The health and economic burden of ozone pollution on Alzheimer's disease and mild cognitive impairment in China.

Ozone pollution is increasingly recognized as a serious environmental threat that exacerbates dementia risks, including Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI). Amid rapid industrialization, China faces significant air quality challenges. However, there has been a scarcity of detailed studies assessing the health and economic impacts of ozone pollution on these conditions. This study aims to address this gap by utilizing the BenMap-CE tool and incorporating parameters obtained from systematic reviews of epidemiological studies, official statistics, and weighted averages, to accurately quantify the effects of ozone exposure in China. This research evaluated the health and economic burdens at both national and provincial levels, focusing on the additional impacts attributed to increased ozone levels. The results reveal that in 2023, compared to 2015, ozone pollution contributed to approximately 110,000 new cases (5.6 per 10,000) of AD and 1.6 million new cases (81.7 per 10,000) of MCI, imposing significant economic costs of about US $1200 million for AD and US $18,000 million for MCI, based on 2015 dollar values. Additionally, our projections indicate that reducing the 2023 ozone concentrations to 70 µg/m3 could significantly curb these conditions, potentially preventing over 210,000 new AD cases (10.7 per 10,000) and 2.9 million (148.1 per 10,000) MCI cases. Such reductions are projected to yield substantial economic benefits, estimated at US $2200 million for AD and US $34,000 million for MCI (2015 dollar values). These findings underscore the profound implications of ozone pollution on public health and the economy in China, highlighting the urgent need for effective ozone management strategies to mitigate these impacts.

Levels, Distribution and Ecological Risk Assessment of PBDEs in Soils and Plants Around the Engineering Plastics Factory.

This study systematically investigated the pollution levels and migration trends of PBDEs in soils and plants around engineering plastics factory, and identified the ecological risks of PBDEs in the environment around typical pollution sources.The results showed that 13 kinds of PBDEs were widely detected in the surrounding areas, and the concentration level was higher than the general environmental pollution level. The total PBDE concentrations (∑13PBDEs) in soils ranged from 14.6 to 278.4 ng/g dry weight (dw), and in plants ranged from 11.5 to 176 ng/g dw. Both soil and plant samples showed that BDE-209 was the most important congener, the pollution level in soil and plant was similar, and the composition of PBDEs congener was similar. In the soil column (50 cm), the radial migration of PBDEs was mainly concentrated in the 0-30 cm section. Except for BDE-66, which was mainly located in the 20-30 cm soil layer, the concentration of PBDEs was the highest in the 0-10 cm region. Furthermore, the environmental risks of PBDEs in soil and plants were evaluated by hazard quotient method, and the HQ values were all < 1, which did not exhibit any ecological risk. The evaluation results also showed that the ecological risk of PBDEs in soil was higher than that of plants, especially penta-BDE, which should be paid more attention.

A Chinese version of the infertility self-efficacy scale: Reliability and validity assessment.

Objective: To translate, cross-culturally adapt and test the reliability and validity of a Chinese version of the Infertility Self-Efficacy scale. Methods: The Infertility Self-Efficacy (ISE) scale was translated into Chinese using forward and backward translations, expert consultation, cognitive interviews and a pilot study. To test the scale's reliability and validity, 515 infertile women in two hospitals were recruited to evaluate the Chinese version of the scale. Content validity was assessed by means of expert consultation. Exploratory factor and confirmatory factor analyses were performed using SPSS 26.0 and Amos 24.0. Reliability tests of the scale included Cronbach's alpha coefficient, split-half reliability and test-retest reliability. Results: The Chinese version of the ISE scale contains 16 items and one dimension. Content validity of the scale was 0.96. Results of exploratory factor analysis suggested that the one factor model was suitable for the scale, and factor loading of all items was greater than 0.4. Model fitting parameters of confirmatory factor analysis of the ISE scale were χ2/df = 2.710, Root Mean Square Error Approximation (RMSEA) = 0.079, Standardized Root Mean Square Residual (SRMR) = 0.042, Comparative Fit Index (CFI) = 0.953, and Tucker-Lewis Index (TLI) = 0.939. Cronbach's alpha coefficient of the Chinese ISE was 0.980; split-half coefficient was 0.972 and retest reliability was 0.848 (P < 0.01). Conclusion: The Chinese ISE scale is a reliable and valid instrument to evaluate the self-efficacy of infertile Chinese women.

