Universal screening and treatment towards the elimination of chronic hepatitis C in China: an economic evaluation.

OBJECTIVES: China has the largest number of hepatitis C virus (HCV) infection in the world, but current levels of diagnosis and treatment are low. The objective of this study was to assess the cost-effectiveness of various universal HCV screening and treatment strategies in China and inform decisions on health policy. STUDY DESIGN: A cost-effectiveness analytical study. METHODS: We developed a Markov model to investigate cost-effectiveness of different HCV screening and treatment strategies in China. We simulated several screening scenarios for Chinese people aged 18-70 years. We estimated incremental cost-effectiveness ratios (ICERs) of different intervention scenarios compared with status quo. RESULTS: Expanded HCV screening and treatment strategy with prioritisation for high-risk groups (Scenario S5) was the most cost-effective strategy (ICER: USD $11,667.71/quality-adjusted life-year [QALY] gained), which resulted in great reduction in HCV-related diseases and deaths, with a 67.11% reduction in cases of chronic HCV. Universal HCV screening and treatment implementation remains a cost-effective strategy when delayed until 2025 (ICER: USD $17,093.69/QALY), yet the delayed strategy is less effective in reducing HCV-related deaths. CONCLUSIONS: Expanded HCV screening and treatment strategy with prioritisation for high-risk groups is the most cost-effective strategy and has lead to a significant reduction in both HCV morbidity and mortality in China, which would essentially eliminate HCV as a public threat.

A postpartum functional assessment tool for women based on the international classification of functioning, disability and health.

BACKGROUND: Postpartum dysfunctions and complications can occur in women. However, functional assessment should be conducted to make treatment plans before any intervention is implemented. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for women postpartum to document functional data and set rehabilitation goals. The purpose of this study was to determine the corresponding domains that should be considered in the evaluation of women's postpartum functioning based on the International Classification of Functioning, Disability and Health (ICF) model using the Delphi method. METHODS: Fifteen domestic experts were invited to conduct two rounds of expert consensus survey on the ICF-based postpartum functional assessment category pool obtained through literature retrieval, clinical investigation, and reference to relevant literature. The sample was medical staff with professional knowledge of women's health. The opinions of experts were summarized, and the positive coefficient, authority coefficient and coordination degree of experts were calculated. RESULTS: A total of 15 domestic experts participated in this expert consensus. Through two rounds of a questionnaire survey, 69 items were finally selected to form the ICF-based postpartum functional assessment tool for women. The items included 32 items of body function, 12 items of body structure, 17 items of activity and participation, and 8 items of environmental factors. In addition, we identified 8 items of personal factors. The expert positive coefficients of the two rounds of expert consensus were both 100%, the authority coefficient was 0.789, and the coefficient of variation was between 0.09 to 0.31. CONCLUSION: A postpartum functional assessment tool for women based on the ICF model was constructed based on the Delphi method, which can provide more comprehensive health management and life intervention for postpartum women. TRIAL REGISTRATION: The Registration number of the Chinese Clinical Trial Registry is ChiCTR2200066163, 25/11/2022.

Disease Burden and Epidemiological Trends of Chronic Kidney Disease at the Global, Regional, National Levels from 1990 to 2019.

