Renewable energy transition to sustainable tourism: extrapolating from core density and non-parametric approaches.

The globe has faced severe challenges recently, and environmental deterioration has become more prominent. Therefore, the world has taken several initiatives to deal with environmental issues while the problem remains intact. Interestingly, the OECD economies are the leading example to understand the accurate picture of sustainability across the near regions. This study makes an effort to introduce the core factors such as economic development, renewable energy, tourism, natural resources, and innovations in OECD economies over the period of 2000-2021. Similarly, to investigate the study's objectives, this study employs the quantile autoregressive distributed lag model (Q-ARDL). The analyzed results show the significant contribution of renewable energy, tourism, and natural resources to environmental sustainability. In contrast, income and innovations contribute to ecological deterioration. Moreover, the quantile causality is being used by this empirical study to investigate the causal association among studied variables. However, using green energy in sustainable tourism is highly recommended for specified economies. In order to deal with environmental pressure, this research proposes green implications to attain the desired sustainability level.

Predicting related factors of immunological response to hepatitis B vaccine in hemodialysis patients based on integration of decision tree classification and logistic regression.

The non/hypo-response rate of the hepatitis B vaccine among hemodialysis (HD) patients is still high, it is of great significance to explore the influencing factors and their relationships. To study the related factors and their relationships using logistic regression model and Chi-squared Automatic Interaction Detection (CHAID) decision tree model. A randomized controlled trial was conducted between February 2014 and May 2015 in China. HD patients being serologically negative for HBsAg and anti-HBs were randomly assigned to receive three intramuscular injections of the standard dose (20 µg) or high dose (60 µg) of recombinant hepatitis B vaccine at months 0, 1, and 6. Those with anti-HBs concentrations <100 mIU/mL, and ≥100 mIU/mL at month 7 were considered as non/hypo-response and high-level response, respectively. The non/hypo-response was 31.34% (89/284). After adjustment for confounders, logistic analysis showed that males (OR = 2.203, 95%CI: 1.109-4.367) and those with higher dialysis frequency (>4 times per 2 weeks) (OR = 1.918, 95%CI: 1.015-3.626) had a significant risk of non/hypo-response. While the CHAID analysis showed that gender, dose, and dialysis frequency were influencing factors of non/hypo-response, and gender is most important. The interaction between gender and dialysis frequency had the greatest effect on immunization, and followed by the interaction between dialysis frequency and vaccine dose. Taken together, gender, dose and dialysis frequency were influencing factors of hepatitis B vaccine in HD patients.

Clinical risk score for predicting invasive fungal disease after allogeneic hematopoietic stem cell transplantation: Analysis of the China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study.

BACKGROUND AND OBJECTIVE: Invasive fungal disease (IFD) is associated with a high mortality for patients with hematological malignancies undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed not only to develop a proven/probable IFD risk-scoring model but to identify high-risk populations that would benefit from anti-fungal prophylaxis. METHODS: Data from the China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study were retrieved, and all patients (n = 1053) undergoing allo-HSCT were randomly divided into the training set (n = 685) for model development and the validation set (n = 368) for model verification. A weighted risk score for proven or probable IFD was established through multivariate logistic regression analysis. RESULTS: The study population had a mean age of 28.95 years and the majority underwent myeloablative transplantation in complete remission 1 (53.4%). Five risk factors of IFD were identified, namely neutropenia lasting longer than 14 days, corticosteroid use, diabetes, haploidentical donor, and unrelated donor. Based on the risk score for IFD, the patients were categorized into three groups: low risk (score 0-4, 1.5%-4.0%), intermediate risk (score 5-8, 9.8%), and high risk (score>8, 24.7%-14.0%). Anti-fungal prophylaxis may provide benefits for patients with intermediate (8.5% vs. 18.5%, P = .0085) or high risk (19.4% vs. 30.8%, P = .4651) but not low risk (2.1% vs. 3.8%, P = .6136) of IFD. CONCLUSION: A practical weighted risk score for IFD in patients receiving allo-HSCT was established, which can aid decision-making regarding the administration of anti-fungal prophylaxis.

Fluconazole is as effective as other anti-mold agents in preventing early invasive fungal disease after allogeneic stem cell transplantation: assessment of antifungal therapy in haematological disease in China.