Prognostic Assessment of Histopathologic Lesions in Patients with Community-Acquired Acute Kidney Injury with Biopsy-Proven Acute Tubular Necrosis.

BACKGROUND: Community-acquired acute kidney injury (CA-AKI) was more likely to be comorbid with underlying kidney histopathological lesions in addition to acute tubular necrosis (ATN). Thus, we tried to clarify the histological determinants that could influence the prognosis and recovery of CA-AKI patients with biopsy-proven ATN. METHODS: Adult patients with CA-AKI with biopsy-proven ATN who underwent renal biopsy at Shanghai Changzheng Hospital from January 1, 2010, to December 31, 2018, were included and followed up for 5 years. The impacts of histopathological lesions on short-term and long-term renal dysfunction were also analysed. RESULTS: Multivariate analysis revealed that ATNs, crescents, and decrease of arteriole lumens increased short-term dialysis requirements. The severity of ATN was closely associated with renal survival. According to the Kaplan-Meier analysis, the severity of ATN was significantly associated with short-term dialysis needs and long-term development of end-stage kidney disease (ESKD) during follow-up. Crescent and decrease of arteriole lumens are significantly associated with progression to ESKD and exert synergistic effects with ATN. For patients who did not progress to dialysis, tubular atrophic/interstitial fibrosis and endocapillary lesions were more relevant to partial recovery of renal function after CA-AKI at the three-month follow-up and increased the risk of chronic kidney disease (CKD) stage 3-5 at the five-year follow-up. According to our correlation analysis, endocapillary lesions and crescents were positively correlated with ATN. CONCLUSIONS: Histopathologic lesions, apart from tubular necrosis, contributed to the detrimental short-term and long-term renal prognosis of CA-AKI patients with ATN; concomitant histopathologic lesions exerted a combined impact on renal survival together with ATN in CA-AKI patients.

Associations Between Neuroinflammation-Related Conditions and Alzheimer's Disease: A Study of US Insurance Claims Data.

Background: Early detection of Alzheimer's disease (AD) is a key component for the success of the recently approved lecanemab and aducanumab. Patients with neuroinflammation-related conditions are associated with a higher risk for developing AD. Objective: Investigate the incidence of AD among patients with neuroinflammation-related conditions including epilepsy, hemorrhage stroke, multiple sclerosis (MS), and traumatic brain injury (TBI). Methods: We used Optum's de-identified Clinformatics Data Mart Database (CDM). We derived covariate-matched cohorts including patients with neuroinflammation-related conditions and controls without the corresponding condition. The matched cohorts were: 1) patients with epilepsy and controls (N = 67,825 matched pairs); 2) patients with hemorrhage stroke and controls (N = 81,510 matched pairs); 3) patients with MS and controls (N = 9,853 matched pairs); and 4) patients TBI and controls (N = 104,637 matched pairs). We used the Cox model to investigate the associations between neuroinflammation-related conditions and AD. Results: We identified that epilepsy, hemorrhage stroke, and TBI were associated with increased risks of AD in both males and females (hazard ratios [HRs]≥1.74, p < 0.001), as well as in gender- and race-conscious subpopulations (HRs≥1.64, p < 0.001). We identified that MS was associated with increased risks of AD in both males and females (HRs≥1.47, p≤0.004), while gender- and race-conscious subgroup analysis shown mixed associations. Conclusions: Patients with epilepsy, hemorrhage stroke, MS, and/or TBI are associated with a higher risk of developing AD. More attention on cognitive status should be given to older patients with these conditions.

Assessment of nomogram model for the prediction of esophageal variceal hemorrhage in hepatitis B-induced hepatic cirrhosis.