BACKGROUND: Chronic kidney disease (CKD) is a serious public health issue worldwide, but the disease burden of CKD caused by different etiologies and changing trends has not been fully examined. METHODS: We collected data from Global Burden of Disease Study 2019 (GBD 2019), including incident cases, age-standardized incidence rate (ASIR), disability-adjusted life years (DALYs), and age-standardized DALY rate between 1990 and 2019 by region, etiology, age, and sex, and calculated the estimated annual percentage change (EAPC) of the rate to evaluate the epidemiological trends. RESULTS: Globally, incident cases of CKD increased from 7.80 million in 1990 to 18.99 million in 2019, and DALYs increased from 21.50 million to 41.54 million. ASIR increased with an EAPC of 0.69 (95% uncertainty interval [UI] 0.49-0.89) and reached 233.65 per 100,000 in 2019, while the age-standardized DALY rate increased with an EAPC of 0.30 (95% UI 0.17-0.43) and reached 514.86 per 100,000. North Africa and the Middle East, central Latin America, and North America had the highest ASIR in 2019. Central Latin America had the highest age-standardized DALY rate, meanwhile. Almost all countries experienced an increase in ASIR, and over 50% of countries had an increasing trend in age-standardized DALY rate from 1990 to 2019. CKD due to diabetes mellitus type 2 and hypertension accounted for the largest disease burden with 85% incident cases and 66% DALYs in 2019 of known causes, with the highest growth in age-standardized DALY rate and a similar geographic pattern to that of total CKD. Besides, the highest incidence rate of total and four specific CKDs were identified in people aged 70 plus years, who also had the highest DALY rate with a stable trend after 2010. Females had a higher ASIR, while males had a higher age-standardized DALY rate, the gap of which was most distinctive in CKD due to hypertension. CONCLUSION: The disease burden of CKD remains substantial and continues to grow globally. From 1990 to 2019, global incident cases of CKD have more than doubled and DALYs have almost doubled, and surpassed 40 million years. CKD due to diabetes mellitus type 2 and hypertension contributed nearly 2/3 of DALYs in 2019 of known causes, and had witnessed the highest growth in age-standardized DALY rate. Etiology-specific prevention strategies should be placed as a high priority on the goal of precise control of CKD.

How does equity restriction affect innovation quality? Evidence from listed manufacturing companies in China.

Improving the innovation quality of manufacturing companies has currently received increasing attention in the transformation from "Made in China" to "Created in China". Equity restriction is now one of the most talked about issues in China's corporate governance structures, but we have a limited understanding of the impact of equity restriction on innovation quality. This paper empirically analyzes the relationship and intrinsic mechanism between equity restriction and innovation quality using all A-share listed manufacturing companies in China from 2007 to 2021 as the research sample. First, the Tobit regression model is used to analyze the impact of equity restriction on innovation quality, and the Heckman two-stage model is used for the endogenous test. Then, the three-step regression model with mediating effects is used to validate the intrinsic mechanism of equity restriction to promote innovation quality from two paths, namely equity incentives and R&D investment. The research results show that equity restriction has a significant positive impact on innovation quality; equity incentives and R&D investment play a mediating role between equity restriction and innovation quality. This paper enriches the research on the influencing factors of innovation quality and provides a theoretical basis based on equity restriction for the transformation of manufacturing towards high-quality innovation, and explores the intrinsic mechanisms by which equity restriction affects innovation quality.

An Exploratory Study on a New Method for Nutritional Status Assessment in Patients with Chronic Kidney Disease.

Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, p < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.

Eye gaze metrics for skill assessment and feedback in kidney stone surgery.

PURPOSE: Surgical skill assessment is essential for safe operations. In endoscopic kidney stone surgery, surgeons must perform a highly skill-dependent mental mapping from the pre-operative scan to the intraoperative endoscope image. Poor mental mapping can lead to incomplete exploration of the kidney and high reoperation rates. Yet there are few objective ways to evaluate competency. We propose to use unobtrusive eye-gaze measurements in the task space to evaluate skill and provide feedback. METHODS: We capture the surgeons' eye gaze on the surgical monitor with the Microsoft Hololens 2. To enable stable and accurate gaze detection, we develop a calibration algorithm to refine the eye tracking of the Hololens. In addition, we use a QR code to locate the eye gaze on the surgical monitor. We then run a user study with three expert and three novice surgeons. Each surgeon is tasked to locate three needles representing kidney stones in three different kidney phantoms. RESULTS: We find that experts have more focused gaze patterns. They complete the task faster, have smaller total gaze area, and the gaze fewer times outside the area of interest. While fixation to non-fixation ratio did not show significant difference in our findings, tracking the ratio over time shows different patterns between novices and experts. CONCLUSION: We show that a non-negligible difference holds between novice and expert surgeons' gaze metrics in kidney stone identification in phantoms. Expert surgeons demonstrate more targeted gaze throughout a trial, indicating their higher level of proficiency. To improve the skill acquisition process for novice surgeons, we suggest providing sub-task specific feedback. This approach presents an objective and non-invasive method to assess surgical competence.

