the breast lesion as malignant; method 2: downgraded BI-RADS when Demetics classified the breast lesion as benign; method 3: BI-RADS was upgraded or downgraded according to Demetrics' diagnosis) were used to compare the diagnostic efficiency of two radiologists with different seniority before and after using Demetics. The correlation between the visual heatmap by Demetics and the Ki-67 expression level of breast cancer was explored. RESULTS: The sensitivity, specificity, and area under curve (AUC) of diagnosis by Demetics, junior radiologist and senior radiologist were 89.5%, 83.1%, 0.863; 76.9%, 82.4%, 0.797 and 81.1%, 89.9%, 0.855, respectively. Method 1 was the best for senior radiologist, which increased AUC from 0.855 to 0.884. For junior radiologist, Method 3 was the best method, improving sensitivity (88.8% vs. 76.9%) and specificity (87.2% vs. 82.4%). Demetics paid more attention to the peripheral area of breast cancer with high expression of Ki-67. CONCLUSION: Demetics has shown good diagnostic efficiency in the assisted diagnosis of breast lesions and is expected to further distinguish Ki-67 status of breast cancer.

Efficacy of the visual cognitive assessment test for mild cognitive impairment/mild dementia diagnosis: a meta-analysis.

Background: Mild cognitive impairment (MCI) is an intermediate stage between normal ageing and dementia. The early identification of MCI is important for timely intervention. The visual cognitive assessment test (VCAT) is a brief language-neutral screening tool for detecting MCI/mild dementia. This meta-analysis evaluated the diagnostic efficacy of the VCAT for MCI/mild dementia. Methods: Medline, Embase, Google Scholar, and Cochrane Library were searched from their inception until August 2023 to identify studies using VCAT to diagnose MCI/mild dementia. The primary outcome was to assess the diagnostic accuracy of the VCAT for detecting MCI/mild dementia through area under the receiver operating characteristic curve (AU-ROC) analysis. The secondary outcome was to explore the correlation between VCAT scores and MCI/mild dementia presence by comparing scores among patients with and without MCI/mild dementia. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated. Results: Five studies with 1,446 older adults (mean age 64-68.3 years) were included. The percentage of participants with MCI/mild dementia versus controls ranged from 16.5% to 87% across studies. All studies were conducted in Asian populations, mostly Chinese, in Singapore and Malaysia. The pooled sensitivity was 80% [95% confidence interval (CI) 68%-88%] and the specificity was 75% (95% CI 68%-80%). The AU-ROCC was 0.77 (95% CI 0.73-0.81). Patients with MCI/mild dementia had lower VCAT scores than the controls (mean difference -6.85 points, p < 0.00001). Conclusion: VCAT demonstrated acceptable diagnostic accuracy in distinguishing MCI/mild dementia in cognitively normal older adults. As a language-neutral and culturally unbiased tool, the VCAT shows promise in detecting MCI/mild dementia. Further studies in non-Asian populations are required. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42023453453.

[Risk Assessment of Heavy Metals in Dust Fall Around Reservoirs in Typical Ecologically Fragile Areas and Traceability Based on APCS-MLR Model].

