Assessment of PD-L1 Expression in Non-Small Cell Lung Cancers Using [68Ga]Ga-DOTA-WL12 PET/CT.

Assessing programmed death ligand-1 (PD-L1) expression in non-small cell lung cancer (NSCLC), particularly in metastatic cases, remains challenging. In this study, surface plasmon resonance (SPR) analysis and [68Ga]Ga-DOTA-WL12 micro-PET/CT imaging are performed. [68Ga]Ga-DOTA-WL12 PET/CT and [18F]FDG PET/CT are performed on a cohort of 20 patients with NSCLC. Semi-quantitative assessments include SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and target-to-background ratio (TBR). DOTA-WL12 exhibits robust PD-L1 binding with a KD value of 0.2 nM. Subsequent human studies reveal significant correlations between PD-L1 expression and the [68Ga]Ga-DOTA-WL12 SUVmax in primary and metastatic lesions, surpassing the [18F]FDG results (r = 0.8889, p <0.0001 vs r = 0.0469, p = 0.8127). Notably, [68Ga]Ga-DOTA-WL12 imaging discerned SUVmax and TBR differences between PD-L1 TPS ≤1% and PD-L1 TPS > 1% groups (p all <0.001). In an NSCLC patient with brain metastases, [68Ga]Ga-DOTA-WL12 shows a SUVmean of 0.04 in the brain background, with TBR values of 17 and 23, underscoring its potential for detecting brain metastases. The study provides initial evidence for the clinical utility of [68Ga]Ga-DOTA-WL12 PET/CT for lesion detection, immunotherapy selection, and therapeutic efficacy evaluation in PD-L1-expressing NSCLC, demonstrating its potential as a valuable tool in NSCLC research and management.

Noninvasive Assessment of Tumor Histological Grade in Invasive Breast Carcinoma Based on Ultrasound Radiomics and Clinical Characteristics: A Multicenter Study.

Rationale and Objectives: We aimed to develop and validate prediction models for histological grade of invasive breast carcinoma (BC) based on ultrasound radiomics features and clinical characteristics. Materials and Methods: A number of 383 patients with invasive BC were retrospectively enrolled and divided into a training set (207 patients), internal validation set (90 patients), and external validation set (86 patients). Ultrasound radiomics features were extracted from all the eligible patients. The Boruta method was used to identify the most useful features. Seven classifiers were adopted to developed prediction models. The output of the classifier with best performance was labeled as the radiomics score (Rad-score) and the classifier was selected as the Rad-score model. A combined model combining clinical factors and Rad-score was developed. The performance of the models was evaluated using receiver operating characteristic curve. Results: Seven radiomics features were selected from 788 candidate features. The logistic regression model performing best among the 7 classifiers in the internal and external validation sets was considered as Rad-score model, with areas under the receiver operating characteristic curve (AUC) values of 0.731 and 0.738. The tumor size was screened out as the risk factor and the combined model was developed, with AUC values of 0.721 and 0.737 in the internal and external validation sets. Furthermore, the 10-fold cross-validation demonstrated that the 2 models above were reliable and stable. Conclusion: The Rad-score model and combined model were able to predict histological grade of invasive BC, which may enable tailored therapeutic strategies for patients with BC in routine clinical use.

Spatiotemporal evolution and mechanisms of tourism efficiency and its decomposition: Evidence from 63 counties in Zhejiang, China.

Although efficiency analysis could reflect the state and quality of tourism's economic development, no research has been conducted investigating the spatiotemporal evolution and mechanisms of county-level tourism efficiency. We quantified tourism efficiency and its decomposition in 63 counties of Zhejiang, employing the bootstrap data envelopment analysis (DEA), hot spot analysis, and quantile regression to explore the spatiotemporal evolution and influencing factors of tourism efficiency, and examine its driving and constraining mechanisms. The results uncovered obvious upward trends in the tourism efficiency of Zhejiang's counties, with the mean value increasing from 0.285 to 0.688. Compared with scale efficiency, the influence of technological efficiency on the growth of comprehensive efficiency increased remarkably. Significant differences were evident in the spatial distributions of the identified hot and cold spots of comprehensive efficiency, which were respectively distributed in northern and southern Zhejiang. The distributions of decomposition efficiency were found to be spatially dependent. The driving mechanism of tourism efficiency involve two driving influences and two constraining influences, including economy and resource driving, market and traffic driving, industry and traffic constraining, and market and industry constraining. The findings of this study contribute to understanding of tourism efficiency growth in regional destinations and provide insights for strategic policymaking in various counties of Zhejiang.

