Economical Production of Phenazine-1-carboxylic Acid from Glycerol by Pseudomonas chlororaphis Using Cost-Effective Minimal Medium.

Phenazine compounds are widely used in agricultural control and the medicine industry due to their high inhibitory activity against pathogens and antitumor activity. The green and sustainable method of synthesizing phenazine compounds through microbial fermentation often requires a complex culture medium containing tryptone and yeast extract, and its cost is relatively high, which greatly limits the large-scale industrial production of phenazine compounds by fermentation. The aim of this study was to develop a cost-effective minimal medium for the efficient synthesis of phenazine compounds by Pseudomonas chlororaphis. Through testing the minimum medium commonly used by Pseudomonas, an ME medium for P. chlororaphis with a high production of phenazine compounds was obtained. Then, the components of the ME medium and the other medium were compared and replaced to verify the beneficial promoting effect of Fe2+ and NH4+ on phenazine compounds. A cost-effective general defined medium (GDM) using glycerol as the sole carbon source was obtained by optimizing the composition of the ME medium. Using the GDM, the production of phenazine compounds by P. chlororaphis reached 1073.5 mg/L, which was 1.3 times that achieved using a complex medium, while the cost of the GDM was only 10% that of a complex medium (e.g., the KB medium). Finally, by engineering the glycerol metabolic pathway, the titer of phenazine-1-carboxylic acid reached the highest level achieved using a minimum medium so far. This work demonstrates how we systematically analyzed and optimized the composition of the medium and integrated a metabolic engineering method to obtain the most cost-effective fermentation strategy.

Impact of Socioeconomic Factors on Prognosis and Clinical Management in Patients with Hepatocellular Carcinoma.

BACKGROUND: The prognosis for patient survival using the tumor-node-metastasis (TNM) staging system may be imperfect, as it based only on biological factors and does not include the socioeconomic factors (SEFs). We integrated the SEFs into the TNM system (TNMSEF), and evaluated whether the novel TNM-SEF staging system showed better prediction capacity and improved clinical guidance in hepatocellular carcinoma (HCC). METHODS: We selected data of 12 514 cases with HCC between 2010 and 2015 from the SEER database. The Kaplan-Meier survival curves and Cox proportional hazards regression were used to analyze cancer-specific survival (CSS) among the TNM-SEF stages. RESULTS: Multivariate Cox analyses showed that insurance status, marital status, year of diagnosis, and income were prominent prognostic SEFs (all P < .05). When compared with the SEF0 stage, the SEF1 stage was significantly associated with a 36.1% increased risk of cancer-specific mortality in HCC overall, a 22.2% increased risk of metastatic HCC, and a 41.8% increased risk of non-metastatic HCC (all P < .001). The concordance index of the TNM-SEF stage (0.768) was better than that of the TNM stage (0.764). Furthermore, patients with SEF0 stage showed higher 5-year CSS than those with SEF1 stage (I: 48.7% vs. 28.1%; II: 41.0% vs. 25.1%; IIIA: 12.8% vs. 5.0%; IIIB: 7.8% vs. 6.0%; IIIC: 6.4% vs. 6.7%; IVA: 8.4% vs. 2.5%; IVB: 2.1% vs. 0.8%; all P < .05). CONCLUSION: We have proved that the SEF stage is an independent predictor for HCC. The combined SEF stage with TNM staging warrants more clinical attention, for improved prognostic prediction and clinical guidance.

[Distribution, Sources, and Risk Assessment of Polyfluoroalkyl Substances in Main Rivers and Soils of Tianjin].

