[Guideline for clinical comprehensive evaluation of Chinese patent medicine (2022 version)].

Currently,the research or publications related to the clinical comprehensive evaluation of Chinese patent medicine are increasing,which attracts the broad attention of all circles. According to the completed clinical evaluation report on Chinese patent medicine,there are still practical problems and technical difficulties such as unclear responsibility of the evaluation organization,unclear evaluation subject,miscellaneous evaluation objects,and incomplete and nonstandard evaluation process. In terms of evaluation standards and specifications,there are different types of specifications or guidelines with different emphases issued by different academic groups or relevant institutions. The professional guideline is required to guide the standardized and efficient clinical comprehensive evaluation of Chinese patent medicine and further improve the authority and quality of evaluation. In combination with the characteristics of Chinese patent medicine and the latest research achievement at home and abroad,the detailed specifications were formulated from six aspects including design,theme selection,content and index,outcome,application and appraisal,and quality control. The guideline was developed based on the guideline development requirements of China Assoication of Chinese medicine. After several rounds of expert consensus and public consultation,the current version of the guideline has been developed.

Perturbative Quantum Monte Carlo Method for Nuclear Physics.

While first order perturbation theory is routinely used in quantum Monte Carlo (QMC) calculations, higher-order terms present significant numerical challenges. We present a new approach for computing perturbative corrections in projection QMC calculations. We demonstrate the method by computing nuclear ground state energies up to second order for a realistic chiral interaction. We calculate the binding energies of several light nuclei up to ^{16}O by expanding the Hamiltonian around the Wigner SU(4) limit and find good agreement with data. In contrast to the natural ordering of the perturbative series, we find remarkably large second-order energy corrections. This occurs because the perturbing interactions break the symmetries of the unperturbed Hamiltonian. Our method is free from the sign problem and can be applied to QMC calculations for many-body systems in nuclear physics, condensed matter physics, ultracold atoms, and quantum chemistry.

Facile synthesis of low-cost MnPO4 with hollow grape-like clusters for rapid removal uranium from wastewater.

In order to deal with the environmental resource problems caused by nuclear pollution and uranium mine wastewater, it is particularly important to develop uranium removal adsorbent materials with low cost, high efficiency and controllable rapid preparation. In this work, the hollow grape-like manganese phosphate clusters (h-MnPO4) were synthesized in 4 h by in-situ etching without template at room temperature, which can quickly and effectively remove uranium ions from wastewater. Due to the reasonable hollow structure, more effective adsorption sites are exposed. The obtained sample h-MnPO4-200 reaches adsorption equilibrium in 1 h and can remove 97.20% uranyl ions (initial concentration is 100 mg L-1). Under the condition of 25 â„ƒ and pH= 4, the maximum adsorption capacity of h-MnPO4-200 for uranium was 751.88 mg g-1. The FT-IR, XPS and XRD analysis showed that -OH and PO43- groups played a key role in the adsorption process. Thanks to the synergistic adsorption mechanism of surface complexation and dissolution-precipitation, h-MnPO4-200 maintained a high removal rate in the presence of competitive anions and cations. In a word, h-MnPO4-200 can be rapidly synthesized through a facile and low-cost method and has a great application prospect in the practical emergency treatment of uranium-containing wastewater.

Visualization of the infection risk assessment of SARS-CoV-2 through aerosol and surface transmission in a negative-pressure ward.

Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a great challenge to the world's public health system. Nosocomial infections have occurred frequently in medical institutions worldwide during this pandemic. Thus, there is an urgent need to construct an effective surveillance and early warning system for pathogen exposure and infection to prevent nosocomial infections in negative-pressure wards. In this study, visualization and construction of an infection risk assessment of SARS-CoV-2 through aerosol and surface transmission in a negative-pressure ward were performed to describe the distribution regularity and infection risk of SARS-CoV-2, the critical factors of infection, the air changes per hour (ACHs) and the viral variation that affect infection risk. The SARS-CoV-2 distribution data from this model were verified by field test data from the Wuhan Huoshenshan Hospital ICU ward. ACHs have a great impact on the infection risk from airborne exposure, while they have little effect on the infection risk from surface exposure. The variant strains demonstrated significantly increased viral loads and risks of infection. The level of protection for nurses and surgeons should be increased when treating patients infected with variant strains, and new disinfection methods, electrostatic adsorption and other air purification methods should be used in all human environments. The results of this study may provide a theoretical reference and technical support for reducing the occurrence of nosocomial infections.

Economic evaluation of varicella vaccination strategies in Jiangsu province, China: a decision-tree Markov model.

