Nomogram-based risk assessment model for left ventricular hypertrophy in patients with essential hypertension: Incorporating clinical characteristics and biomarkers.

Left ventricular hypertrophy (LVH) is a hypertensive heart disease that significantly escalates the risk of clinical cardiovascular events. Its etiology potentially incorporates various clinical attributes such as gender, age, and renal function. From mechanistic perspective, the remodeling process of LVH can trigger increment in certain biomarkers, notably sST2 and NT-proBNP. This multicenter, retrospective study aimed to construct an LVH risk assessment model and identify the risk factors. A total of 417 patients with essential hypertension (EH), including 214 males and 203 females aged 31-80 years, were enrolled in this study; of these, 161 (38.6%) were diagnosed with LVH. Based on variables demonstrating significant disparities between the LVH and Non-LVH groups, three multivariate stepwise logistic regression models were constructed for risk assessment: the "Clinical characteristics" model, the "Biomarkers" model (each based on their respective variables), and the "Clinical characteristics + Biomarkers" model, which amalgamated both sets of variables. The results revealed that the "Clinical characteristics + Biomarkers" model surpassed the baseline models in performance (AUC values of the "Clinical characteristics + Biomarkers" model, the "Biomarkers" model, and the "Clinical characteristics" model were .83, .75, and .74, respectively; P < .0001 for both comparisons). The optimized model suggested that being female (OR: 4.26, P <.001), being overweight (OR: 1.88, p = .02) or obese (OR: 2.36, p = .02), duration of hypertension (OR: 1.04, P = .04), grade III hypertension (OR: 2.12, P < .001), and sST2 (log-transformed, OR: 1.14, P < .001) were risk factors, while eGFR acted as a protective factor (OR: .98, P = .01). These findings suggest that the integration of clinical characteristics and biomarkers can enhance the performance of LVH risk assessment.

Occurrence, source apportionment, and carcinogenic risk assessment of polycyclic aromatic hydrocarbons in urban road dusts in Shanghai.

Polycyclic aromatic hydrocarbons (PAHs), as a class of important environmental pollutants, have received considerable concern due to their widespread existence and biological toxicity. The main purpose of this study was to determine concentrations, spatial distribution, possible sources, and potential health risk of PAHs in urban road dust in Shanghai, China. The concentration of Σ26PAHs ranged from 53.0 to 28,700 ng g-1 in road dust samples from Shanghai, which is at the low to medium level compared with other areas around the world. PAHs with 4-5 rings were predominant components in road dust. The level of PAHs in road dust was significantly higher than those in soil and river sediment in Shanghai. Six possible sources of PAHs were apportioned by PMF model. The contribution of pyrogenic PAHs accounted for 91.3% of the total PAHs in road dusts. The motor vehicular emission, natural gas, and coal combustion were main sources for urban road dust PAHs from Shanghai. Four dibenzopyrene (DBP) isomers were contributed averagely 75% of total TEQBaP concentration. DBalP, BaP, DBaiP, BbF, and DBA were main contributors to total carcinogenic potency, which totally contributed from 69.6 to 91.8% (median 89.1%) to total TEQBaP in urban road dusts of Shanghai. The results of incremental lifetime carcinogenic risk (ILCR) assessment showed that the total risk values exposed to 24 PAHs in road dust were lower than 10-4 at all sampling sites, indicating that exposure to dust-bound PAHs at present level was unlikely to result in high carcinogenic risk for both children and adults in Shanghai.

[Source and Health Risk Assessment of PM2.5-Bound Metallic Elements in Road Dust in Zibo City].

To study the pollution characteristics, sources, and ecological and health risk of PM2.5-bound metallic elements in road dust in Zibo City, a total of 97 dust samples were collected in eight districts between October 2016 and May 2017, and particles smaller than 2.5 µm were suspended filtered using a resuspension system. Inductively coupled plasma mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES) were used to investigate 18 metal elements within the dust samples. The results showed that the mass fraction of Ca[ω(Ca)] was highest with an average of 120307.7 mg·kg-1, which was 7.2 times higher than the soil background values for Shandong Province. The mean values of ω(Zn), ω(Cu), ω(Sb), and ω(Cd) were 13.9, 11.7, 13.3, and 29.6 times higher than the background values, respectively. The geo-accumulation index (Igeo) indicated high levels of Cd, Zn, Cu, and Sb pollution, especially in winter. Enrichment factors (EFs) also indicated high concentrations of Cd, Zn, Sb, and Cu in the road dust, which were notably affected by human activities. Principal component analysis (PCA) showed that biomass combustion, coal burning, vehicle emissions, iron and steel smelting, and soil dust are the five main sources of metal elements in road dust in Zibo City. The potential ecological risk of Cd and the total potential risk were extremely high during three seasons and was highest in winter. Health risk assessment showed that As and Pb had a non-carcinogenic risk for children, while Cr presents a carcinogenic risk. In conclusion, pollution from PM2.5-bound metallic elements in road dust in Zibo City is derived from anthropogenic sources and is most severe during winter. Importantly, the levels of pollution detected represent potential ecological risk as well as some non-carcinogenic and carcinogenic risks for children. Therefore, the source control of road dust requires particular attention.