Rapid urbanization and industrialization may potentially impact the spatial distribution and transmission of polyfluoroalkyl substances (PFASs). Tianjin, a typical industrialized city with a high urbanization level around Bohai Bay, was selected to evaluate the spatial distribution and ecological risks of PFASs. Water and soil samples were systematically collected and analyzed by using solid-phase extraction and high-performance liquid chromatography-tandem mass spectrometry (HPLC/MS-MS) methods. The results showed that all 12 PFASs were detected in water and soils, and the detection rates of the other congeners were low. The concentrations of ΣPFASs in water ranged from 3.93 to 357.85 ng ·L-1, and the levels of ΣPFASs in soils ranged from 4.60 to 63.85 ng ·g-1. PFBA was the major component in water and soils, and the contribution of PFBA was 37% and 67% in water and soils, respectively. The spatial difference in ΣPFASs in the water bodies was significant. ΣPFAS concentrations in the surface water were higher in the north (mean value of 63.83 ng ·L-1) than in the south (mean value of 51.71 ng ·L-1) and higher in the eastern coastal area (mean value of 71.36 ng ·L-1) than in the western area (mean value of 36.08 ng ·L-1). ΣPFAS concentrations from upstream to downstream of the rivers showed an increasing trend. The highest PFAS concentration was found in the Chaobai River, and the lowest was detected in the South Canal. The spatial distribution of PFASs in soils was higher in the south (mean value of 13.33 ng ·g-1) than in the north (mean value of 6.38 ng ·g-1) and higher in the eastern coastal region (mean value of 11.45 ng ·g-1) than in the western region (mean value of 6.94 ng ·g-1). The soil concentrations of ΣPFASs in the Haihe River Basin were the highest. The source analysis results showed that the emulsification of rubber products, food packaging process, paper surface treatment, fire extinguishing agent use, and electrochemical fluorination process in industrial production were the main sources of PFASs in the soils in the study area. PFOS/PFOA, PFOA/PFNA, and PFHpA/PFOA analyses showed that the main source of PFASs in water bodies was the degradation of precursors. ΣPFASs in a few areas originated from the direct emissions from production, but the atmospheric deposition was small. The results of the ecological risk evaluation indicated that the exposure concentrations of PFASs in water and soils in the study area were at a low ecological risk level. However, the long-term ecological effects of PFASs cannot be ignored because of their long-distance transport capability and high food chain (web) accumulation capability.

Patients' Preferences for Artificial Intelligence Applications Versus Clinicians in Disease Diagnosis During the SARS-CoV-2 Pandemic in China: Discrete Choice Experiment.

BACKGROUND: Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19. OBJECTIVE: This study aims to visualize and measure patients' heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future. METHODS: A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables' coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes. RESULTS: A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis "accuracy" attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes. CONCLUSIONS: Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People's preferences for the "accuracy" and "diagnostic expenses" attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration.

Economic burden of IADPSG gestational diabetes diagnostic criteria in China: propensity score matching analysis from a 7-year retrospective cohort.

INTRODUCTION: The International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) increased the morbidity significantly, but the cost and effectiveness of its application are still unclear. This study aimed to analyze the impact of the IADPSG criteria for diagnosing GDM in China on the perinatal outcomes, and medical expenditure of GDM women versus those with normal glucose tolerance (NGT). RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study involving 7794 women admitted at the First Affiliated Hospital of Jinan University (Guangzhou, China), from November 1, 2010 to October 31, 2017. The perinatal outcomes and medical expenditure were retrieved from the electronic medical records in the hospital. Propensity score matching (PSM, in a 1:1 ratio) algorithm was used to minimize confounding effects on the difference in the two cohorts. RESULTS: PSM minimized the difference of baseline characteristics between women with and without GDM. Of 7794 pregnant women, half (n=3897) were all of the pregnant women with GDM admitted to the hospital during the period, the other half women had NGT and were selected randomly to match with their counterparts. Adopting the IADPSG criteria was associated with reduced risk of emergency cesarean section, polyhydramnios, turbid amniotic fluid and perineal injury (p<0.01 for all) and having any one of the adverse fetal outcomes (p<0.01), including fetal distress, umbilical cord around the neck, neonatal encephalopathy, admission to neonatal intensive care unit, birth trauma, neonatal hypoglycemia and fetal death. After PSM, the median total medical expenditure by the GDM women was ¥912.9 (US$140.7 in 2015) more than that of the the NGT women (p=0.09). CONCLUSIONS: Despite the increasing medical expenditure, screening at 24-28 gestational weeks under the IADPSG guidelines with the 2-hour, 75 g oral glucose tolerance test can improve short-term maternal and neonatal outcomes.