BACKGROUND: Esophageal variceal (EV) hemorrhage is a life-threatening consequence of portal hypertension in hepatitis B virus (HBV) -induced cirrhotic patients. Screening upper endoscopy and endoscopic variceal ligation to find EVs for treatment have complications, contraindications, and high costs. We sought to identify the nomogram models (NMs) as alternative predictions for the risk of EV hemorrhage. METHODS: In this case-control study, we retrospectively analyzed 241 HBV-induced liver cirrhotic patients treated for EVs at the Second People's Hospital of Fuyang City, China from January 2021 to April 2023. We applied univariate analysis and multivariate logistic regression to assess the accuracy of various NMs in EV hemorrhage. The area under the curve (AUC) and calibration curves of the receiver's operating characteristics were used to evaluate the predictive accuracy of the nomogram. Decision curve analysis (DCA) was used to determine the clinically relevant of nomograms. RESULTS: In the prediction group, multivariate logistic regression analysis identified platelet distribution and spleen length as independent risk factors for EVs. We applied NMs as the independent risk factors to predict EVs risk. The NMs fit well with the calibration curve and have good discrimination ability. The AUC and DCA demonstrated that NMs with a good net benefit. The above results were validated in the validation cohort. CONCLUSION: Our non-invasive NMs based on the platelet distribution width and spleen length may be used to predict EV hemorrhage in HBV-induced cirrhotic patients. NMs can help clinicians to increase diagnostic performance leading to improved treatment measures.

Assessment of the methodological, recommendation and reporting quality of global guidelines for neck pain and synthesis of evidence and recommendations: a systematic review protocol.

INTRODUCTION: Neck pain is a global health problem that can cause severe disability and a huge medical burden. Clinical practice guideline (CPG) is an important basis for clinical diagnosis and treatment. A high-quality CPG plays a significant role in clinical practice. However, the quality of the CPGs for neck pain lacks comprehensive assessment. This protocol aims to evaluate the methodological, recommendation, reporting quality of global CPGs for neck pain and identify key recommendations and gaps that limit evidence-based practice. METHOD: CPGs from January 2013 to November 2023 will be identified through a systematic search on 13 scientific databases (PubMed, Cochrane Library, Embase, etc) and 7 online guideline repositories. Six reviewers will independently evaluate the quality of CPGs for neck pain by using the Appraisal of Guidelines for Research and Evaluation, the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence and the Reporting Items for Practice Guidelines in Healthcare tools. Intraclass correlation coefficient will be used to test the consistency of the assessment. We will identify the distribution of evidence and recommendations in each evidence-based CPGs for neck pain and regrade the level of evidence and strength of recommendations by adopting the commonly used Grading of Recommendations, Assessment, Development and Evaluations system. The key recommendations based on high-quality evidence will be summarised. In addition, we will categorise CPGs by different characteristics and conduct a subgroup analysis of the results of assessment. ETHICS AND DISSEMINATION: No subjects will be involved in this systematic review, so there is no need for ethical approval. The finding of this review will be summarised as a paper for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023417717.

Clinical value assessment for serum hsa_tsr013526 in the diagnosis of gastric carcinoma.

Gastric carcinoma (GC) is a malignant tumor that is detrimental to human health. Transfer RNA-derived small RNAs are a newly identified class of noncoding small RNAs with specific biological functions that are aberrantly expressed in cancer. The aim of this study was to investigate the potential of hsa_tsr013526 as a biomarker for GC. Quantitative real-time fluorescence polymerase chain reaction was used to detect the expression level of hsa_tsr013526. The molecular characteristics of hsa_tsr013526 were verified by agarose gel electrophoresis, Sanger sequencing, and separation of nuclear and cytoplasmic RNA fractions. By testing the receiver operating characteristic (ROC) curves, the diagnostic efficiency of GC using hsa_tsr013526 was determined. Finally, we predicted the downstream of hsa_tsr013526 using functional assays and bioinformatics analysis. Serum expression of hsa_tsr013526 was higher in GC patients than in healthy donors. Serum expression showed differential changes in GC patients, gastritis patients, and healthy donors. Chi-squared tests showed that high expression of hsa_tsr013526 was significantly correlated with T stage, lymphatic metastasis, and tumor node metastasis stage. ROC curve analysis indicated that GC patients could be discriminated from healthy donors or gastritis patients based on their serum levels of hsa_tsr013526. Furthermore, hsa_tsr013526 expression was significantly reduced in postoperative GC patients (p = .0016). High expression of hsa_tsr013526 promotes gastric cancer cell proliferation, invasion, and migration. Serum hsa_tsr013526 was stable and specific, and could be used for dynamic monitoring of GC patients. Therefore, hsa_tsr013526 may be a new biomarker for the diagnosis and postoperative monitoring of GC patients.