Integrated assessment of the pollution and risk of heavy metals in soils near chemical industry parks along the middle Yangtze River.

Industrialization in riparian areas of critical rivers has caused significant environmental and health impacts. Taking eight industrial parks along the middle Yangtze River as examples, this study proposes a multiple-criteria approach to investigate soil heavy metal pollution and associated ecological and health risks posed by industrial activities. Aiming at seven heavy metals, the results show that nickel (Ni), cadmium (Cd), and copper (Cu) exhibited the most significant accumulation above background levels. The comprehensive findings from Pearson correlation analysis, cluster analysis, principal component analysis, and industrial investigation uncover the primary sources of Cd, arsenic (As), mercury (Hg), and lead (Pb) to be chemical processing, while Ni and chromium (Cr) are predominantly derived from mechanical and electrical equipment manufacturing. In contrast, Cu exhibits a broad range of origins across various industrial processes. Soil heavy metals can cause serious ecological and carcinogenic health risks, of which Cd and Hg contribute to >70 % of the total ecological risk, and As contributes over 80 % of the total health risk. This study highlights the importance of employing multiple mathematical and statistical models in determining and evaluating environmental hazards, and may aid in planning the environmental remediation engineering and optimizing the industry standards.

Human health risk assessment of volatile organic compounds in oil-based drill cuttings of shale gas.

Waste oil-based drill cuttings contain dioxins and volatile organic compounds (VOCs), which have the potential to cause serious health effects in humans. Therefore, this paper took oil-based drill cuttings (OBDCs) as the research object and carried out the testing of VOCs and dioxins content by using GC-MS and HRGCS-HRMS and comprehensively evaluated the content, composition and distribution pattern of VOCs and dioxins and the risk to human health posed by the two pollutants in OBDCs. The results showed that the VOCs did not exceed the emission limits in ESPPI (GB 31571-2015), but it is vital to recognise that 1,2-dichloropropane has the potential to cause cancer risk, with soil and groundwater risk control values of 662.95 mg·kg-1 and 0.066 mg·kg-1, respectively. Benzene, 1,2-dichloropropane and 8 other VOCs pose a non-carcinogenic risk to humans. The levels of polychlorinated dibenzofurans (PCDFs) exceeded those of polychlorinated dibenzo-p-dioxins (PCDDs), which accounted for 95.76 percent of the total PCDD/Fs, 2,3,4,7,8-P5CDF (56.00%), 2,3,7,8-T4CDF (9.20%), 1,2,3,6,7,8-H6CDF (8.80%) and 1,2,3,7,8-P5CDF (8.00%) were the main contributing monomers. The findings of the assessment on exposure risk indicate that there is a respiratory risk to oil-based drill cuttings dioxins for adults and children exceeded the World Health Organisation (WHO) acceptable daily intake (ADI) (1-4 pgTEQ/kg/d). Finally, three aspects of solid waste pre-treatment prior to incineration, the incineration process and post incineration were used to reduce the environmental and human health risks from dioxins.

Quantitative ultrasound image assessment of the optic nerve subarachnoid space during 90-day head-down tilt bed rest.

