Does environmental regulation lessen health risks? Evidence from Chinese cities.

Introduction: Atmospheric pollution is a severe problem confronting the world today, endangering not only natural ecosystem equilibrium but also human life and health. As a result, governments have enacted environmental regulations to minimize pollutant emissions, enhance air quality and protect public health. In this setting, it is critical to explore the health implications of environmental regulation. Methods: Based on city panel data from 2009 to 2020, the influence of environmental regulatory intensity on health risks in China is examined in this study. Results: It is discovered that enhanced environmental regulation significantly reduces health risks in cities, with each 1-unit increase in the degree of environmental regulation lowering the total number of local premature deaths from stroke, ischemic heart disease, and lung cancer by approximately 15.4%, a finding that remains true after multiple robustness tests. Furthermore, advances in science and technology are shown to boost the health benefits from environmental regulation. We also discover that inland cities, southern cities, and non-low-carbon pilot cities benefit more from environmental regulation. Discussion: The results of this research can serve as a theoretical and empirical foundation for comprehending the social welfare consequences of environmental regulation and for guiding environmental regulation decision-making.

Quantitative Assessment of Keloids Using Ultrasound Shear Wave Elastography.

This study was aimed at investigating the value of shear wave elastography (SWE) in quantitative evaluation of keloids. A total of 87 patients with 139 keloids were enrolled. Vancouver scar scale (VSS) scores were recorded. Thickness and blood flow grade were evaluated using high-frequency ultrasound. Skin stiffness (mean speed of shear wave, Cmean) was evaluated using SWE in both transverse and longitudinal sections. All measurements were performed in both keloids and site-matched unaffected skin (normal controls). The reliability of measurements was evaluated using intra- and inter-class correlation coefficients by two observers. Inter- and intra-observer repeatability was excellent (correlation coefficient > 0.99, p < 0.01). The SWE results revealed a significant increase in Cmean in keloids (p < 0.001) compared with the normal controls. Cmean in the longitudinal section was greater than that in the transverse section for keloids (p < 0.001). Cmean was highly positively correlated with VSS score (r = 0.904, p < 0.001), moderately positively correlated with thickness (r = 0.490, p < 0.001) and less positively correlated with blood flow (r = 0.231, p < 0.01). This non-invasive, tolerable and convenient imaging technique could be an effective tool for objectively evaluating keloid stiffness in the future, thus laying a foundation for the treatment and evaluation of keloids.

Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA?

BACKGROUND: The aim of this study was to find out the most commonly involved sites and the most important ultrasonic features in psoriatic arthritis (PsA). METHODS: In total, 120 PsA patients and 320 psoriasis vulgaris (non-PsA) patients were assessed by grayscale and power Doppler (PD) ultrasound (US). Joints, tendons, enthesis, and bursa changes were observed. Weights of affected anatomical sites of PsA patients (overall weights >90%) were calculated. Affected anatomical sites between PsA and non-PsA patients were compared. Ultrasonic features of joint, tendon, entheses, and bursa changes between PsA and non-PsA patients were also compared. Finally, the test performance of ultrasonic features for the diagnosis of PsA was calculated. RESULTS: The anatomical sites with the highest weights were the Achilles tendon, quadriceps tendon, and knee; weights of these anatomical sites were all more than 5%. Among the affected anatomical sites of PsA patients, most of the anatomical sites were more greatly affected in the PsA patients than in the non-PsA patients (all P<0.05). The comparison of the affected Achilles tendon, quadriceps tendon, MTP1, subacromial-subdeltoid bursa, MCP4, and MCP3 showed no significance between PsA and non-PsA patients (all P>0.05). Joint synovial thickening, joint PD signal grades, joint bone erosions, tendon sheath synovial thickening, tendon sheath PD signals, enthesis bone erosions, and enthesis PD signals in PsA patients were higher than in non-PsA patients (all P<0.05). Joint PD signal grades, joint bone erosions, enthesis bone erosions, and enthesis PD signals showed the highest specificities, which were 96.06%, 95.15%, 96.93%, and 94.63% respectively. CONCLUSIONS: The most common involvement sites of PsA were the Achilles tendon, quadriceps tendon, and knee, and some sites in non-PsA patients were also highly involved. The most important features in PsA included joint PD signal grades, joint bone erosion, entheses bone erosions, and entheses PD signals in US assessment.

Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography.

BACKGROUND: To investigate the role of shear wave elastography (SWE) in patients with lateral epicondylitis (LE) by assessing the common extensor tendon (CET) elasticity. METHODS: A total of 62 unilateral LE patients were enrolled. Shear wave speed (SWS) and the thickness of CET in both elbows, along with the involved elbows with pre- and post-treatment, were obtained by SWE. The differences between groups, inter- and intra-observer agreements, and diagnostic accuracy were analyzed with a paired t-test, intraclass correlation coefficients (ICCs), and receiver operator characteristic (ROC) curve, respectively. RESULTS: LE patients had significantly lower SWS on lesion sides compared to healthy elbows (P<0.05). The SWS of involved elbows were significantly higher after non-operation treatment than before treatment. The inter- and intra-observer agreements were excellent (ICCs: 0.900-0.993) for SWE measurements. Moreover, a 12.2 m/s cutoff value of mean SWS (C mean) for discriminating LE patients from healthy subjects revealed a sensitivity and specificity of 93% and 93%, respectively. CONCLUSIONS: SWE is a valid imaging technique for the diagnosis of LE and monitoring of the treatment effect. Future studies are essential for investigating the correlations among clinical examinations, conventional ultrasound, and SWE.