To assess the health risk status and pollution sources of heavy metals in the atmosphere of ecologically vulnerable areas, the surrounding area of Dahekou Reservoir in Xilingol League was selected as the study area. From 2021 to 2022, 12 monitoring points for atmospheric dust fall were collected for a period of one year. A total of 144 samples were collected to determine the contents of eight types of heavy metals, namely Cr, Ni, Pb, Cu, Zn, Mn, As, and Cd. The potential ecological index (Eri) and health risk assessment model were used to assess the risk level of atmospheric heavy metals on ecological security and human health. The analysis of enrichment factors, principal components, and the model of absolute principal component multiple linear regression (APCS-MLR) receptor were used to analyze the sources of heavy metal pollution qualitatively in the atmosphere of the study area. The results showed that:① the mean value of the comprehensive potential ecological risk of heavy metals in the annual atmospheric dust fall in the study area was at a high ecological risk, and only the Cd value was at a very high risk level among the heavy metals, whereas the remaining were at a slight risk. ② The results of the health risk showed that intake by hand, mouth, and skin contact were the main exposure routes, which led to non-carcinogenic and carcinogenic risks. Children were under non-carcinogenic and acceptable carcinogenic risks in different months. During those months, the main source of the risks was As. ③ Through enrichment factor analysis, principal component analysis, and APCS-MLR receptor model calculation, the results revealed that the proportion of wind-blown sources was the largest, accounting for 37.82%, and the contribution rates of coal combustion and traffic sources to Cu, Cd, Pb, and Zn were 73.01%, 40.22%, 70.31%, and 32.82%, respectively. The contribution rate of mining activities to As was 42.59%, while that of industrial sources of Cd was 22.01%; the contributions of other human activity sources of Cd, As, Pb, and Zn were 21.12%, 34.40%, 23.04%, and 32.15%, respectively.

A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system.

Introduction: In recent years, China has implemented the Diagnosis Related Groups (DRG) payment system as part of its healthcare insurance reimbursement policy. Numerous studies have focused on the effectiveness of DRG payment system in controlling unreasonable growth in medical expenses. However, there has been no systematic report on the types of unintended behaviors exhibited by doctors under the DRG payment system. Methods: The study first utilized interrupted time series analysis to analyze medical records and insurance data from eight hospitals. It investigated the data changes in MDC and ADRG groups before and after the implementation of the DRG payment system. Subsequently, a semi-structured interview method was employed to conduct qualitative research on the unintended behaviors of physicians, aiming to gain a more accurate understanding of specific changes in physician behavior after the implementation of the DRG payment system. Results: This study discovered that doctors engage in unintended behaviors within the framework of the DRG payment system. Discussion: In the early implementation of the DRG payment system in China, the contradictions between the flawed DRG payment methods and supporting systems and the actual diagnostic and treatment work manifested in the form of unintended doctor behaviors. Most of these unintended behaviors can be considered reasonable feedback from doctors to cope with the existing system flaws. They are conducive to identifying the deficiencies in China's DRG payment system and suggesting directions for improvement.

Combining polygenic risk scores and human leukocyte antigen variants for personalized risk assessment of type 1 diabetes in the Taiwanese population.

AIMS: To analyse the genome-wide association study (GWAS) data of patients with type 1 diabetes mellitus (T1D) in order to develop a risk score for the genetic effects on T1D risk and age at diagnosis in the Taiwanese population. MATERIALS AND METHODS: We selected 610 patients with T1D and 2511 healthy individuals from an electronic medical record database of more than 300 000 individuals with genetic information, analysed their GWAS data, and developed a polygenic risk score (PRS). RESULTS: The PRS, based on 149 selected single-nucleotide polymorphisms, could effectively predict T1D risk. A PRS increase was associated with increased T1D risk (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.72-2.55). Moreover, a 1-unit increase in standardized T1D PRS decreased the age at diagnosis by 0.74 years. Combined PRS and human leukocyte antigen (HLA) DQA1*03:02-DQA1*05:01 genotypes could accurately predict T1D risk. In multivariable models, HLA variants and PRS were independent risk factors for T1D risk (OR 3.76 [95% CI 1.54-9.16] and 1.71 [95% CI 1.37-2.13] for HLA DQA1*03:02-DQA1*05:01 and PRS, respectively). In a limited study population of those aged ≤18 years, PRS remained significantly associated with T1D risk. The association between T1D PRS and age at diagnosis was more obvious among males and patients aged ≤18 years. CONCLUSIONS: Polygenic risk score and HLA variations enable personalized risk estimates, enhance newborn screening efficiency for ketoacidosis prevention, and addresses the gap in data on T1D prediction in isolated Asian populations.

Nano zero-valent iron enhances the absorption and transport of chromium in rice (Oryza sativa L.): Implication for Cr risks management in paddy fields.