Prognostic Value of Tumor Multifocality in Pediatric Papillary Thyroid Carcinoma: A Real-Life Multicentric Study.

OBJECTIVE: To investigate the association of multifocality with clinical outcomes in pediatric papillary thyroid cancer. STUDY DESIGN: Multicenter retrospective study of prospectively collected data. SETTING: Tertiary referral center. METHODS: This study included patients 18 years or younger who underwent total thyroidectomy and radioiodine ablation for papillary thyroid carcinoma (PTC) between 2005 and 2020 at 3 tertiary adult and pediatric hospitals in China. For disease-free survival (DFS), events were defined as persistent and/or recurrent diseases. The primary outcome was the association of tumor multifocality and DFS, assessed using Cox proportional hazards regression models. RESULTS: One hundred and seventy-three patients (median age 16 years [range, 5-18 years]) were recruited. Multifocal diseases were seen in 59 patients (34.1%). After a median follow-up of 57 (range, 12-193 months) months, 63 (36.4%) patients had persistent diseases. There was a significant association between tumor multifocality and decreased DFS on univariable analysis (hazard ratio [HR] = 1.90, p = .01), yet it was nonsignificant after multivariate adjustment (HR = 1.20, p = .55). In a subgroup analysis of 132 pediatric patients with clinically M0 PTC, neither unadjusted HR (2.21, p = .06) nor adjusted HR (1.70, p = .27) of multifocal PTC was significantly higher in comparison to unifocal PTC. CONCLUSION: In this highly selective surgical pediatric patient cohort with PTC, tumor multifocality was not an independent risk factor for decreased DFS.

What role does digital finance play in low-carbon development? Evidence from five major urban agglomerations in China.

In the epoch of the digital economy, digital finance (DF) has become an indispensable engine driving the high-quality development of the Chinese economy. The issues of how DF can be used to alleviate environmental pressure and how a long-term governance mechanism for carbon emissions reduction be formed have become particularly important. Based on the panel data of five national urban agglomerations in China from 2011 to 2020, this study utilizes the panel double fixed-effects model and chain mediation model to verify the impact mechanism of DF on carbon emissions efficiency (CEE). Some valuable findings are drawn below. First, the overall CEE of the urban agglomerations has potential for improvement, and the CEE and DF development level of each urban agglomeration have regional heterogeneity. Second, a U-shaped correlation is observed between DF and CEE. Technological innovation and industrial structure upgrading have a chain mediating effect in DF affecting CEE. In addition, the breadth and depth of DF have a notable negative impact on CEE, and the digitalization degree of DF shows a significant positive correlation with CEE. Third, the influencing factors of CEE have regional heterogeneity. Finally, this study provides relevant suggestions based on the empirical conclusions and analysis.

Modifying the Power and Performance of 2-Dimensional MoS2 Field Effect Transistors.

Over the past 60 years, the semiconductor industry has been the core driver for the development of information technology, contributing to the birth of integrated circuits, Internet, artificial intelligence, and Internet of Things. Semiconductor technology has been evolving in structure and material with co-optimization of performance-power-area-cost until the state-of-the-art sub-5-nm node. Two-dimensional (2D) semiconductors are recognized by the industry and academia as a hopeful solution to break through the quantum confinement for the future technology nodes. In the recent 10 years, the key issues on 2D semiconductors regarding material, processing, and integration have been overcome in sequence, making 2D semiconductors already on the verge of application. In this paper, the evolution of transistors is reviewed by outlining the potential of 2D semiconductors as a technological option beyond the scaled metal oxide semiconductor field-effect transistors. We mainly focus on the optimization strategies of mobility (µ), equivalent oxide thickness (EOT), and contact resistance (RC ), which enables high ON current (Ion ) with reduced driving voltage (Vdd ). Finally, we prospect the semiconductor technology roadmap by summarizing the technological development of 2D semiconductors over the past decade.