The elevation in the optic nerve sheath (ONS) pressure (ONSP) due to microgravity-induced headward fluid shift is the primary hypothesized contributor to SANS. This longitudinal study aims to quantify the axial plane of the optic nerve subarachnoid space area (ONSSA), which is filled with cerebrospinal fluid (CSF) and expands with elevated ONSP during and after head-down tilt (HDT) bed rest (BR). 36 healthy male volunteers (72 eyes) underwent a 90-day strict 6° HDT BR. Without obtaining the pre-HDT data, measurements were performed on days 30, 60, and 90 during HDT and at 6 recovery time points extended to 180-days (R + 180) in a supine position. Portable B-scan ultrasound was performed using the 12 MHz linear array probe binocularly. The measurements of the ONS and the calculation of the ONSSA were performed with ImageJ 1.51 analysis software by two experienced observers in a masked manner. Compared to R + 180, the ONSSA on HDT30, HDT60, and HDT90 exhibited a consistently significant distention of 0.44 mm2 (95% CI: 0.13 to 0.76 mm2, P = 0.001), 0.45 mm2 (95% CI: 0.15 to 0.75 mm2, P = 0.001), and 0.46 mm2 (95% CI: 0.15 to 0.76 mm2, P < 0.001), respectively, and recovered immediately after HDT on R + 2. Such small changes in the ONSSA were below the lateral resolution limit of ultrasound (0.4 mm) and may not be clinically relevant, possibly due to ONS hysteresis causing persistent ONS distension. Future research can explore advanced quantitative portable ultrasound-based techniques and establish comparisons containing the pre-HDT measurements to deepen our understanding of SANS.

The burden of vision loss due to cataract in China: findings from the Global Burden of Disease Study 2019.

OBJECTIVE: To provide a reference for future policy and measure formulation by conducting a detailed analysis of the burden of vision loss due to cataract by year, age, and gender in China from 1990 to 2019. METHODS: Data on the prevalence and disability-adjusted life-years (DALYs) due to cataract in China and neighboring and other G20 countries were extracted from the 2019 Global Burden of Disease (GBD) study to observe the changing trends of vision loss. RESULTS: The number and rate of all-age prevalence and DALYs for cataract in China increased significantly from 1990 to 2019. The age-standardized DALYs rate witnessed a slowly declining trend by 10.16%. And the age-standardized prevalence increased by 14.35% over the 30-year period. Higher prevalence and DALYs were observed in female population from 1990 through 2019, with little improvement over the decades(all p < 0.001). The disease burden of cataract is higher in middle-aged and elderly people. Blindness accounted for the largest proportion of vision impairment burden caused by cataract in China. The age-standardized prevalence and DALY rate of cataract in China were lower than those in India and Pakistan, but higher than those in Russia, South Korea, North Korea, Singapore, and Japan. CONCLUSIONS: In the past 30 years, although the age-standardized DALYs rate has decreased slightly in China, the all-age prevalence and DALYs have both increased. This study highlights the importance of reducing cataract burden by providing timely and easily accessible quality care, especially in females and the elderly population.

Job preferences of Chinese primary health care workers: A discrete choice experiment.

OBJECTIVE: Primary health workers (PHWs) are a critical pillar of health systems but primary health care centers often struggle to attract and retain talented staff. To better understand why this is, we investigated the job preference of PHWs in a Chinese urban setting. METHODS: In a discrete choice experiment, PHWs from 15 primary health care centers in Guangzhou, China, made trade-offs between several hypothetical job scenario combinations of salary, type of health institution, bianzhi (permanent post), work years required for promotion, career development and training opportunities, educational opportunities for children, and community respect. Based on the estimate of the mixed logit model, willingness to pay and policy simulations were applied to estimate the utility of each attribute. RESULTS: Data were collected from 446 PHWs. The PHWs were willing to forgo Chinese Renminbi 2806.1 (US$ 438.5) per month to obtain better education opportunities for their children, making it the most important non-monetary factor. Their preferences were also influenced relatively more by salary, bianzhi, and community respect, than with the other attributes we tested for, work years required for promotion, career development and training opportunities, and type of health institution. CONCLUSION: Salary is a robust predictive factor, while three non-monetary factors (opportunities for children's education, bianzhi, and community respect) are essential in retaining health workers in primary care.

Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma.