Chromium (Cr) accumulating in soil caused serious pollution to cultivated land. At present, nano zero-valent iron (nZVI) is considered to be a promising remediation material for Cr-contaminated soil. However, the nZVI impact on the behavior of Cr in the soil-rice system under high natural geological background value remains unknown. We studied the effects of nZVI on the migration and transformation of Cr in paddy soil-rice by pot experiment. Three different doses of nZVI (0, 0.001 % and 0.1 % (w/w)) treatments and one dose of 0.1 % (w/w) nZVI treatment without plant rice were set up. Under continuous flooding conditions, nZVI significantly increased rice biomass compared with the control. At the same time, nZVI significantly promoted the reduction of Fe in the soil, increased the concentration of oxalate Fe and bioavailable Cr, then facilitated the absorption of Cr in rice roots and the transportation to the aboveground part. In addition, the enrichment of Fe(III)-reducing bacteria and sulfate-reducing bacteria in soil provided electron donors for Cr oxidation, which helps to form bioavailable Cr that is easily absorbed by plants. The results of this study can provide scientific basis and technical support for the remediation of Cr -polluted paddy soil with high geological background.

Identifying the evolution of ecological poverty alleviation efficiency and its influencing factors: evidence from counties in Northeast China.

Ecological poverty alleviation (EPA) is an effective strategy to address the vicious circle of poverty and environmental destruction in poor areas. However, it remains controversial whether this strategy has really succeeded in this respect. Previous research investigated the impact of a certain factor on EPA, and only few studies integrated them to explore their differential effects, thereby overlooking the complexity of EPA. Therefore, this study quantified the overall efficiency of the EPA strategies of 28 poor counties in three provinces of Northeast China from 2005 to 2018 by using a super-efficiency slacks-based measure model. This model can take into account undesirable outputs; as such, it has significant advantages in measuring the coordination among economic and social development and environmental protection. The Tobit model was used to explore the factors influencing EPA efficiency. The results show that, first, the majority of counties investigated had an EPA efficiency below the overall national average. Second, as for the factors influencing EPA efficiency, it was found that (1) GDP per capita and investment in environmental governance favored EPA efficiency, as they are conducive to stimulating regional consumption dynamics and achieving green economic development; (2) science and technology expenditure and urbanization were not conducive to EPA efficiency; and (3) industrial structure and trade had insignificant effects on EPA efficiency, due to the small scale of industry and the inadequacy of the policy system. This study assessed EPA efficiency from a holistic perspective, and addressed the controversies over EPA's influencing factors, thereby providing an effective method to conduct regional EPA assessment and improve EPA performance in poor regions of China.

Cardiac MRI-Based Assessment of Myocardial Injury in Asymptomatic People Living With Human Immunodeficiency Virus: Correlation With nadir CD4 Count.