This study evaluated different varicella vaccination strategies in Jiangsu province, China. A decision-tree Markov model was used to evaluate the cost effectiveness of various varicella vaccination strategies for children, including direct and selective vaccination (serotesting pre-vaccination). A cohort of one-year-old children was followed through 60 one-year Markov cycles. The parameter estimation was based on field work, the literature, and statistical yearbooks. We calculated the incremental cost-utility ratio (ICUR) using the saved quality-adjusted life year (QALY). One-way and probability sensitivity analyses were performed to assess uncertainty. Among 100,000 cohort members, one-dose and two-dose direct vaccination averted 8061 and 10,701 varicella cases, respectively, compared with no vaccination. Furthermore, compared with no vaccination, one-dose and two-dose direct vaccination saved one QALY at the ICUR of USD 21,401.33 and USD 35,420.81, respectively, at less than three times the per capita gross domestic product (USD 47,626.86) of Jiangsu. The ICURs of the one-dose and two-dose selective strategies versus no vaccination were USD 42,623.62 and USD 51,406.35 per QALY gained, respectively. The cost effectiveness results were most sensitive to the QALY loss of outpatients and vaccine prices. Thus, in Jiangsu, one-dose and two-dose direct varicella vaccination in children could be cost effective at the willingness to pay threshold of three times provincial GDP per capita from a societal perspective. The findings were sensitive to the vaccine price and health utility of varicella cases.

Adverse Events and Resource Use Before and After Treat-to-Target in Rheumatoid Arthritis: A Post Hoc Analysis of a Randomized Controlled Trial.

OBJECTIVE: Treat-to-target (TTT) is an accepted paradigm for care of patients with rheumatoid arthritis (RA). Because TTT can be associated with more medication switches, concerns arise regarding whether implementing TTT may increase adverse events and/or resource use. The aim of this study was to examine adverse events and resource use during the preintervention and intervention periods of the TTT intervention trial. METHODS: We used data from 6 practices enrolled in an 18-month cluster-randomized controlled trial to compare adverse events and resource use before (months 1-9) and during (months 10-18) a TTT intervention. The outcomes of interest, adverse events and resource use, were based on medical record review of all rheumatology visits for RA patients before and during the intervention. RESULTS: We examined records for 321 patients before the intervention and 315 during the intervention. An adverse event was recorded in 10.2% of visits before the intervention and 8.8% of visits during the intervention (P = 0.41). Biologic disease-modifying antirheumatic drugs were taken by 53.6% of patients before the intervention and 49.8% of patients during the intervention (P = 0.73). Rheumatology visits were more frequent before the intervention (mean ± SD 4.0 ± 1.4) than during the intervention (mean ± SD 3.6 ± 1.2; P = 0.02). More visits were accompanied by monitoring laboratory tests before the intervention (90.0%) compared with during the intervention (52.7%; P < 0.001). A greater percentage of visits before the intervention included diagnostic imaging (15.4%) versus during the intervention (8.9%; P < 0.001). CONCLUSION: We observed similar rates of adverse events before and during the implementation of TTT for RA. Rheumatology visits, use of laboratory monitoring, and diagnostic imaging did not increase during the TTT intervention.

Low-Cost and Scaled-Up Production of Fluorine-Free, Substrate-Independent, Large-Area Superhydrophobic Coatings Based on Hydroxyapatite Nanowire Bundles.

To date, the scaled-up production and large-area applications of superhydrophobic coatings are limited because of complicated procedures, environmentally harmful fluorinated compounds, restrictive substrates, expensive equipment, and raw materials usually involved in the fabrication process. Herein, the facile, low-cost, and green production of superhydrophobic coatings based on hydroxyapatite nanowire bundles (HNBs) is reported. Hydrophobic HNBs are synthesised by using a one-step solvothermal method with oleic acid as the structure-directing and hydrophobic agent. During the reaction process, highly hydrophobic C-H groups of oleic acid molecules can be attached in situ to the surface of HNBs through the chelate interaction between Ca2+ ions and carboxylic groups. This facile synthetic method allows the scaled-up production of HNBs up to about 8 L, which is the largest production scale of superhydrophobic paint based on HNBs ever reported. In addition, the design of the 100 L reaction system is also shown. The HNBs can be coated on any substrate with an arbitrary shape by the spray-coating technique. The self-cleaning ability in air and oil, high-temperature stability, and excellent mechanical durability of the as-prepared superhydrophobic coatings are demonstrated. More importantly, the HNBs are coated on large-sized practical objects to form large-area superhydrophobic coatings.

Chitosan-coated mesoporous microspheres of calcium silicate hydrate: environmentally friendly synthesis and application as a highly efficient adsorbent for heavy metal ions.