BACKGROUND: The introduction of mold-active antifungal drugs has led clinicians to reconsider the use of fluconazole for preventing invasive fungal disease (IFD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study of recipients of allo-HSCT, we evaluated the effects of different antifungal prophylaxes on the incidence of IFD at different times after transplantation. METHODS: Among the 1,401 patients registered in the prospective China Assessment of Antifungal Therapy in Haematological Disease (CAESAR) study database, there were 661 eligible patients who received primary antifungal prophylaxis. The incidence of IFD at different times after transplantation (early, late, and very late) and overall survival were compared for patients who received different drugs. RESULTS: The overall incidence of probable IFD was 7.0% in the fluconazole group, 12.6% in the itraconazole group, 1.4% in the voriconazole group, and 5.2% in the micafungin group (P=0.0379). However, the four groups had no significant differences in early, late, or very late IFD. The risk factors associated with IFD were neutropenia for more than 14 days, age greater than 18 years, and receipt of transplantation from an alternative (unrelated and haploidentical) donor (P<0.05). Sub-group analysis of alternative donors indicated that the efficacy of fluconazole was similar to the other three drugs in preventing early IFD. CONCLUSIONS: Our results suggest that the efficacy of fluconazole is similar to that of mold-active drugs in preventing early IFD in HSCT patients, even in high-risk patients receiving transplantation from alternative donors. Further prospective randomized studies are needed to confirm this conclusion.

Clinical risk score for invasive fungal diseases in patients with hematological malignancies undergoing chemotherapy: China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study.

Invasive fungal disease (IFD) is a major infectious complication in patients with hematological malignancies. In this study, we examined 4889 courses of chemotherapy in patients with hematological diseases to establish a training dataset (n = 3500) by simple random sampling to develop a weighted risk score for proven or probable IFD through multivariate regression, which included the following variables: male patients, induction chemotherapy for newly diagnosed or relapsed disease, neutropenia, neutropenia longer than 10 days, hypoalbuminemia, central-venous catheter, and history of IFD. The patients were classified into three groups, which had low (0-10, ~1.2%), intermediate (11-15, 6.4%), and high risk ( > 15, 17.5%) of IFD. In the validation set (n = 1389), the IFD incidences of the groups were ~1.4%, 5.0%, and 21.4%. In addition, we demonstrated that antifungal prophylaxis offered no benefits in low-risk patients, whereas benefits were documented in intermediate (2.1% vs. 6.6%, P = 0.007) and high-risk patients (8.4% vs. 23.3%, P = 0.007). To make the risk score applicable for clinical settings, a pre-chemo risk score that deleted all unpredictable factors before chemotherapy was established, and it confirmed that anti-fungal prophylaxis was beneficial in patients with intermediate and high risk of IFD. In conclusion, an objective, weighted risk score for IFD was developed, and it may be useful in guiding antifungal prophylaxis.

Impact of clinical utility of MRD assessment with different techniques on survival in acute B lymphoblastic leukemia.

We investigated the impact of minimal residual disease (MRD) obtained from different approaches on the outcomes of 141 B lymphoblastic leukemia (B-ALL) patients. Among 169 samples with more than 5% blasts by morphology, 3.6% (6/169) were Flow-MRD negative. Of the 212 positive molecular-MRD samples from Ph+ ALL patients, 55 (25.9%) were Flow-MRD negative. Before consolidation or allogeneic stem cell transplantation (allo-HSCT), negative Flow-MRD was associated with improved survival (p = .019 and .041, respectively) for Ph- ALL patients, but not for Ph+ ALL (p = .111 and .812, respectively). There was no difference in overall survival (OS) by achievement of complete molecular response at complete remission (CR, p = .333 and .863, respectively). Our results indicated that the results of MRDs detected with different methods varied. Flow-MRD can be used as a reliable prognostic marker for Ph- ALL patients. MRD either by flow cytometry or quantitative reverse transcription-polymerase chain reaction (qRT-PCR) at CR did not affect OS or DFS for Ph+ ALL.

Assessment of functional tag single nucleotide polymorphisms within the DRD2 gene as risk factors for post-traumatic stress disorder in the Han Chinese population.

BACKGROUND: Gene variations related to the dopaminergic pathway have been implicated in a number of neuropsychiatric disorders, including post-traumatic stress disorder (PTSD). Dopamine D2 receptor (DRD2) has been shown to significantly contribute to neuropsychiatric disorders and may specifically contribute to predisposition to PTSD. This study aimed to evaluate the association of polymorphisms within the entire DRD2 gene with PTSD in a case-control study. MATERIALS AND METHODS: A total of 834 unrelated Han Chinese adults, including 497 healthy volunteers and 337 patients with PTSD, were used in this study. Fifteen tag single-nucleotide polymorphisms (tSNPs) were selected spanning the entire DRD2 gene through the construction of haplotype bins. Genotypes were gathered using an improved multiplex ligation detection reaction (iMLDR) technique. Allelic frequencies and clinical characteristics were compared in two independent Han Chinese populations. Moreover, the functionality of the rs2075652 and rs7131056 polymorphisms were assessed by measuring transcriptional enhancer activities. RESULTS: Fifteen tag SNPs were identified in the Han Chinese population and all were common SNPs. Among 15 tSNPs, two of them (rs2075652 and rs7131056) significantly associated with PTSD. PTSD individuals were more likely to carry the rs2075652A and rs7131056A allele compared to the controls (P<0.05). The haplotype GTGATCGCGCAGGCG, had a risk effect on PTSD occurrence (OR=1.75, 95% CI: 1.24-2.48, P=0.002). Additionally, the rs2075652 polymorphism contained intronic enhancer activities. CONCLUSIONS: The rs2075652 and rs7131056 polymorphisms, and the haplotype GTGATCGCGCAGGCG within the DRD2 gene, may be potential markers to predict susceptibility to PTSD.