Economic and environmental evaluation of flux agents in the vitrification of resin waste: A SWOT analysis.

Flux agents play an important role in the pyrolysis treatment of vitrifying hazardous wastes. Among these is plasma jets, a cost-less flux agent derived from shell powder which can be used to create vitrification. It is a promising option to be applied in the vitrification of elements and to remove the VOCs of hazardous waste, namely, resin from PCB scrap in an atmospheric-pressure microwave plasma reactor. In this study, a laboratory scale experiment was conducted. The experiment was performed in the pyrolysis of resin which was added with flux agents. The economic evaluation of the flux agents, and the circular economy concept of the final residue derived from the plasma pyrolysis was then analyzed post treatment. To test the strength and weakness of the experiment, the SWOT analysis was performed. The outcome helped in the understanding of the cost-less flux agent used in the pyrolysis treatment of hazardous waste. Results showed that fusing shell powder in resin was better for improving the removal efficiency of VOCs, such as benzene and toluene as well as toxic metals than compared to other flux agents such as limestone and quartz sand. Moreover, the final residue of resin was found to fulfil the concept of circular economy where it could be reused as an absorbent of methyl blue, thereby indicating good absorption performance, from 1 ppm-100 ppm. The twelve strategies that were derived from the SWOT analysis could be used as information outlining the current internal and external condition for the development and application of shell powder. Shell powder, as a cost-less flux agent, has the potential for enhancing waste management and circular economy when used in the pyrolysis treatment of future hazardous wastes.

Human biomonitoring of eight trace elements in urine of residents living in rural areas along the Yangtze River, China.

The rapid economic development and industrialization have made heavy metal contamination a great public concern, especially in China. However, the levels of heavy metals in human body, especially those susceptible to the effect of industrial progression, are rarely explored. In this study, eight elements in 2643 urinary samples of individuals living in rural areas along the Yangtze River were determined through inductively coupled plasma optical emission spectrometry (As, Cr, Cu, Fe, Mn, Pb, and Zn) and TAS-990 atomic absorption spectrophotometry (Cd). Two-level regression model was applied to explore the potential factors associated with the level of the eight trace elements. After adjusting for urinary creatinine, the geometric means were 77.5, 10.98, 14.39, 13.00, 0.59, 1.51, 489.62, and 1.80 µg/g for As, Cr, Cu, Fe, Mn, Pb, Zn, and Cd, respectively. The level of eight elements varied among individual and familial characteristics. Compared with domestic and international results, the rural residents living in riverside areas had higher level of As, Cd, Cr, Fe, and Zn. Therefore, industrial progression followed by economic development has resulted in high body burden of heavy metals. Targeted public health policies should be made to improve the local environment and the recognition of potential risk factors.

Quick chronic liver failure-sequential organ failure assessment: an easy-to-use scoring model for predicting mortality risk in critically ill cirrhosis patients.