BACKGROUNDS: The purpose of this study is to investigate the relationship between clinical characteristics and cervical lymph node metastasis (LNM) in patients with thyroid carcinoma, as well as estimate the preoperative diagnosis values of ultrasound (US) and contrast enhanced computed tomography (CECT) examinations on the neck for detection of cervical LNM in thyroid carcinoma. METHODS: A retrospective analysis of 3 026 patients with surgically proven thyroid carcinoma was conducted. Patients' clinical characteristics, including gender, age, tumor size, bilateral lesions, multifocality, adenomatous nodules, Hashimoto's thyroiditis (HT), and extrathyroidal extension, were collected to explore their association with cervical LNM in thyroid carcinoma. Preoperative assessments for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were conducted through US and CECT. The diagnostic value of US, CECT and US combined with CECT for detection of LNM located in various cervical compartments was estimated based on the pathological results. RESULTS: The risk of cervical LNM was higher in thyroid cancer patients who were male, age < 55 years old, tumor size > 10 mm, bilateral lesions, and extrathyroidal extension, while multifocality, adenomatous nodules and HT had no significant effect on LNM. US, CECT and US combined with CECT all had a higher sensitivity to LLNM (93.1%, 57.8%, 95.4%) than to CLNM (32.3%, 29.0%, 43.4%). US and CECT had a high specificity to both CLNM and LLNM (94.3-97.8%). CONCLUSION: Preoperative clinical characteristics and imaging examinations on patients with thyroid carcinoma are crucial to the evaluation of cervical lymph nodes and conducive to individualizing surgical treatments by clinicians. US combined with CECT are superior to single US or CECT alone in detection of CLNM and LLNM.

Magnetocardiography-based coronary artery disease severity assessment and localization using spatiotemporal features.

Objective.This study aimed to develop an automatic and accurate method for severity assessment and localization of coronary artery disease (CAD) based on an optically pumped magnetometer magnetocardiography (MCG) system.Approach.We proposed spatiotemporal features based on the MCG one-dimensional signals, including amplitude, correlation, local binary pattern, and shape features. To estimate the severity of CAD, we classified the stenosis as absence or mild, moderate, or severe cases and extracted a subset of features suitable for assessment. To localize CAD, we classified CAD groups according to the location of the stenosis, including the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA), and separately extracted a subset of features suitable for determining the three CAD locations.Main results.For CAD severity assessment, a support vector machine (SVM) achieved the best result, with an accuracy of 75.1%, precision of 73.9%, sensitivity of 67.0%, specificity of 88.8%, F1-score of 69.8%, and area under the curve of 0.876. The highest accuracy and corresponding model for determining locations LAD, LCX, and RCA were 94.3% for the SVM, 84.4% for a discriminant analysis model, and 84.9% for the discriminant analysis model.Significance. The developed method enables the implementation of an automated system for severity assessment and localization of CAD. The amplitude and correlation features were key factors for severity assessment and localization. The proposed machine learning method can provide clinicians with an automatic and accurate diagnostic tool for interpreting MCG data related to CAD, possibly promoting clinical acceptance.

Revealing Disparities in Porous Networks Between Yttria Aerogel Assemblies with Nanosheets and Nanoparticles and Their Ultrathermal Insulation and Optical Properties.

Recent advancements have introduced anisotropic structures, particularly 2D nanosheets, into aerogels, resulting in unique morphologies and exceptional properties that differ from those assembled by isotropic nanoparticles. However, exploration of the distinct porous networks and the resulting properties is limited. We focus on rare earth yttria (Y2O3) aerogels as a case in point and demonstrate the synthesis of aerogels with nanosheet and nanoparticle assemblies using elaborative sol-gel chemistry. With the aid of X-ray computed tomography, three-dimensional visualizations of the aerogels provide relative compressive views of the porous network, revealing that the Y2O3 aerogel assembled by nanosheets possesses a hierarchical pore structure characterized by uneven pore distribution, particularly the presence of macropores throughout; in contrast, these consist of nanoparticles exhibiting a relative uniform pore distribution. High-temperature examinations indicate that the nanosheet aerogels are much more stable with a specific surface area of 64 m2·g-1 after being exposed at 1300 °C; meanwhile, the aerogels present durable and efficient thermal insulation performances. The exceptional thermal properties are attributed to the synergistic effects of the nanosheets' crystalline nature and the hierarchical porous network. The nanosheet Y2O3 aerogel also exhibited superior luminescent emission characteristics, further enhancing its potential for various applications. Our findings provide further insights into optimization of the microstructures in nanoporous aerogels, particularly through the utilization of anisotropic nanosheets.