A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China.

INTRODUCTION: There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China. METHODS: This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate, and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs, and utility values were estimated from official reports, published literature, and analysis of the patient-level insurance data in China. To assess the impact of parameters' uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters, and probabilistic sensitivity analysis (PSA) was conducted using the Monte Carlo simulation. RESULTS: The therapy of clopidogrel plus ASA is a cost-effective option in comparison with ASA alone for the treatment of NSTEACS in China, leading to 0.0548 life years (LYs) and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus ASA is associated with an incremental cost of 43,340 China Yuan (CNY) per QALY gained and 41,030 CNY per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 CYN per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold. CONCLUSION: This analysis suggests that treatment with clopidogrel plus ASA for up to 1 year for patients with NSTEACS is cost effective in the local context of China from a public payers' perspective. FUNDING: Sanofi China.

Assessment of radiofrequency ablation margin by MRI-MRI image fusion in hepatocellular carcinoma.

AIM: To investigate the feasibility and clinical value of magnetic resonance imaging (MRI)-MRI image fusion in assessing the ablative margin (AM) for hepatocellular carcinoma (HCC). METHODS: A newly developed ultrasound workstation for MRI-MRI image fusion was used to evaluate the AM of 62 tumors in 52 HCC patients after radiofrequency ablation (RFA). The lesions were divided into two groups: group A, in which the tumor was completely ablated and 5 mm AM was achieved (n = 32); and group B, in which the tumor was completely ablated but 5 mm AM was not achieved (n = 29). To detect local tumor progression (LTP), all patients were followed every two months by contrast-enhanced ultrasound, contrast-enhanced MRI or computed tomography (CT) in the first year after RFA. Then, the follow-up interval was prolonged to every three months after the first year. RESULTS: Of the 62 tumors, MRI-MRI image fusion was successful in 61 (98.4%); the remaining case had significant deformation of the liver and massive ascites after RFA. The time required for creating image fusion and AM evaluation was 15.5 ± 5.5 min (range: 8-22 min) and 9.6 ± 3.2 min (range: 6-14 min), respectively. The follow-up period ranged from 1-23 mo (14.2 ± 5.4 mo). In group A, no LTP was detected in 32 lesions, whereas in group B, LTP was detected in 4 of 29 tumors, which occurred at 2, 7, 9, and 15 mo after RFA. The frequency of LTP in group B (13.8%; 4/29) was significantly higher than that in group A (0/32, P = 0.046). All of the LTPs occurred in the area in which the 5 mm AM was not achieved. CONCLUSION: The MRI-MRI image fusion using an ultrasound workstation is feasible and useful for evaluating the AM after RFA for HCC.

[Inorganic N deposition in the Bayinbuluk alpine grassland of the central Tianshan mountains].

N deposition has increased significantly with economic development and intensive human activities in China and has affected natural ecosystems in remote areas. To evaluate the atmospheric N deposition of the Bayinbuluk alpine grassland of the central Tianshan Mountains, the dry and wet N depositions were monitored from May 2010 to December 2011. Fluxes of HNO3, NH3, NO2, particulate ammonium and nitrate (pNH4+ and pNO3-) averaged at 1.47, 0.68, 0.13, 0.23 and 0.25 kg N x hm(-2) x a(-1), respectively. Wet depositions of NH(4+)-N and NO(3-)-N were 2.47 and 1.59 kg N x hm(-2) x a(-1), respectively. Total atmospheric inorganic N deposition fluxes averaged at 6.82 kg N x hm(-2) x a(-1), and the wet and dry depositions were 4.06 and 2.76 kg N x hm(-2) x a(-1), respectively. Nitrogen deposition fluxes showed a significant seasonal change, with 72.1% of dry N deposition occurring in spring and summer, and 78.3% of wet N deposition concentrating in summer and autumn.

Costs of screening children for hearing disorders and delivery of hearing aids in China.

BACKGROUND: The burden of disease of hearing disorders among children is high, but a large part goes undetected. School-based screening programs in combination with the delivery of hearing aids can alleviate this situation, but the costs of such programs are unknown. AIM: To evaluate the costs of a school-based screening program for hearing disorders, among approximately 216,000 school children, and the delivery of hearing aids to 206 children at three different care levels in China. METHODS: In a prospective study design, screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire, administered to the parents of the child. Data were collected at three study sites representing primary, secondary and tertiary care levels. RESULTS: Total screening and hearing aid delivery costs ranged between RMB70,000 (US$9,000) and RMB133,000 (US$17,000) in the three study sites. Health care cost per child fitted ranged from RMB5,900 (US$760) at the primary care level, RMB7,200 (US$940) at the secondary care level, to RMB8,600 (US$1,120) at the tertiary care level. Household costs were only a small fraction of the overall costs. Cost per child fitted ranged between RMB1,608 and RMB2,812 (US$209-US$365), depending on perspective of analysis and study site. The program was always least costly in the primary care setting. CONCLUSION: Hearing screening and the delivery of hearing aids in China is least costly in a primary care setting. Important questions remain concerning its implementation.