BACKGROUND: There are known cardiac manifestations of HIV, but the findings in asymptomatic subjects are still not fully explored. PURPOSE: To evaluate for the presence of subclinical myocardial injury in asymptomatic people living with human immunodeficiency virus (PLWH) by cardiac MRI and to explore the possible association between subclinical myocardial injury and HIV-related clinical characteristics. STUDY TYPE: Cross-sectional. POPULATION: A total of 80 asymptomatic PLWH (age: 53 years [47-56 years]; 90% male) and 50 age- and sex-matched healthy participants. FIELD STRENGTH/SEQUENCE: A 3-T, cine sequence, T1, T2, and T2* mapping. ASSESSMENT: Function analysis was derived from short axis, two-, three-, and four-chamber cine images by feature tracking. Regions of interest were manually selected in the midventricular septum T1, T2, and T2* mapping sequences. PLWH were evaluated for T1 increment (△T1 mapping = native T1 - cutoff values) and HIV-related clinical characteristics, particularly the nadir CD4 count. And PLWH were stratified into two groups according to the cutoff value of native T1: elevated native T1 and normal. STATISTICAL TESTS: T test, Wilcoxon rank-sum test, Chi-square test, Spearman rank correlation, and logistic regression. P <0.05 indicated statistical significance. RESULTS: Asymptomatic PLWH revealed significantly higher native myocardial T1 values (1241 ± 29 msec vs. 1189 ± 21 msec), T2 values (40.7 ± 1.5 msec vs. 37.9 ± 1.4 msec), and lower LVGRS (30.2% ± 6.2% vs. 35.8% ± 6.4%), LVGCS (-18.0% ± 2.5% vs. -19.5% ± 2.0%), and LVGLS (-16.0% ± 3.8% vs. -17.9% ± 2.6%) but showed no difference in T2* values (17.3 msec [16.3-19.1 msec] vs. 18.3 msec [16.5-19.3 msec], P = 0.201). A negative correlation between the native T1 increment in PLWH with subclinical myocardial injury and the nadir CD4 count (u = -0.316). Nadir CD4 count <500 cells/mm3 was associated with higher odds of elevated native T1 myocardial values (odds ratio, 6.12 [95% CI, 1.07-34.91]) in PLWH. DATA CONCLUSION: Subclinical myocardial inflammation and dysfunction were present in asymptomatic PLWH, and a lower nadir CD4 count may be a risk factor for subclinical myocardial injury. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 2.

Water Environment Characteristics and Water Quality Assessment of Water Source of Diversion System of Project from Hanjiang to Weihe River.

The water source of the water diversion project from the Hanjiang River to the Weihe River is one of the most important drinking water sources in China. Its water quality is related to the water safety of the long-distance water diversion system from the Hanjiang to Weihe Rivers. In order to explore the spatiotemporal change trend of the water environment characteristics of the water source area and analyze the key factors that have a greater impact on it, this study collected 9 types of water environment physical and chemical parameters from 10 water quality monitoring sections from 2017 to 2019; the water environment characteristics of the water source area of the water diversion system from the Hanjiang River to the Weihe River were analyzed and evaluated by using the variance analysis method, the hierarchical cluster analysis method and the water quality identification index evaluation method. The results were as follows. (1) There was spatiotemporal heterogeneity in a number of physical and chemical parameters in the water body of the water source. In terms of time, the concentrations of CODMn, COD, BOD5 and F- were higher in the flood season (July-October) than in the non-flood season (November-June). The concentrations of DO, TP and TN in the non-flood season were higher than those in the flood season. Spatially, the concentration of physical and chemical parameters of the water body in the Huangjinxia Reservoir area was higher than that in the Sanhekou Reservoir area. (2) The water quality of the water source area was good. The comprehensive water quality reached the Class II water quality standard of surface water environmental quality. Time showed that the comprehensive water quality in the non-flood season was better than that in the flood season. Spatially, the overall water quality of the tributaries was better than that of the mainstream. TN is a key indicator that affects water quality. (3) The spatial and temporal differences in water quality in water source areas are mainly affected by factors such as rainfall, temperature and human activities. This study can provide a scientific and data basis for related research on maintaining and improving the quality of the ecological environment of the water source areas of the Hanjiang to Weihe River Water Diversion System.

Characteristics and health risk assessment of heavy metal pollution in atmospheric particulate matter in different regions of the Yellow River Delta in China.