BACKGROUND AND AIM: Critically ill cirrhosis patients have an increased risk of morbidity and mortality, even after admission to the ICU. Our objectives were to compare the predictive accuracy of model for end-stage liver disease (MELD), MELD-Na, UK model for end-stage liver disease, and chronic liver failure-sequential organ failure assessment (CLIF-SOFA) by the development and validation of an easy-to-use prognostic model [named quick CLIF-SOFA (qCLIF-SOFA)] for early risk prediction in critically ill patients with cirrhosis. PATIENTS AND METHODS: Overall, 1460 patients were extracted from the MIMIC-III database and enrolled in this study at 30-day and 90-day follow-up. qCLIF-SOFA was developed in the established cohort (n=730) and a performance analysis was completed in the validation cohort (n=730) using area under the receiver operating characteristic curve. Results were compared with CLIF-SOFA. RESULTS: The performance of CLIF-SOFA was significantly better than that of MELD, MELD-Na, and UK model for end-stage liver disease for predicting both 30-day and 90-day mortality (all P<0.05). qCLIF-SOFA consisted of five independent factors (bilirubin, creatinine, international normalized ratio, mean arterial pressure, and vasopressin) associated with mortality. In the established cohort, CLIF-SOFA and qCLIF-SOFA predicted mortality with area under the receiver operating characteristic curve values of 0.768 versus 0.743 at 30-day, 0.747 versus 0.744 at 90-day, and 0.699 versus 0.706 at 1 year, respectively (all P>0.05). A similar result was observed in the validation cohort (0.735 vs. 0.734 at 30 days, 0.723 vs. 0.737 at 90 days, and 0.682 vs. 0.700 at 1 year, respectively, all P>0.05). CONCLUSION: The utility of CLIF-SOFA was further shown to predict mortality for critically ill cirrhosis patients. The novel and simpler qCLIF-SOFA model showed comparable accuracy compared with existing CLIF-SOFA for prognostic prediction.

Acute circulatory failure-chronic liver failure-sequential organ failure assessment score: a novel scoring model for mortality risk prediction in critically ill cirrhotic patients with acute circulatory failure.

BACKGROUND AND AIM: Acute circulatory failure (ACF) is associated with high mortality rates in critically ill cirrhotic patients. Only a few accurate scoring models exist specific to critically ill cirrhotic patients with acute circulatory failure (CICCF) for mortality risk assessment. The aim was to develop and evaluate a novel model specific to CICCF. PATIENTS AND METHODS: This study collected and analyzed the data on CICCF from the Multiparameter Intelligent Monitoring in Intensive Care-III database. The acute circulatory failure-chronic liver failure-sequential organ failure assessment (ACF-CLIF-SOFA) score was derived by Cox's proportional hazards regression. Performance analysis of ACF-CLIF-SOFA against CLIF-SOFA and model for end-stage liver disease systems was completed using area under the receiver operating characteristic curve. RESULTS: ACF-CLIF-SOFA identified six independent factors: mean arterial pressure [hazard ratio (HR)=0.984, 95% confidence interval (CI): 0.978-0.990, P<0.001], vasopressin (HR=1.548, 95% CI: 1.273-1.883, P<0.001), temperature (HR=0.764, 95% CI: 0.694-0.840, P<0.001), bilirubin (HR=1.031, 95% CI: 1.022-1.041, P<0.001), lactate (HR=1.113, 95% CI: 1.084-1.142, P<0.001), and urine output (HR=0.854, 95% CI: 0.767-0.951, P=0.004). ACF-CLIF-SOFA showed a better predictive performance than CLIF-SOFA and model for end-stage liver disease in terms of predicting mortality (0.769 vs. 0.729 vs. 0.713 at 30 days, 0.757 vs. 0.707 vs. 0.698 at 90 days, 0.733 vs. 0.685 vs. 0.691 at 1 year, respectively, all P<0.05). CONCLUSION: ACF-CLIF-SOFA, as the first model specific to CICCF, enables a more accurate prediction at 30-day, 90-day, and 1-year follow-up periods than other existing scoring systems.

Cumulative risk assessment of phthalates associated with birth outcomes in pregnant Chinese women: A prospective cohort study.