Quantitative assessment of treatment efficacy in keloids using high-frequency ultrasound and shear wave elastography: a preliminary study.

The purpose of this study was to investigate the performance of high-frequency ultrasound (HFUS) and shear wave elastography (SWE) in the quantitative evaluation of therapeutic responses of keloids. 43 patients with 76 keloids were recruited into this study. In keloids and symmetrical sites, the skin thickness was measured using HFUS and skin stiffness expressed as elastic moduli (Young's modulus and shear wave velocity) was measured using SWE. The coefficient of variation values were calculated by using difference values of skin elastic moduli and skin thickness. A significant increase of both skin stiffness and thickness appeared in pre-treated keloids compared with post-treated keloids (P < 0.001) and normal controls (P < 0.001), respectively. Stiffness in post-treated keloids and normal skins was significantly different (P < 0.001), while the difference in thickness measurements showed no significance (P = 0.56, >0.05). The coefficient of variation of Young's modulus was the highest when compared between (i) pre-treated keloids and theirs site-matched areas; (ii) pre-treated and post-treated keloids. SWE, which showed greater ability in determining the extent of keloids recovery, may provide an ideal tool to assess the stiffness of keloids and theirs therapeutic response.

Quantitative Assessment of Skin Stiffness Using Ultrasound Shear Wave Elastography in Systemic Sclerosis.

This study was aimed at investigating the performance of ultrasound shear wave elastography (US-SWE) in the assessment of skin (the dermis) stiffness in patients with systemic sclerosis (SSc). The thickness and elastic modulus of the skin were measured using US-SWE at 6 sites in 60 SSc patients and 60 healthy volunteers: the bilateral middle fingers and forearms and the anterior chest and abdomen. To evaluate clinical scores, the measurements were also extended to 17 skin sites in 30 patients. The diagnostic performance of US-SWE in the differentiation of SSc from healthy skin was determined by receiver operating characteristic (ROC) curve analysis, and the reliability of the measurement was evaluated with intra- and inter-class correlation coefficients. The results of US-SWE were compared with modified Rodnan skin thickness scores. Our results indicated that (i) the elastic modulus values were significantly higher in SSc patients than in controls, with or without normalization by skin thickness; (ii) receiver operating characteristic analysis revealed normalized US-SWE cutoff values with a very high accuracy for right and left fingers (areas under the curve = 0.974 and 0.949), followed by left forearm (0.841), anterior abdomen (0.797), right forearm (0.772) and anterior chest (0.726); (iii) the reliability of US-SWE measurements was good for all examined sites with intra-observer correlation coefficients of 0.845-0.996 and inter-observer correlation coefficients of 0.824-0.985; and (iv) total scores of skin involvement determined at 17 sites (modified Rodnan skin thickness scores) correlated with skin stiffness (r = 0.832) and thickness (r = 0.736). In conclusion, US-SWE is a quantitative method with high specificity, sensitivity and reliability in the detection of SSc involvement. This non-invasive, real-time and operator-independent imaging technique could be an ideal tool for the assessment of SSc disease.

[Quantitative Assessment of Skin Thickness using High Frequency Ultrasound in Systemic Sclerosis].

OBJECTIVE: To investigate the performance of high frequency ultrasound in the assessment of skin thickness in patients with systemic sclerosis (SSc). METHODS: The study included 82 SSc (SSc group) and 67 healthy volunteers (control group) from 2014 to 2016. The skin thickness at bilateral middle fingers and forearms,anterior chest and abdominal wall was measured using high frequency ultrasound. All the patients with SSc underwent the modified rodnan skin score (mRSS) over 17 anatomical sites by an experienced dermatologist. The differences in age,sex,height,body mass,body mass index (BMI) and skin thickness between SSc patients and healthy controls were compared. Receiver operating characteristic (ROC) curve analysis was performed to determine the performance of high frequency ultrasound in the differentiation of SSc from healthy skin,and the correlation of mRSS with skin thickness were analyzed. RESULTS: SSc patients and healthy controls shared similar demographic features (age,sex ratio,height,body mass,BMI) (P>0.05). Skin thickness values in SSc patients were increased significantly at fingers and forearms compared with healthy controls (P<0.05). The area under the curve (AUC) was 0.938, 0.905, 0.608, 0.586, 0.398, 0.321 at right and left finger,right and left forearm,chest and abdominal wall. Among them,AUC>0.9 of right and left fingers can be used for diagnosis,The skin thickness cut-off value for determining the diagnosis of SSc were as follows: 1.35 mm at the right finger with 84.1% sensitivity and 95.5% specificity,1.26 mm at the right forearm with 86.6% sensitivity and 89.6% specificity,respectively. Skin thickness increased significantly with mRSS. The correlation of total mRSS scores with total skin thickness was 0.599 (P<0.001),and the correlation of local mRSS score with local skin thickness were 0.400-0.623 (P<0.001),with the highest correlation coefficient at right finger and the lowest at abdomen. CONCLUSION: High frequency ultrasound may reflect extent of skin involvement of SSc,and skin thickness assessed with high frequency ultrasound appeared to be highly specific and sensitive at fingers.