To understand the characteristics, temporal and spatial variation, and health risks of atmospheric heavy metal pollution in different areas of the YRD (Yellow River Delta), atmospheric particles samples were collected in the YRD in China during 2016-2017. A total of 10 monitoring points were chosen in different areas (industrial parks, main urban areas, and rural areas) in the YRD, heavy metals were monitored using atomic fluorescence spectrometry and graphite furnace atomic absorption spectrometry. The results showed that TSP (total suspended particulate), PM10 (particulate matter with an aerodynamic diameter less than 10 µm), and PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 µm) contents were higher in the Kenli EDZ (economic development zone) and Kenli urban areas than those in other points. The concentration range of heavy metals in atmospheric samples at 10 points was different, with a difference of five orders of magnitude, of which the content of copper (Cu) was the highest, with the highest concentration of 4.375 µg/m3, and the content of particulate mercury (Hg) was the lowest, with the minimum concentration of 0.00001 µg/m3. Among the nine heavy metals, the contents of cadmium (Cd), lead (Pb), and Hg were higher in winter than in summer, and chromium (Cr), nickel (Ni), Cu, and manganese (Mn) were higher in summer than in winter. In addition to Hg, the contents of the other eight heavy metals in particulate matter showed a trend that urban areas and EDZs had higher concentrations than cities and towns and nature reserves, which can be attributed to industrial activities and coal-fired fuel emissions. Health risk assessment was carried out for adults and children, respectively, and the results showed that carcinogens have no obvious carcinogenic risk, but As and Cr have major potential carcinogenic risk. Among the noncarcinogenic substances, Mn has the greatest noncarcinogenic risk, and urban areas and economic development zones have the greatest risk. This study investigated the characteristics and health risk assessment of atmospheric heavy metal pollution in different areas in the YRD to supplement the research contents of atmospheric particulate heavy metals in the YRD in domestics and overseas. It is also critical to study the pollution and migration of heavy metals in China.

Mercury Induced Tissue Damage, Redox Metabolism, Ion Transport, Apoptosis, and Intestinal Microbiota Change in Red Swamp Crayfish (Procambarus clarkii): Application of Multi-Omics Analysis in Risk Assessment of Hg.

As one of the most toxic elements, mercury (Hg) is a widespread toxicant in aquatic environments. Crayfish are considered suitable for indicating the impact of heavy metals on aquatic crustaceans. Nevertheless, Hg toxicity on Procambarus clarkii is largely unknown. In this research, the acute Hg-induced alterations of biochemical responses, histopathology, hepatopancreatic transcriptome, and intestinal microbiome of Procambarus clarkii were studied. Firstly, Hg induced significant changes in reactive oxygen species (ROS) and malonaldehyde (MDA) content as well as antioxidant enzyme activity. Secondly, Hg exposure caused structural damage to the hepatopancreas (e.g., vacuolization of the epithelium and dilatation of the lumen) as well as to the intestines (e.g., dysregulation of lamina epithelialises and extension of lamina proprias). Thirdly, after treatment with three different concentrations of Hg, RNA-seq assays of the hepatopancreas revealed a large number of differentially expressed genes (DEGs) linked to a specific function. Among the DEGs, a lot of redox metabolism- (e.g., ACOX3, SMOX, GPX3, GLO1, and P4HA1), ion transport- (e.g., MICU3, MCTP, PYX, STEAP3, and SLC30A2), drug metabolism- (e.g., HSP70, HSP90A, CYP2L1, and CYP9E2), immune response- (e.g., SMAD4, HDAC1, and DUOX), and apoptosis-related genes (e.g., CTSL, CASP7, and BIRC2) were identified, which suggests that Hg exposure may perturb the redox equilibrium, disrupt the ion homeostasis, weaken immune response and ability, and cause apoptosis. Fourthly, bacterial 16S rRNA gene sequencing showed that Hg exposure decreased bacterial diversity and dysregulated intestinal microbiome composition. At the phylum level, there was a marked decrease in Proteobacteria and an increase in Firmicutes after exposure to high levels of Hg. With regards to genus, abundances of Bacteroides, Dysgonomonas, and Arcobacter were markedly dysregulated after Hg exposures. Our findings elucidate the mechanisms involved in Hg-mediated toxicity in aquatic crustaceans at the tissue, cellular, molecular as well as microbial levels.

Pollution Characteristics and Human Health Risk Assessment of Heavy Metals in Street Dust from a Typical Industrial Zone in Wuhan City, Central China.