Digital economy, industrial transformation and upgrading, and spatial transfer of carbon emissions: The paths for low-carbon transformation of Chinese cities.

Under the background of increasingly fierce global economic competition and severe climate change, seeking new soft resource input is the key for China to break through the bottleneck of economic transformation. Based on the data from 278 Chinese cities from 2006 to 2019, multi-dimensional empirical tests were conducted to investigate the relationship between digital economy (DE) and spatial transfer of carbon emissions (CE). The results show that DE directly reduced CE. Mechanism analysis shows that DE reduced CE through local industrial transformation and upgrading (ITU). Spatial analysis shows that DE reduced local CE while aggravating neighboring CE. The spatial transfer of CE was attributed to the fact that when DE promoted the local ITU, it induced the transfer of the backward and polluting industries to neighboring regions, resulting in the spatial transfer of CE. Moreover, the spatial transfer effect of CE was maximum at 200 km. However, in recent years, rapid DE development has weakened the spatial transfer effect of CE. The results can provide insights into understanding the carbon refuge effect of industrial transfer in China in the context of DE and facilitate formulating appropriate industrial policies to promote inter-regional carbon reduction synergy. Thus, this study can provide a theoretical reference for achieving the dual-carbon target of China and the green economic recovery of other developing countries.

The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon.

The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.

Leaching characteristics and pollution risk assessment of potentially harmful elements from coal gangue exposed to weathering for different periods of time.

To explore the leaching behavior and potential degree of pollution that can result from the backfilling of goafs with different types of coal gangue (CG), fresh CG from the Hongqi Coal Mine goaf and surface CG (weathered for 1 year) were selected as the research objects in this study. A series of leaching experiments were carried out using the Ordovician limestone karst waters of the mining areas as the soaking solution. A comparative study on the dissolution characteristics of Fe3+, Mn2+, and SO42- and on the traditional water quality parameters of the two types of CG was conducted. The results showed that the soaked, weathered CG displayed a higher ion dissolution value than fresh CG. The ratio of each ion was as follows: Fe3+ was 1, Mn2+ was 2.86 ~ 68.18, and SO42- was 1.34 ~ 2.09. Over time, the ion concentration of water samples that initially contained high ion concentration values showed a decreasing trend after CG was soaked in these waters, but the values were still in the range of high ion release concentrations. The pH and oxidation‒reduction potential (ORP) values of the leachate of both CG types indicated that the leachates were weakly alkaline and weakly oxidizing, and the overall change in total dissolved solids (TDS) was small and consistent with the SO42- trend. SO42- in the leachate of the weathered CG showed a more significant correlation with the pH and TDS of the soaking solution, and it was the major pollutant. According to the geoaccumulation index evaluation, weathered CG had higher pollution potential than fresh CG. Fe3+ presented a slight and moderate risk for contamination.

[Rapid health technology assessment of four oral Chinese patent medicines in treatment of functional gastrointestinal disorders].

To provide proof of the evidence-based medicine and decision-making information for the clinical decision of functional gastrointestinal disorders(FGIDs), this study evaluated and compared the efficacy, safety, and economy of four oral Chinese patent medicines(CPMs) in the treatment of FGIDs using the method of rapid health technology assessment. The literature was systematically retrieved from CNKI, Wanfang, VIP, SinoMed, EMbase, PubMed, Cochrane Library and ClinicalTrials.gov from the establishment of the databases to May 1, 2022. Two evaluators screened out the literature, extracted data, evaluated the quality of the literature, and descriptively analyzed the results according to the prepared standard. Eventually, 16 studies were included, all of which was rando-mized controlled trial(RCT). The results showed that Renshen Jianpi Tablets, Renshen Jianpi Pills, Shenling Baizhu Granules, and Buzhong Yiqi Granules all had certain effects on the treatment of FGIDs. Renshen Jianpi Tablets treated FGIDs and persistent diarrhea. Shenling Baizhu Granules treated diarrhea with irritable bowel syndrome and FGIDs. Buzhong Yiqi Granules treated diarrhea with irritable bowel syndrome, FGIDs, and chronic diarrhea in children. Renshen Jianpi Pills treated chronic diarrhea. The four oral CPMs all have certain effects on the treatment of FGIDs and have specific advantages for specific patients. Compared with other CPMs, Renshen Jianpi Tablets have higher clinical universality. However, there are problems such as insufficient clinical research evidence, generally low quality of evidence, lack of comparative analysis among medicines, and lack of academic evaluation. More high-quality clinical research and the economic research should be carried out in the future, so as to provide more evidence for the evaluation of the four CPMs.