Improved solar-driven water purification using an eco-friendly and cost-effective aerogel-based interfacial evaporator with exceptional photocatalytic capabilities.

As a promising solution to address the global challenge of freshwater scarcity, solar-powered interfacial steam generation has undergone notable advancements. This study introduces a novel solar-driven interfacial evaporation membrane (ZnIn2S4@SiO2/ACSA, ZSAS) comprising a ZnIn2S4@SiO2 composite and a black sodium alginate aerogel infused with activated carbon. The ZSAS membrane demonstrates exceptional light absorption and thermal insulation, leading to elevated surface temperatures and reduced heat dissipation into the bulk water. Furthermore, the incorporation of AC reinforces the mechanical properties of the ZSAS membrane and enhances the water purification performance. These collective features result in an impressive evaporation rate of 1.485 kg m-2 h-1 and a high photothermal conversion efficiency of 91.2% under 1 sun irradiation for the optimal ZSAS membrane. Moreover, the optimal ZSAS membrane can effectively remove salts, heavy metal ions, and organic pollutants, benefitting from its superior evaporation separation effect and the photocatalytic properties of the ZnIn2S4@SiO2 composite.

A simulation and risk assessment framework for water-energy-environment nexus: A case study in the city cluster along the middle reach of the Yangtze River, China.

In the Anthropocene, there is a strong interlinkage among water, energy, and the environment. The water-energy-environment nexus (WEEN) has been vigorously advocated as an emerging development paradigm and a global research agenda. Based on the nexus concept, a framework for the WEEN complex system simulation and risk assessment is developed. The three metropolitan areas of the city cluster along the middle reaches of the Yangtze River (CCMRYR) are taken as the objects. Regional policies are combined with generic shared socio-economic pathways (SSPs) to form a localized SSPs suitable for the research region. The dynamic simulation of the WEEN complex system and the risk analysis are carried out with the combination of system dynamics models and copula functions. Results show that: There are obvious differences in water utilization, energy consumption, air pollutant emissions, and water pollutant emissions among the three metropolitan areas. The issue of high carbon intensity in the Wuhan Metropolitan Coordinating Region needs to be emphasized and solved from the perspective of optimizing the industrial structure. Adhering to current development patterns, there will be successive peaks in water utilization, energy consumption, and carbon emissions in Wuhan, Dongting Lake, and Poyang Lake Metropolitan Coordinating Region by 2030, leading to high synergy risks at the systemic level, with maximum values of 0.84, 0.85, 0.62, respectively. A development path based on conservation priorities indicates that future policymaking needs to prioritize a resource-saving and pollution-control development pattern directed by technological upgrading against the backdrop of scarce natural resource endowments. The localized SSPs are a beneficial extension that enriches the narrative of regional-scale SSPs. The evolutionary trajectories and risk assessments of WEEN complex systems under different localized SSPs provide a sweeping insight into the consequences of policy decisions, thus enabling policymakers to appraise policy rationality and implement appropriate corrective measures.

Company scaling and its deviations: New indicators for enterprise evaluation and bankruptcy prediction.