Chitosan-coated calcium silicate hydrate (CSH/chitosan) mesoporous microspheres formed by self-assembly of nanosheets have been synthesized in aqueous solution under ambient conditions without using any toxic surfactant or organic solvent. The method reported herein has advantages of simplicity, low cost and being environmentally friendly. The BET specific surface area of CSH/chitosan mesoporous microspheres is measured to be as high as ~356 m(2) g(-1), which is considerably high among calcium silicate materials. The as-prepared CSH/chitosan mesoporous microspheres are promising adsorbent and exhibit a quick and highly efficient adsorption behavior toward heavy metal ions of Ni(2+), Zn(2+), Cr(3+), Pb(2+) Cu(2+) and Cd(2+) in aqueous solution. The adsorption kinetics can be well fitted by the pseudo second-order model. The maximum adsorption amounts of Ni(2+), Zn(2+), Pb(2+), Cu(2+) and Cd(2+) on CSH/chitosan mesoporous microspheres are extremely high, which are 406.6, 400, 796, 425 and 578 mg/g, respectively. The CSH/chitosan adsorbent exhibits the highest affinity for Pb(2+) ions among five heavy metal ions. The adsorption capacities of the CSH/chitosan adsorbent toward heavy metal ions are relatively high compared with those reported in the literature.

[Contamination and ecological risk assessment of polycyclic aromatic hydrocarbons in water and in Karst underground river catchment].

Water samples in Laolongdong underground river catchment were collected to determine the concentration, compositional profiles, and evaluate ecological risk of 16 priority polycyclic aromatic hydrocarbons (PAHs). PAHs were measured by GC/MS. The total concentrations of 16 PAH ranged from 81.5-8019 ng · L(-1) in underground river, 288.7-15,200 ng · L(-1) in karst springs, and 128.4-2,442 ng · L(-1) in surface water. Affected by waste water from Huangjueya town, concentrations of PAHs in underground river were higher than those in surface water and waste water from sinkhole. The PAHs profiles were dominated by 3 ring PAHs. There were differences of monthly variations of PAHs contents in the water, due to waste water, season and different characteristics of PAH. Surface water and waste water from sinkhole played an important role on contamination in the river. The levels of ecological risk were generally moderately polluted and heavily polluted according to all detected PAH compounds in the water.

Health risk assessment for vehicle inspection workers exposed to airborne polycyclic aromatic hydrocarbons (PAHs) in their work place.

Inhalatory and dermal exposures of on-duty vehicle inspection workers to polycyclic aromatic hydrocarbons (PAHs) in Beijing were investigated from April 18 to May 17, 2011. Exposure levels to particulate PAHs for the vehicle inspection workers at gasoline, bus and diesel lines were found to be 56.07 ng m(-3), 111.72 ng m(-3) and 199.80 ng m(-3), respectively. A probabilistic risk assessment framework was integrated with the toxic equivalence factors (TEFs) and the incremental lifetime cancer risk (ILCR) approaches to quantitatively estimate the exposure risk for vehicle inspection workers of the three work lines. The median values of inhalation risk were estimated to be 3.7 × 10(-7), 5.0 × 10(-7) and 1.37 × 10(-6), respectively, while the median dermal ILCR values were 7.05 × 10(-6), 6.98 × 10(-6) and 1.28 × 10(-5), respectively for gasoline, bus, and diesel inspection workers. Total ILCR was higher than the acceptable risk level of 10(-6), indicating unacceptable potential cancer risk.

Treatment of rheumatoid arthritis in the Medicare Current Beneficiary Survey.

INTRODUCTION: Numerous studies across different health systems have documented that many patients with rheumatoid arthritis (RA) do not receive disease-modifying anti-rheumatic drugs (DMARDs). Relatively little is known about correlates of DMARD use and whether there are socioeconomic and demographic disparities. We examined DMARD use during 2001 to 2006 in the Medicare Current Beneficiary Survey (MCBS), a longitudinal US survey of randomly selected Medicare beneficiaries. METHODS: Participants in MCBS with RA were included in the analyses, and DMARD use was based on an in-home assessment of all medications. Variables included as potential correlates of DMARD use in weighted regression models included race/ethnicity, insurance, income, education, rheumatology visit, region, age, gender, comorbidity index, and calendar year. RESULTS: The cohort consisted of 509 MCBS participants with a diagnosis code for RA. Their median age was 70 years, 72% were female, and 24% saw a rheumatologist. Rates of DMARD use ranged from 37% among those <75 years of age to 25% of those age 75 to 84 and 4% of those age 85 and older. The multivariable adjusted predictors of DMARD use include: visit with a rheumatologist in the prior year (odds ratio, OR, 7.74, 95% CI, 5.37, 11.1) and older patient age (compared with <75 years, ages 75 to 84, OR 0.58, 95% CI 0.37, 0.92, and 85 and over, OR 0.09, 95% CI 0.02, 0.31). In those without a rheumatology visit, lower income and older age were associated with a significantly reduced probability of DMARD use; no association of DMARD use with income or age was observed for subjects seen by rheumatologists. Race and ethnicity were not significantly associated with receipt of DMARDs. CONCLUSIONS: Among individuals not seeing rheumatologists, lower income and older age were associated with a reduced probability of DMARD use.