Label-Free Sensing of Cell Viability Using a Low-Cost Impedance Cytometry Device.

Cell viability is an essential physiological status for drug screening. While cell staining is a conventional cell viability analysis method, dye staining is usually cytotoxic. Alternatively, impedance cytometry provides a straightforward and label-free sensing approach for the assessment of cell viability. A key element of impedance cytometry is its sensing electrodes. Most state-of-the-art electrodes are made of expensive metals, microfabricated by lithography, with a typical size of ten microns. In this work, we proposed a low-cost microfluidic impedance cytometry device with 100-micron wide indium tin oxide (ITO) electrodes to achieve a comparable performance to the 10-micron wide Au electrodes. The effectiveness was experimentally verified as 7 µm beads can be distinguished from 10 µm beads. To the best of our knowledge, this is the lowest geometry ratio of the target to the sensing unit in the impedance cytometry technology. Furthermore, a cell viability test was performed on MCF-7 cells. The proposed double differential impedance cytometry device has successfully differentiated the living and dead MCF-7 cells with a throughput of ~1000 cells/s. The label-free and low-cost, high-throughput impedance cytometry could benefit drug screening, fundamental biological research and other biomedical applications.

Spatially explicit carbon emissions by remote sensing and social sensing.

Scientific simulation of carbon emissions is an important prerequisite for achieving low-carbon green development and carbon peak and carbon neutralization. This study proposed a carbon emissions spatialization method based on nighttime light (NTL) remote sensing and municipal electricity social sensing. First, the economics-energy comprehensive index (EECI) was proposed by integrating the NTL and municipal electricity consumption (EC) data. Second, the carbon emissions were spatialized at a fine scale based on NTL, EC, and EECI, respectively. Finally, the geographical detector model was applied to quantify the influencing factors on carbon emissions from the perspectives of individuals and interactions. Results show that combining remote sensing and social sensing data helps depict carbon emissions accurately. The factor analysis found that GDP and population were the basis of carbon emissions, while the secondary industry and urbanization rate were the direct factors. This study is expected to provide constructive suggestions and methods for emission reduction, carbon peak, and carbon neutrality in high-density cities in China.

State transition of carbon emission efficiency in China: empirical analysis based on three-stage SBM and Markov chain models.

Assessing China's carbon emission efficiency (CEE) and analyzing efficiency state transition trends are necessary to accelerate the promotion of carbon emission reduction and achieve low carbon goals. This study evaluates China's economic and social environments by using the entropy weight method. The CEE of 30 Chinese provinces from 2006 to 2020 is measured using the three-stage slack-based model with an undesirable output. Then, this study introduces a Markov chain to explore the state transition trend of China's CEE. The research conclusions are as follows. First, compared with the social environment, the economic environment has a more significant impact on CEE. Second, the CEE of the eastern region is the highest, followed by that of the central region and the western region, which has the worst CEE. Third, the inefficiency of the central and western regions pulls down the overall CEE of China. Fourth, the state of China's CEE is gradually shifting to a high level; however, achieving a leapfrog shift is difficult.

Dose-effect relationship of different acupuncture courses on chronic insomnia disorder: study protocol for a randomized controlled trial.

Background: Chronic insomnia disorder (CID) is increasing in prevalence year by year, is long lasting, and potentially risky. Acupuncture has been widely used in the clinical management of this condition. However, there is still a lack of direct evidence on the dose-effect relationship between different acupuncture courses and clinical efficacy. To identify this relationship, we will design a randomized controlled trial to clarify the difference in efficacy of different acupuncture courses for CID. Methods and design: This is a prospective, parallel, single center randomized controlled trial. Two hundred and one participants with CID will be randomly divided into three groups (Group A, Group B, and Group C). The three groups will be given acupuncture therapy for 4, 6, and 8 weeks, three sessions per week, with at least 1 day between sessions. Follow-up will continue until the third month after the end of treatment. The primary outcome is the Insomnia Severity Index (ISI), and secondary outcomes include percentage of ISI < 8 points, the Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Fatigue Severity Scale (FSS), medication use, and safety. Discussion: This study is expected to provide direct evidence for the optimal treatment cycle of acupuncture for CID, as well as to facilitate health economic evaluation. Clinical trial registration: https://clinicaltrials.gov/, identifier [ChiCTR2300073711].