Improvement in the sensitivity of newborn screening for Fabry disease among females through the use of a high-throughput and cost-effective method, DNA mass spectrometry.

Many female carriers of Fabry disease are likely to develop severe morbidity and mortality. However, by our own estimation, around 80% of female newborns are missed by our current enzyme-based screening approach. Our team's aim was to develop an improved cost-effective screening method that is able to detect Fabry disease among female newborns. In Taiwan, based on a database of 916,000 newborns, ~98% of Fabry patients carry mutations out of a pool of only 21 pathogenic mutations. An Agena iPLEX platform was designed to detect these 21 pathogenic mutations using only a single-assay panel. A total of 54,791 female infants were screened and 136 female newborns with the IVS4 + 919G > A mutation and one female newborn with the c.656T > C mutation were identified. Using the current enzyme-based newborn screening approach as baseline, around 83% of female newborns are being missed. Through a family study of the IVS4 female newborns, 30 IVS4 adult family members were found to have left ventricular hypertrophy. Ten patients received endomyocardial biopsy and all were found to have significant globotriaosylceramide (Gb3) accumulation in their cardiomyocytes. All of these individuals now receive enzyme replacement therapy. We have demonstrated that the Agena iPLEX assay is a powerful tool for detecting females with Fabry disease. Furthermore, through this screening, we also have been able to identify many disease-onset adult family members who were originally undiagnosed for Fabry disease. This screening helps them to receive treatment in time before severe and irreversible cardiac damage has occurred.

Quantitative Assessment of Skin Stiffness in Localized Scleroderma Using Ultrasound Shear-Wave Elastography.

The purpose of this study was to evaluate the usefulness of ultrasound shear-wave elastography (US-SWE) in characterization of localized scleroderma (LS), as well as in the disease staging. A total of 21 patients with 37 LS lesions were enrolled in this study. The pathologic stage (edema, sclerosis or atrophy) of the lesions was characterized by pathologic examination. The skin elastic modulus (E-values including Emean, Emin, Emax and Esd) and thickness (h) was evaluated both in LS lesions and site-matched unaffected skin (normal controls) using US-SWE. The relative difference of E-values (ERD) was calculated between each pair of lesions and its normal control for comparison among different pathologic stages. Of the 37 LS lesions, 2 were in edema, 22 were in sclerosis and 13 were in atrophy. US-SWE results showed a significant increase of skin elastic modulus and thickness in all lesions (p < 0.001 in sclerosis and p < 0.05 in atrophy) compared with the normal controls. The measured skin elastic modulus and thickness were greater in sclerosis than in atrophy. However, once normalized by skin thickness, the atrophic lesions, which were on average thinner, appeared significantly stiffer than those of the sclerosis (normalized ERD: an increase of 316.3% in atrophy vs. 50.6% in sclerosis compared with the controls, p = 0.007). These findings suggest that US-SWE allows for quantitative evaluation of the skin stiffness of LS lesions in different stages; however, the E-values directly provided by the US-SWE system alone do not distinguish between the stages, and the normalization by skin thickness is necessary. This non-invasive, real-time imaging technique is an ideal tool for assessing and monitoring LS disease severity and progression.

Quantitative Assessment of Healthy Skin Elasticity: Reliability and Feasibility of Shear Wave Elastography.

The goal of this study was to investigate the reliability and feasibility of shear wave elastography by assessing the elasticity of the healthy skin of 40 volunteers. Young's moduli for bilateral fingers, forearms, anterior chest (sternum), and anterior abdomen were determined with both transverse and longitudinal sectional measurements. Reliability of measurements was evaluated using intra- and inter-class correlation coefficients with two observers. Our results revealed that the elastic modulus values of the skin between symmetric parts of fingers and forearms did not statistically different. No differences were found between the transverse and longitudinal sections of forearms, anterior chest, and abdomen (p > 0.05), except for middle fingers (p = 0.004). Inter-observer and intra-observer repeatability (inter- and intra-class correlation coefficients) varied from moderate to excellent depending on the skin site (0.62-0.91). In conclusion, shear wave elastography reached a good consistency in measuring healthy skin elasticity. Further studies are needed to provide more information on the factors that influence the reliability of shear wave elastography measurements in both healthy and diseased skin.