A prospective cohort study of a Chinese population of mother-neonate pairs (n = 3103) was conducted to investigate the relationship between the cumulative hazard index (HI) of combined diethyl phthalate (DEP), dibutyl phthalate (DBP), dibenzyl phthalate (BBzP) and di(2-ethylhexyl) phthalate (DEHP) exposure and birth outcomes. The estimated HI for phthalates was based on phthalate metabolite concentrations in urine collected between 5th and 14th gestational weeks. The median HI values according to the European Food Safety Authority tolerable daily intake (HITDI) and U.S. Environmental Protection Agency reference dose (HIRfD) were 0.358 and 0.187, respectively. A total of 16.3% and 1.9% of the women exhibited HITDI and HIRfD exceeding the value of one, respectively. In unadjusted models, the categories (low < P25, median P25-P50, high > P75) of HITDI were associated with decreased birth weight (ß = -26.34 g, p = 0.021) and head circumference (ß = -0.09 cm, p = 0.029), whereas those for HIRfD were negatively associated with birth weight (ß = -31.74 g, p = 0.005), birth length (ß = -0.11 cm, p = 0.032), head circumference (ß = -0.13 cm, p = 0.003) and chest circumference (ß = -0.10 cm, p = 0.021) in all neonates. Adjustment for potential confounders revealed that HIRfD was inversely associated with head circumference (ß = -0.10 cm, p = 0.020). Stratification by gender indicated that HIRfD was associated with decreased birth length (ß = -0.17 cm, p = 0.041) in infant boys and HITDI was associated with decreased birth weight (ß = -33.12 g, p = 0.036) and head circumference (ß = -0.13 cm, p = 0.027) in girls. This is the first study on the cumulative risk assessment of phthalate exposures in pregnant Chinese women. We found that the HI values of multiple phthalate co-exposure were sex-specifically related to birth outcomes.

Incorporation of zinc for fabrication of low-cost spinel-based composite ceramic membrane support to achieve its stabilization.

In order to reduce environment risk of zinc, a spinel-based porous membrane support was prepared by the high-temperature reaction of zinc and bauxite mineral. The phase evolution process, shrinkage, porosity, mechanical property, pore size distribution, gas permeation flux and microstructure were systematically studied. The XRD results, based on a Zn/Al stoichiometric composition of 1/2, show a formation of ZnAl2O4 structure starting from 1000°C and then accomplished at 1300°C. For spinel-based composite membrane, shrinkage and porosity are mainly influenced by a combination of an expansion induced by ZnAl2O4 formation and a general densification due to amorphous liquid SiO2. The highest porosity, as high as 44%, is observed in ZnAl4 membrane support among all the investigated compositions. Compared with pure bauxite (Al), ZnAl4 composite membrane support is reinforced by ZnAl2O4 phase and inter-locked mullite crystals, which is proved by the empirical strength-porosity relationships. Also, an increase in average pore diameter and gas flux can be observed in ZnAl4. A prolonged leaching experiment reveals the zinc can be successfully incorporated into ceramic membrane support via formation of ZnAl2O4, which has substantially better resistance toward acidic attack.

Functional CT for assessment of early vascular physiology in liver tumors.

BACKGROUND: CT perfusion has been reported to have great advantages in detecting hepatic diseases. However, currently there are no studies showing the potential value of multi-slice CT perfusion with the deconvolution model method in diagnosing early hemodynamic changes caused by liver tumors. This study was undertaken to determine if early hemodynamic changes caused by liver tumors can be depicted with the perfusion imaging of multi-slice CT. METHODS: Ten New Zealand white rabbits before and after VX2 liver tumor inoculation served as the experimental animals. Ten normal rabbits served as controls. All underwent multi-slice CT perfusion for the measurement of hepatic blood flow (HBF), hepatic blood volume (HBV), mean transit time (MTT), permeability of capillary vessel surface (PS) and hepatic artery index (HAI). RESULTS: With the exception of MTT, which decreased significantly at the tumor periphery, HBF, HBV, PS and HAI increased significantly compared with the surrounding normal tissue. All these changes occurred at days 5-9 after tumor inoculation. Statistically significant changes in these values were detected with tumor growth. CONCLUSIONS: The hemodynamic changes in the liver caused by rabbit VX2 liver tumor can be detected after tumor inoculation, and functional CT can evaluate the physiological characteristics of early tumor angiogenesis.