Toxic trace element assessment for soils/sediments deposited during Hurricanes Katrina and Rita from southern Louisiana, USA: a sequential extraction analysis.

Analysis of soil/sediment samples collected in the southern Louisiana, USA, region three weeks after Hurricanes Katrina and Rita passed was performed using sequential extraction procedures to determine the origin, mode of occurrence, biological availability, mobilization, and transport of trace elements in the environment. Five fractions: exchangeable, bound to carbonates, bound to iron (Fe)-manganese (Mn) oxides, bound to organic matter, and residual, were subsequently extracted. The toxic trace elements Pb, As, V, Cr, Cu, and Cd were analyzed in each fraction, together with Fe in 51 soil/sediment samples. Results indicated that Pb and As were at relatively high concentrations in many of the soil/sediment samples. Because the forms in which Pb and As are present tend to be highly mobile under naturally occurring environmental conditions, these two compounds pose an increased health concern.Vanadium and Cr were mostly associated with the crystal line nonmobile residual fraction. A large portion of the Cu was associated with organic matter and residual fraction. Cadmium concentrations were low in all soil/sediment samples analyzed and most of this element tended to be associated with the mobile fractions. An average of 21% of the Fe was found in the Fe-Mn oxide fraction, indicating that a substantial part of the Fe was in an oxidized form. The significance of the overall finding of the present study indicated that the high concentrations and high availabilities of the potentially toxic trace elements As and Pb may impact the environment and human health in southern Louisiana and, in particular, the New Orleans area.

Chronic myeloid leukemia in the Asia-Pacific region: current practice, challenges and opportunities in the targeted therapy era.

Chronic myeloid leukemia (CML) management varies across Asia due to disparities in affluence and healthcare provision. We surveyed CML management practice at 33 hospitals in 14 countries/regions to identify treatment challenges and opportunities for harmonization. Patients were generally treated according to international guidelines; however, tyrosine kinase inhibitors (TKIs) and molecular monitoring are inaccessible to many patients not covered by national insurance or eligible for subsidized treatment. Late diagnosis and suboptimal monitoring, often due to cost and accessibility issues, are challenges. Priorities for Asia include: extending accessibility to TKIs; specialist laboratory monitoring; and enriching data to support regional CML management guidelines.

[A novel single nucleotide polymorphism-based method for quantitative assessment of chimerism after allogeneic stem cell transplantation.].

OBJECTIVE: To develop a novel single nucleotide polymorphism (SNP)-PCR based method for quantitative detection of chimerism after allogeneic haemopoietic stem cell transplantation (allo-HSCT), and to explore its feasibility, accuracy and superiority. METHODS: 18 SNP loci were sereened to identify informative markers for detecting chimerism in each donor/recipient pair before transplantation. Then the chimerism rate of each informative marker was analyzed by real-time quantitative PCR (RQ-PCR). The accuracy and sensitivity were verified by multiple proportion dilution and analogy chimerism compared with quantitative detection of short tandem repeat (STR)-PCR, fluorescence in situ hybridization (FISH) and fusion gene. RESULTS: (1) The average slope of the 17 time amplications of the internal control plasmid was -3.39, the average intercept was 39.97, correlation coefficients were more than 0.995, which was close to the theoretical level. The intra- and interassay variability was 0.50% and 1.1%, respectively, which were both in the allowed ranges. A linear correlation with artificial mixed chimerism is above 0.99 and a sensitivity of 0.01% proved reproducible. (2) At least one informative marker could be found in over 95% of 40 donor/recipient pairs. The results of the chimerisms derived from SNP-PCR were consistent with that from STR-PCR (96.7%), FISH and fusion gene analasis (P > 0.05); the quantitative results of special fusion gene transcripts were negtive in complete chimerism samples, and positive in mixed chimerism samples. CONCLUSIONS: This new assay which overcome the PCR competition and plateau biases of STR-PCR provides an accurate, reliable and rapid quantitative assessment of mixed chimerism after allo-transplantation. It is highly promising for of clinical application and may take the place of STR-PCR in the conventional chimerisim assessment.