Many studies have shown that scaling laws widely exist in various complex systems, such as living organisms, cities, and online communities. In this research, we found that scaling laws also hold for companies. The macroscopic variables of companies, such as incomes, expenses, or total liability, all have power-law relationships with respect to the sizes of companies, which can be measured by sales, total assets, or the total number of employees. What is more, we also found the power law exponents always deviate from 1. That means large companies naturally have certain advantages, but the widely used financial indicators based on total volume or ratio may not reflect the company's status well because they are also size-dependent. To tackle this problem, this paper proposes a new set of evaluation indices based on the deviations of the macroscopic variables from the scaling law to eliminate the size-dependent effect. We found that the indicators based on deviations can give more reasonable evaluations for companies and can outperform other conventional indicators to predict the financial distress of companies.

Measuring the cross-border spillover effects and telecoupling processes of ecosystem services in Western China.

Ecosystem services provide the basic elements for global economic development. In the context of the deepening global integration process, countries and regions are increasingly connected, resulting in a series of cross-country, cross-regional, multi-scale socio-economic-environmental impacts, these new situations and changes require a multi-site, two-way, and cross-temporal and spatial scale comprehensive study of "the relationship between ecosystem services and humans". Based on this, we apply a telecoupling synthesis framework to explore the socio-economic and eco-environmental interactions of ecosystem service spillover effects. Results show that (1) the spillover effect of ecosystem services in western China is significant. More than 66% of ecosystem services spillover to eastern China provinces, and more than 40% of ecosystem services spillover to countries in Southeast Asia, South Asia, and Central Asia, resulting in a total of 679 million people benefiting from the spillover effect. (2) There are also multiple telecoupling processes between the ecosystem service spillovers in the ecologically fragile areas in western China and the rest of the world. In combination with the scenario simulation of the InVEST model, the services such as water supply, soil retention, flood mitigation, and food supply have significant impacts on sustainable development and human well-being in Asia and even the world. (3) The positive feedback effect of telecoupling is critical to the protection of the ecological environment as well as the improvement of people's livelihood and well-being in Western China's ecologically fragile areas. Therefore, we propose strengthening ecological compensation cooperation between local governments and implementing compensatory transfer payments between upstream and downstream. Simultaneously, international cooperation must be strengthened, and an ecological compensation transfer mechanism with beneficiary countries must be established, while the cross-regional flow of ecosystem services must be maintained. This study provides an example for the "ecosystem services and human relations" in multiple places, two directions and across time and space scales, and also practical reference significance for China implementation of projects such as the "the Belt and Road" initiative and transnational and cross regional resource allocation.

Study on spatiotemporal distribution characteristics and driving factors of carbon emission in Anhui Province.

Carbon emission is related to global ecological security, and economic development inevitably leads to an increase in carbon emission. In recent years, as a rapidly developing province in China's economy, Anhui Province has experienced significant differences in the spatiotemporal distribution of carbon emission in different regions due to differences in development foundation, urbanization level, population size, industrial structure, etc., providing representative empirical cases for research. Based on the carbon emission data of Anhui Province before the COVID-19, this study used exploratory spatial data analysis method and Geodetector to analyze the spatial and temporal distribution characteristics and drivers of carbon emission in Anhui Province. The study found that (1) the spatial differentiation and spatial correlation of carbon emission in Anhui Province are significant, At the beginning, it shows the characteristics of "high north and low south" and "high west and low east", and then the "core-edge" structure of carbon emission becomes obvious. Carbon emission hotspot areas increase and then decrease, mainly in Hefei, Fuyang and Chuzhou City, etc. The coldspot areas are mainly located in the southern and western mountainous areas, and the degree of aggregation is decreasing year by year. (3) The level of urbanization, economic development and population size are the main driving factors of the spatial variation of carbon emissions, while the industrial structure has the least influence. And most factors produce nonlinear enhancement when spatially superimposed with other factors. (4) The high value areas of economic development, population density, secondary industry structure, and energy intensity are all at high levels of carbon emission, and a combination of factors leads to the creation of high risk areas for carbon emission. The study provides a basis for reducing carbon emission in the next stage of Anhui Province, focusing on key carbon emission areas, and sustainable development.

Assessment of sub-micron subsurface damage in glass.