This study aimed to assess the pollution levels, sources, and human health risks of heavy metals in street dust from a typical industrial district in Wuhan City, Central China. In total, 47 street dust samples were collected from the major traffic arteries and streets around Wuhan Iron and Steel (Group) Company (WISC) in Qingshan District, Wuhan. The concentrations of heavy metals (Cr, Mn, Ni, Zn, Fe, Cu, and Cd) in street dust were determined by atomic absorption spectroscopy. Results indicated that the mean concentrations of Zn (249.71 mg/kg), Cu (51.15 mg/kg), and Cd (0.86 mg/kg) in street dust were higher than their corresponding soil background values in Hubei Province. Heavy metal enrichment is closely related to urban transportation and industrial production. The pollution level of heavy metals in street dust was assessed using the geo-accumulation method (Igeo) and potential ecological risk assessment (PERI). Based on the Igeo value, Cr, Mn, Fe, and Ni showed no pollution, Zn and Cu showed light to moderate contamination, and Cd showed moderate contamination. The PERI values of heavy metals in street dust ranged between 76.70 and 7027.28, which represents a medium to high potential ecological risk. Principal component analysis showed that the sources of heavy metals in street dust were mainly influenced by anthropogenic activities. Among the studied metals, Cu, Cr, Zn, Fe, and Mn mainly come from industrial processes, while Ni and Cd come from traffic exhaust. The non-carcinogenic risk indexes of heavy metals for children and adults are ranked as Cr > Cu > Ni > Cd > Zn. The health risks to children through the different exposure pathways are higher than those for adults. Hand-to-mouth intake is the riskiest exposure pathway for non-carcinogenic risk. In addition, Cr, Ni, and Cd do not pose a carcinogenic risk for the residents.

The relationship between Comprehensive Geriatric Assessment parameters and depression in elderly patients.

Background: Depression is common and serious among elderly patients. The treatment of elderly depression is often delayed owing to insufficient diagnosis, which eventually leads to adverse consequences. Aims: To explore the association between the parameters of the Comprehensive Geriatric Assessment and depression in elderly patients. Methods: A cross-sectional study of 211 outpatients and inpatients aged ≥ 65 years from the Comprehensive Geriatric Assessment database was conducted. A Comprehensive Geriatric Assessment inventory was prepared by compiling and screening general characteristics, chronic diseases (cardiovascular disease, diabetes, and peptic ulcer disease), nutritional status, daily living ability, anthropometric measurements (body mass index (BMI), upper arm circumference, and calf circumference), and blood biochemical indicators (hemoglobin, albumin, prealbumin, triglycerides, and low-density lipoprotein cholesterol). The Geriatric Depression Scale was also conducted for each elderly patient to screen for depression. A multivariable logistic regression analysis was used to determine the association between the parameters of the Comprehensive Geriatric Assessment and geriatric depression. Results: There were 63 patients in the depression group with a median age of 84.00 years, and 148 patients in the non-depression group with a median age of 78.50 years. After controlling for confounders, the risk of depression in elderly patients with cardiovascular diseases was 6.011 times higher than that in those without cardiovascular diseases (p < 0.001); and the risk of depression in elderly patients with peptic ulcer diseases was 4.352 times higher than that in those without peptic ulcer diseases (p < 0.001); the risk of depression in elderly patients decreased by 22.6% for each 1-point increase in the Mini Nutritional Assessment (p < 0.001). The risk of depression in elderly patients decreased by 19.9% for each 1-point increase in calf circumference (p = 0.002), and by 13.0% for each 1-point increase in albumin (p = 0.014). Conclusion: Our findings suggest that Comprehensive Geriatric Assessment parameters, such as cardiovascular disease, peptic ulcer disease, Mini Nutritional Assessment score, calf circumference, and albumin, were associated with depression. The Comprehensive Geriatric Assessment can assist in the early identification of depression in the elderly population.

How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application.

BACKGROUND: Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services. METHODS: A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China. RESULTS: Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution. CONCLUSIONS: Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Environmental technology spillovers and green start-up emergence: the moderating role of patent commercialization policy and patent enforcement.