Green and Low-Cost Natural Lignocellulosic Biomass-Based Carbon Fibers-Processing, Properties, and Applications in Sports Equipment: A Review.

At present, high-performance carbon fibers (CFs) are mainly produced from petroleum-based materials. However, the high costs and environmental problems of the production process prompted the development of new precursors from natural biopolymers. This review focuses on the latest research on the conversion of natural lignocellulosic biomass into precursor fibers and CFs. The influence of the properties, advantages, separation, and extraction of lignin and cellulose (the most abundant natural biopolymers), as well as the spinning process on the final CF performance are detailed. Recent strategies to further improve the quality of such CFs are discussed. The importance and application of CFs in sports equipment manufacturing are briefly summarized. While the large-scale production of CFs from natural lignocellulosic biomass and their applications in sports equipment have not yet been realized, CFs still provide a promising market prospect as green and low-cost materials. Further research is needed to ensure the market entry of lignocellulosic biomass-based CFs.

Assessment of the Benefits of Targeted Interventions for Pandemic Control in China Based on Machine Learning Method and Web Service for COVID-19 Policy Simulation.

Taking the Chinese city of Xiamen as an example, simulation and quantitative analysis were performed on the transmissions of the Coronavirus Disease 2019 (COVID-19) and the influence of intervention combinations to assist policymakers in the preparation of targeted response measures. A machine learning model was built to estimate the effectiveness of interventions and simulate transmission in different scenarios. The comparison was conducted between simulated and real cases in Xiamen. A web interface with adjustable parameters, including choice of intervention measures, intervention weights, vaccination, and viral variants, was designed for users to run the simulation. The total case number was set as the outcome. The cumulative number was 4,614,641 without restrictions and 78 under the strictest intervention set. Simulation with the parameters closest to the real situation of the Xiamen outbreak was performed to verify the accuracy and reliability of the model. The simulation model generated a duration of 52 days before the daily cases dropped to zero and the final cumulative case number of 200, which were 25 more days and 36 fewer cases than the real situation, respectively. Targeted interventions could benefit the prevention and control of COVID-19 outbreak while safeguarding public health and mitigating impacts on people's livelihood.

Identification of Homozygous Regions With Adverse Effects on the Five Economic Traits of Duroc Pigs.

Runs of homozygosity (ROH) are widely used to estimate genomic inbreeding, which is linked to inbreeding depression on phenotypes. However, the adverse effects of specific homozygous regions on phenotypic characteristics are rarely studied in livestock. In this study, the 50 K SNP data of 3,770 S21 Duroc (American origin) and 2,096 S22 Duroc (Canadian origin) pigs were used to investigate the harmful ROH regions on five economic traits. The results showed that the two Duroc lines had different numbers and distributions of unfavorable ROHs, which may be related to the different selection directions and intensities between the two lines. A total of 114 and 58 ROH segments were found with significant adverse effects on the economic traits of S21 and S22 pigs, respectively. Serval pleiotropic ROHs were detected to reduce two or multiple phenotypic performances in two Duroc populations. Candidate genes in these shared regions were mainly related to growth, fertility, immunity, and fat deposition. We also observed that some ROH genotypes may cause opposite effects on different traits. This study not only enhances our understanding of the adverse effects of ROH on phenotypes, but also indicates that ROH information could be incorporated into breeding programs to estimate and control the detrimental effects of homozygous regions.

Global burden and trends of neglected tropical diseases from 1990 to 2019.