We present a new, to the best of our knowledge, experimental method for assessing sub-micron level subsurface damage (SSD) on optical glass. The method correlates surface characteristics such as the fracture toughness and Young's modulus via nanoindentation with the penetration depth into the tested surfaces at different overall penetration depths, as revealed by magnetorheological finishing spotting techniques. Our results on ground surfaces suggest that low surface roughness does not necessarily imply the absence of SSD. We also compared SSD on surfaces processed by deterministic microgrinding and femtosecond (fs) laser polishing. The fs-laser polished surfaces revealed no detectable SSD, thus establishing the feasibility of fs-laser polishing for precision optical manufacturing.

Authorized Generics In The US: Prevalence, Characteristics, And Timing, 2010-19.

Authorized generics are approved brand-name drugs that are sold by brand-name manufacturers or licensees without brands on their labeling. Despite their prevalence in prescription drug markets in the US, little is known about trends in their launches, their timing relative to traditional generics, and the characteristics of their respective brand-name drugs. We linked Food and Drug Administration and IQVIA data to investigate newly launched authorized generics during the period 2010-19. We found 854 launches over this period, with launches peaking in 2014. Marketing appears strategic: In markets with traditional generics, three-fourths of authorized generics launched after the respective generic competition started. When we focused on markets where generics were eligible for the 180-day exclusivity, about 70 percent of authorized generics launched before or during the exclusivity period. These findings provide insights for future research on the effect of authorized generics on competition, prices, and access to generics.

Assessment of microplastic contamination in an eastern Pacific tuna (Katsuwonus pelamis) and evaluation of its health risk implication through molecular docking and metabolomics studies.

This work investigated microplastic (MP) pollution in a commercially-important tuna species Katsuwonus pelamis (K. pelamis) from the Eastern Pacific and health implications. 125 MPs were extracted from gills, esophagus, stomachs, intestinal tracts, and muscle of K. pelamis. MPs in the esophagus was the highest, ∼7.6 times higher than that in the gill. Polyester and polyethylene terephthalate (PET) were dominant. Molecular docking implied that PET stabilized the complex via forming 4 new hydrogen bonds that interacted with Arg83, Gln246, Thr267, and Gly268, given that PET can enter glycerol kinase protein active pocket. Metabonomic results suggested that Glycerol 3-phosphate up expressed 1.66 more times that of control groups with no MPs in the muscle. This confirmed that MPs would lie in the glycerol kinase protein active pocket, which triggered menace to K. pelamis. The results provided insights into suggested the potential influence of MPs on the sustainability of fisheries and seafood safety.

Impacts of financial development on the energy consumption in China from the perspective of poverty alleviation efficiency.

Poverty alleviation and energy saving are two major issues of sustainable development targets. Meanwhile, financial development (FD) is a powerful engine of economic growth, which is regard as a valid approach to contain the demand for energy consumption (EC). However, few studies link the three factors and explore the specific impact mechanism of poverty alleviation efficiency (PE) on the tie between FD and EC. Thus, we employ the mediation and threshold models to evaluate the influence of FD on the EC in China during 2010-2019 from the perspective of PE. We affirm that FD indirectly promotes EC through the channel of PE. The mediating effect of PE is responsible for 15.75% of the total effect of FD on the EC. Moreover, FD generates a significant threshold impact on the EC considering the change of PE. When the PE exceeds 0.524, the role of FD in promoting EC is strengthened. Ultimately, the outcome suggests policymakers need to prominent the trade-off between energy saving and poverty reduction during the fast evolution of financial system.

Improving Health and Addressing Social Determinants of Health Through Hospital Partnerships.