A temporospatial assessment of environmental quality in urbanizing Ethiopia.

Global environmental quality has been negatively affected by urbanization, particularly vulnerable in the Sub-Saharan Africa. Therefore, understanding the underlying mechanism and driving forces for the change of environmental quality with urbanization process is essential to improve the environmental sustainability. In this study, the compounded night light index (CNLI) and remote sensing ecological index (RSEI) were used respectively to evaluate the urbanization level and environmental quality in Ethiopia from 2010 to 2020. On this basis, a temporospatial assessment framework was proposed, followed by methods of coupling coordination degree, spatial autocorrelation, elasticity, and decomposition. The results showed that 63 out of 690 woredas experienced environmental deterioration. Socioeconomic effect, carbon intensity, and climate change were decomposed as drivers to environmental quality, with socioeconomic effects contributing >68% of environmental improvement, while carbon intensity and climate change were responsible for >51% and >58% of environmental deterioration from 2010 values. Continuous increase in impervious surfaces resulted in a six-fold increase in surface runoff, which raised the flooding risk in sub areas and rural landscapes. This demands reforms of climate strategies and proper livestock management.

The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China.

BACKGROUND: Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. METHODS: A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. RESULTS: The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. CONCLUSION: The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.

Synchronization control of time-delay neural networks via event-triggered non-fragile cost-guaranteed control.

This paper is devoted to event-triggered non-fragile cost-guaranteed synchronization control for time-delay neural networks. The switched event-triggered mechanism, which combines periodic sampling and continuous event triggering, is used in the feedback channel. A piecewise functional is first applied to fully utilize the information of the state and activation function. By employing the functional, various integral inequalities, and the free-weight matrix technique, a sufficient condition is established for exponential synchronization and cost-related performance. Then, a joint design of the needed non-fragile feedback gain and trigger matrix is derived by decoupling several nonlinear coupling terms. On the foundation of the joint design, an optimization scheme is given to acquire the minimum cost value while ensuring exponential stability of the synchronization-error system. Finally, a numerical example is used to illustrate the applicability of the present design scheme.

Costs of dementia with lewy bodies: A Chinese multicenter cross-sectional study.

INTRODUCTION: Dementia with Lewy bodies (DLB) significantly increases the economic burden on caregivers and society, but few studies have focused on the costs. This study aims to evaluate the current economic costs of DLB and its related factors. METHODS: A total of 193 patients diagnosed with probable DLB were consecutively enrolled from 6 memory clinics between August 2017 to July 2021. Data were collected from August to December of 2021, patients' per capita annual economic costs related to DLB in the year preceding the interview were evaluated, and factors related to the costs were assessed using regression analysis. RESULTS: Patients with DLB led to per capita annual total costs of US $21,378.3 in 2021, with direct medical costs, direct non-medical costs and indirect costs of US $3471.4, US $3946.4 and US $13,960.5, respectively, accounting for 16.2%, 18.5% and 65.3%, of total costs. Factors related to the costs of DLB showed that impairments in activities of daily living (ADL) and caregivers' subjective burden had a greater impact on the total, direct medical and indirect costs. CONCLUSION: The economic burden of DLB in China is huge, and indirect costs account for the largest proportion, serious impairment of the ADL and the subjective burden of caregivers, which possibly has a greater effect on costs. The substantial contributions made by family members and other unpaid caregivers of DLB should be fully recognized in strategic policy discussions and in case-level planning and assessments.