BACKGROUND: An updated analysis of neglected tropical diseases (NTDs) from a global perspective is missing from the literature. We aimed to assess the global burden and trends of NTDs from 1990 to 2019. METHODS: Yearly incident case, mortality and disability-adjusted life years (DALYs) data for NTDs were extracted from the Global Burden of Disease Study 2019 (GBD 2019) based on global, regional, country, social development index (SDI), age and sex categories. The age-standardized rate (ASR) and number of incident cases, mortality and DALYs were computed from 1990 to 2019. The estimated annual percentage change (EAPC) in the ASR was calculated to quantify the changing trend. RESULTS: Globally, the age-standardized incidence rate (ASIR) and the number of incident cases of total NTDs increased between 1990 and 2019, whereas the age-standardized mortality rate (ASMR), mortality, age-standardized DALY rate and DALYs of total NTDs decreased. Although tropical Latin America, South Asia, Southeast Asia and Oceania had the highest ASIR for total NTDs in 2019, tropical Latin America was the only region to experience a decreasing trend in ASIR from 1673.5 per 100 000 in 2010 to 1059.2 per 100 000 in 2019. The middle, high-middle and high SDI regions experienced increasing ASIR trends between 1990 and 2019, whereas the low-middle SDI region remained stable, and the low SDI region presented a decreasing trend. Children and older adults were vulnerable to dengue, rabies and leishmaniasis (cutaneous and mucocutaneous). Females had a higher ASIR but a lower ASMR and age-standardized DALY rate than males. CONCLUSIONS: NTDs still represent a serious problem for public health, and the increasing ASIR and incident cases globally may require more targeted strategies for prevention, control and surveillance, especially among specific populations and endemic areas.

How does the ecological compensation mechanism adjust the industrial structure? Evidence from China.

The ecological compensation (EC) mechanism is an innovative institutional arrangement which can effectively realize the coordinated development of social-economic growth and ecological protection. The current research on the evaluation of the implementation effect of EC mechanism mainly focuses on its environmental performance, how the EC mechanism guides the economically underdeveloped areas in the upper reaches of the basin to embark on the road of high-quality economic development, especially the mechanism of how EC triggers the optimization and upgrading of industrial structure, it is a topic worthy of in-depth discussion. This study takes China's first cross-provincial horizontal EC mechanism pilot (Xin'an River Basin EC) as the research object and regards it as a quasi-natural experiment. This paper selects the annual panel data of the 11 cities involved from 2009 to 2019 and builds a DID model to study the mechanism of EC affecting industrial structure adjustment systematically. The results show that the EC mechanism mainly promotes the adjustment of the industrial structure in the pilot area through two paths, this is achieved by triggering the transfer of backward or highly polluting industries and promoting the upgrading of the industrial structure. At the same time, technological innovation plays a part intermediary role in the impact of EC to promote the upgrading of industrial structure. Further analysis found that the larger the funds of compensation input, the higher the assessment intensity, the better the effects are. Finally, this study puts forward relevant policy recommendations to further release the potential of the horizontal EC for the reference of decision-makers.

Global burden and trends of sexually transmitted infections from 1990 to 2019: an observational trend study.