Hospitals and health systems are forming partnerships to develop an integrated social network of services that better address the needs of their surrounding communities and their social determinants of health (SDOH). There is little research on the association of these partnered services with hospital outcomes. This study examined the association between hospital social need partnerships and activities to improve hospital and community outcomes. A secondary cross-sectional design to analyze 2021 census data of nonfederal short-term acute care hospitals in the United States was utilized. Data were obtained from the American Hospital Association. Four multilevel logistic regression models were used to analyze data from 1005 hospitals. The authors found that hospital partnership type differed in association to social need outcomes. They found that hospitals with a partnership with health insurance providers were more likely to have better health outcomes. Hospitals partnered with health insurance providers, local organizations addressing housing insecurity, local businesses, or chambers of commerce were more likely to have decreased health care costs. Hospitals partnered with health care providers, health insurance providers, local organizations providing legal assistance, or law enforcement/safety forces were more likely to have decreased utilization of hospital services. However, hospitals partnered with other local or state government or social service organizations were less likely to indicate decreased utilization of services. Many hospitals and health systems across the United States are screening for SDOH and are advancing health care delivery and improving the community's overall health and well-being by identifying unmet social needs and partnering with the community to address them.

Assessment of integrated patterns of human-animal-environment health: a holistic and stratified analysis.

BACKGROUND: Data-driven research is a very important component of One Health. As the core part of the global One Health index (GOHI), the global One Health Intrinsic Drivers index (IDI) is a framework for evaluating the baseline conditions of human-animal-environment health. This study aims to assess the global performance in terms of GOH-IDI, compare it across different World Bank regions, and analyze the relationships between GOH-IDI and national economic levels. METHODS: The raw data among 146 countries were collected from authoritative databases and official reports in November 2021. Descriptive statistical analysis, data visualization and manipulation, Shapiro normality test and ridge maps were used to evaluate and identify the spatial and classificatory distribution of GOH-IDI. This paper uses the World Bank regional classification and the World Bank income groups to analyse the relationship between GOH-IDI and regional economic levels, and completes the case studies of representative countries. RESULTS: The performance of One Health Intrinsic Driver in 146 countries was evaluated. The mean (standard deviation, SD) score of GOH-IDI is 54.05 (4.95). The values (mean SD) of different regions are North America (60.44, 2.36), Europe and Central Asia (57.73, 3.29), Middle East and North Africa (57.02, 2.56), East Asia and Pacific (53.87, 5.22), Latin America and the Caribbean (53.75, 2.20), South Asia (52.45, 2.61) and sub-Saharan Africa (48.27, 2.48). Gross national income per capita was moderately correlated with GOH-IDI (R2 = 0.651, Deviance explained = 66.6%, P < 0.005). Low income countries have the best performance in some secondary indicators, including Non-communicable Diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal Epidemic Disease, Animal Biodiversity, Air Quality and Climate Change, Land Resources and Environmental Biodiversity. CONCLUSIONS: The GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was sub-Saharan Africa. There is a positive correlation between the GOH-IDI and country economic status, with high-income countries performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.

The assessment in patients with acute fatty liver of pregnancy (AFLP) treated with plasma exchange: a cohort study of 298 patients.

BACKGROUND: To assess the prevalence, risk factors, clinical characteristics of Acute fatty liver of pregnancy (AFLP) patients, and outcomes of AFLP patients treated with plasma exchange (PE). METHODS: We retrospectively reviewed the AFLP patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University and Xijing Hospital of Air Force Medical University from January 2012 to May 2022. Final prediction model for death among AFLP by means of stepwise backward elimination with p value < 0.05. Patients treated with and without PE were compared by propensity-matched cohort study. RESULTS: Two hundred ninety eight patients with the diagnosis of AFLP, and finally 290 patients were enrolled in the cohort study, 50 of whom (17.2%) were dead. Compared with AFLP patients alive, the dead of patients were more likely to be combined encephalopathy (p < 0.01), postpartum hemorrhage (p < 0.01), and found significantly higher frequency of fetal distress (p = 0.04), fetal death (p < 0.01). we developed a predicted probability value and with an area under the receiver operating characteristics (ROC) curve of 0.94 (95%CI 0.87 to 1.00), indicating AFLP patients' death. The patients treated with PE had a significantly lower 60-day mortality rate (OR 0.42, 95% CI 0.29 to 2.64, p = 0.04), and significantly shorter duration of hospital-free days at day 28 (p = 0.01). CONCLUSIONS: In conclusion, our study indicated that liver function were risk factors for maternal mortality, and PE was a protective factor for maternal 60-day mortality and hospital-free days at day 28 in AFLP patients.