While research on the creation of green start-ups recognizes the influence of technology spillovers, less attention has been given to the relative importance of heterogeneous technology spillover sources and how they contribute to green start-up emergence. This study aims to fill this lacuna in the existing literature by investigating the relationship between green start-up entry and environmental technology in universities, research institutes, and firms. We primarily focus on the moderating effects of patent commercialization policy and patent enforcement in the relationship. The results show that environmental technology in universities, research institutes, and firms has a positive influence on both of green and non-green start-up emergences. Among them, firms play the most important role, followed by research institutes and universities. Besides, patent commercialization policy plays a negative role in shaping the relationship between green start-ups and environmental technology of universities and firms and the relationship between non-green start-ups and university environmental technology. However, the role of patent commercialization policy does not hold in other cases. Moreover, patent enforcement is negatively related to the relationship between both of green and non-green start-ups and environmental technology of universities and firms, except for research institutes. It indicates that regions should emphasize the dominant position of firms in environmental technology innovation and formulate specific innovation measures for different organizations to better foster local green entrepreneurship.

Per- and polyfluoralkyl substances (PFAS) in drinking water system: Target and non-target screening and removal assessment.

The massive use and the persistence of per- and polyfluoroalkyl substances (PFAS) have led to their frequent detection in aquatic environments, which may further threaten drinking water safety. So far, our knowledge about the occurrence of PFAS in drinking water system is still very limited. Here we investigated the occurrence and removal of PFAS in a drinking water system using non-target, suspect and target screening strategies. Sampling was performed in three seasons in the drinking water system including a water source, two drinking water treatment plants, and tap water in five households. The results showed detection of 17 homologous series with 51 homologues in non-target screening and 50 potential PFAS detected in suspect screening. Probable structures were proposed for 15 PFAS with high confidence levels (the first three of the five levels), with seven of them being reported for the first time in drinking water system. Semi-quantification was performed on seven homologous series based on target PFAS, the estimated total concentrations for non-target PFAS ranged between 4.10 and 17.6 ng/L. Nine out of 50 target PFAS were found and precisely quantified (

Better clinical benefits and potential cost saving of an enhanced recovery pathways for laparoscopic adrenalectomy.

BACKGROUND: Enhanced recovery pathways (ERPs) have been demonstrated to be clinically and economically effective for colorectal surgery. However, data are lacking to support the cost-effectiveness of ERPs for laparoscopic adrenalectomy, as well as potential economic loss. This study aims to determine the cost-effectiveness of ERPs vs. conventional care (CC) for patients undergoing laparoscopic adrenalectomy. METHODS: A single centered retrospective case-control study was performed. Patients undergoing laparoscopic adrenalectomy from January 2018 to June 2021 were enrolled. One inpatient ward used ERPs, whereas the other did not. Case control was used for matching (53 patients for each group). Postoperative outcomes were recorded up to 30 days after surgery. ERPs-specific costs were integrated into the model. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration, which were reported in Renminbi. A bootstrap independent t-test was used for comparison. RESULTS: The two groups were matched in terms of demographics and surgical details. Hospital stay was significantly shorter in the ERPs group (2.54 days, P<0.001). The rate of complications was lower in the ERPs group (1 vs. 7 patients, P=0.031), there was no severe complications or morbidity. ERPs-specific costs were ¥656 per patient. The self-payment cost difference per patient between the two groups was ¥3,154.52 in favor of the ERPs group, but this was not statistically significant (P=0.113). The mean direct saving per patient in the ERPs group was ¥8,326.00, the total costs saving including indirect and potential overhead per patient was ¥18,247.60. CONCLUSIONS: Enhanced recovery is cost-effective compared with conventional perioperative management for laparoscopic adrenalectomy. Savings were noted in disposable materials, medicine and medical services, radiology and laboratory costs, with no increase in morbidity or duration.