BACKGROUND: Sexually transmitted infections (STIs) are a major public health issue worldwide, but there is a paucity of literature on their burden and trends globally. We aimed to assess the global disease burden and trends of STIs from 1990 to 2019. METHODS: In this observational trend study, we collected data on incident cases, age-standardised incidence rate, and disability-adjusted life-years (DALYs), and calculated age-standardised DALY rates, for five STIs (syphilis, chlamydia, gonorrhoea, trichomonas, and genital herpes) between 1990 and 2019, by sex, geographical region, and cause using data exclusively from the Global Burden of Disease study 2019. The estimated annual percentage changes in the age-standardised incidence rate and age-standardised DALY rate were calculated to quantify the changing trend. FINDINGS: Globally, the age-standardised incidence rate of STIs showed a decreasing trend with an estimated annual percentage change of -0·04 (95% uncertainty interval [UI] -0·08 to 0·00) from 1990 to 2019, reaching 9535·71 per 100 000 person-years (8169·73 to 11 054·76) in 2019. The age-standardised DALY rate showed a decreasing trend with an estimated annual percentage change of -0·92 (-1·01 to -0·84) and reached 22·74 per 100 000 person-years (14·37 to 37·11) in 2019. The sub-Saharan African region had the highest age-standardised incidence rate (19 973·12 per 100 000 person-years, 17 382·69 to 23 001·57) and age-standardised DALY rate (389·32 per 100 000 person-years, 154·27 to 769·74). Adolescents had the highest incidence rate (18 377·82 per 100 000 person-years, 14 040·38 to 23 443·31) and showed stable total STI trends, except for an upward trend of syphilis between 2010 (347·65 per 100 000 person-years, 203·58 to 590·69) and 2019 (423·16 per 100 000 person-years, 235·70 to 659·01). Male individuals had a higher age-standardised incidence rate (10 471·63 per 100 000 person-years, 8892·20 to 12 176·10) than female individuals (8602·40 per 100 000 person-years, 7358·00 to 10001·18), whereas female individuals had a higher age-standardised DALY rate (33·31 per 100 000 person-years, 21·05 to 55·25) than male individuals (12·11 per 100 000 person-years, 7·63 to 18·93). INTERPRETATION: Although most countries showed a decrease in age-standardised rates of incidence and DALYs for STIs, the absolute incident cases and DALYs increased from 1990 to 2019. Therefore, STIs still represent a global public health challenge, especially in sub-Saharan Africa and Latin America, which warrants more attention and health prevention service. FUNDING: Mega-Project of National Science and Technology for the 13th Five-Year Plan of China and the National Natural Science Foundation of China.

Assessment of fetal cardiac diastolic function of gestational diabetes mellitus using dual-gate Doppler.

ABSTRACT: Gestational Diabetes Mellitus (GDM), as a common complication of pregnancy, has an increasing trend globally. GDM leads to maternal complications and fetal complications. Fetal cardiac diastolic dysfunction is strongly associated with GDM. This study aims to assess the ventricular diastolic function of fetuses exposed to GDM by looking into the diagnostic parameters using both conventional method and Dual-gate Doppler method (DD). And to investigate the potential of DD method in early detection of fetal cardiac diastolic dysfunction.56 women diagnosed with GDM and 55 non-GDM pregnant women were enrolled in their 24 to 30 weeks of gestation. Conventional method and DD method were applied to measure mitral and tricuspid inflow velocities E-waves, A-waves on pulsed-wave Doppler, and mitral and tricuspid annular velocities e'-waves, a'-waves on Tissue Doppler imaging. E/A, e'/a' and E/e' ratio was calculated. The difference between GDM and control groups was statistically tested and analysed using one-sample Kolmogorov-Smirnov test, Student t test, Mann-Whitney U test and Kruskal-Wallis test and Bland-Altman plot analysis.Intraobserver intraclass correlation coefficients of E/A, e'/a', and E/e' value of both mitral and tricuspid valve are all greater than 0.80, while interobserver intraclass correlation coefficients are between 0.71 and 0.88. Right (6.35 vs 6.79; P = .001) ventricular function showed significantly lower E/e' ratios in the GDM group compared with control fetuses by conventional method. Both left (6.16 vs 6.59; P = .036) and right (6.28 vs 6.75; P = .01) ventricular function showed significantly lower E/e' ratios in the GDM group compared with control fetuses by DD method.Exposure to high level of maternal blood glucose leads to impaired diastolic function in the fetuses. Fetal right ventricular function is a potential key point to study to enable an early detection for fetal diastolic dysfunction since the alteration and damage are more likely to happen in right ventricular. Measurement of E/e' ratio using DD method is considered as a promising method in fetal cardiac diastolic function assessment. Well or poorly control of the GDM does not have significant influence on the fetal diastolic function thus an early detection of GDM and GDM induced fetal cardiac dysfunction is necessary.