Risk assessment of heavy metals in road and soil dusts within PM2.5, PM10 and PM100 fractions in Dongying city, Shandong Province, China.

15 road and 14 soil dust samples were collected from an oilfield city, Dongying, from 11/2009-4/2010 and analyzed by inductively coupled plasma-mass spectroscopy (ICP-MS) for V, Cr, Mn, Co, Ni, Cu, Zn, As, Cd and Pb within PM(2.5), PM(10) and PM(100) fractions synchronously. Metal concentrations, sources and human health risk were studied. Results showed that both soil and road dust exhibited higher values for Mn and Zn and lower values for Co and Cd for the three fractions. Mass concentration ratios of PM(2.5)/PM(10) and PM(10)/PM(100) for metals in road and soil dust indicate that most of the heavy metals tend to concentrate in fine particles. Geoaccumulation index and enrichment factors analysis showed that Cu, Zn and Cd exhibited moderate or heavy contamination and significant enrichment, indicating the influence of anthropogenic sources. Vanadium, Cr, Mn and Co were mostly not enriched and were mainly influenced by crustal sources. For Ni, As and Pb, they ranged from not enriched to moderately enriched and were influenced by both crustal materials and anthropogenic sources. The conclusions were confirmed by multivariate analysis methods. Principle component analysis revealed that the major sources were vehicle emission, industrial activities, coal combustion, agricultural activities and crustal materials. The risk assessment results indicated that metal ingestion appeared to be the main exposure route followed by dermal contact. The most likely cause for cancer and other health risks are both the fine particles of soil and road dusts.

Variation in initial kidney replacement therapy for end-stage renal disease due to lupus nephritis in the United States.

OBJECTIVE: Little is known about the patterns of use of initial kidney replacement therapies among patients with lupus nephritis (LN) end-stage renal disease (ESRD). We aimed to identify sociodemographic and clinical factors associated with variation in initial kidney replacement therapies among LN ESRD patients. METHODS: Patients with incident LN ESRD (1995-2006) were identified in the US Renal Data System. Age, sex, race, ethnicity, medical insurance, employment status, residential region, clinical factors, and comorbidities were considered as potential predictors of ESRD treatment choice, i.e., peritoneal dialysis (PD), hemodialysis (HD), or preemptive kidney transplantation in age-adjusted and multivariable-adjusted logistic regression analyses. RESULTS: Of the 11,317 individuals with incident LN ESRD, 82.0% initiated HD, 12.2% initiated PD, and 2.8% underwent preemptive kidney transplantation. Receiving initial PD was significantly associated with earlier calendar year, female sex, higher albumin and hemoglobin levels, and lower serum creatinine levels. African Americans (versus whites), Medicaid beneficiaries and those with no health insurance (versus private insurance), and those unemployed (versus employed) had significantly reduced PD initiation. Comorbidities including congestive heart failure, peripheral vascular disease, and the inability to ambulate were also associated with decreased PD. Many sociodemographic and clinical factors favoring PD were associated with preemptive kidney transplant (versus dialysis) as well. CONCLUSION: Few patients with LN ESRD receive initial PD or preemptive kidney transplantation. Race, ethnicity, employment, and medical insurance type are strongly associated with initial kidney replacement therapy choice. Future studies need to investigate the appropriateness of sociodemographic and clinical variation and the comparative effectiveness of kidney replacement therapies for LN ESRD.

Evaluation of selected rheumatoid arthritis activity scores for office-based assessment.

OBJECTIVE: Patient-reported measures can quickly provide assessments of rheumatoid arthritis (RA) disease activity in the office setting and do not require a laboratory test or physician examination. The goal of our study was to establish the validity of patient-reported indices compared to the C-reactive protein-based Disease Activity Score (DAS28-CRP4). METHODS: Baseline and 1-year followup DAS28-CRP4 data were obtained from 740 RA subjects and were compared to indices (MDHAQ, CDAI, RAPID, RADAI, GAS) according to cyclic citrullinated peptide (CCP) status and change at 1 year. Pairwise correlations were calculated for each index. RESULTS: Among 740 subjects, mean age 57 years, disease duration 14 years, the CDAI (r = 0.84, Δ r = 0.80) and RAPID (r = 0.71, Δ r = 0.70) had the highest correlation with the DAS28-CRP4 scores at baseline and 1 year. These correlations were not influenced by CCP status, disease-modifying antirheumatic drug use, biologic use, or by disease duration. CONCLUSION: In RA, the CDAI and RAPID correlated well with the DAS28-CRP4. They may both be practical and informative in the care of patients in the office setting.