Statin-Associated Liver Dysfunction and Muscle Injury: epidemiology, Mechanisms, and Management Strategies.

Surveillance of drug safety is an important aspect in the routine medical care. Adverse events caused by real-world drug utilization has become one of the leading causes of death and an urgent issue in the field of toxicology. Cardiovascular disease is now the leading cause of fatal diseases in most countries, especially in the elderly population who often suffer from multiple diseases and need long-term multidrug therapy. Among which, statins have been widely used to lower bad cholesterol and regress coronary plaque mainly in patients with hyperlipidemia and atherosclerotic cardiovascular diseases (ASCVD). Although the real-world benefits of statins are significant, different degrees and types of adverse drug reactions (ADR) such as liver dysfunction and muscle injury, have a great impact on the original treatment regimens as well as the quality of life. This review describes the epidemiology, mechanisms, early identification and post-intervention of statin-associated liver dysfunction and muscle injury based on the updated clinical evidence. It provides systematic and comprehensive guidance and necessary supplement for the clinical safety of statin use in cardiovascular diseases.

Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review.

Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with diverse clinical presentations. Alterations in energy expenditure state are commonly observed in patients with PPGL. However, the reported prevalence of hypermetabolism varies significantly and the underlying mechanisms and implications of this presentation have not been well elucidated. This review discusses and analyzes the factors that contribute to energy consumption. Elevated catecholamine levels in patients can significantly affect substance and energy metabolism. Additionally, changes in the activation of brown adipose tissue (BAT), inflammation, and the inherent energy demands of the tumor can contribute to increased resting energy expenditure (REE) and other energy metabolism indicators. The PPGL biomarker, chromogranin A (CgA), and its fragments also influence energy metabolism. Chronic hypermetabolic states may be detrimental to these patients, with surgical tumor removal remaining the primary therapeutic intervention. The high energy expenditure of PPGL has not received the attention it deserves, and an accurate assessment of energy metabolism is the cornerstone for an adequate understanding and treatment of the disease.

Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End-Stage Renal Disease Under Maintenance Dialysis.

BACKGROUND: Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end-stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear. PURPOSE: To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD. STUDY TYPE: Prospective. POPULATION: One hundred fifty-eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis. FILED STRENGTH/SEQUENCE: 3.0 T, balanced steady-state free precession (bSSFP) cine and modified Look-Locker inversion recovery (MOLLI) sequences. ASSESSMENT: LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median. STATISTICAL TESTS: Cox proportional hazard regression and log-rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C-statistics and DeLong tests. A P value <0.05 was considered statistically significant. RESULTS: Thirty-four MACE occurred during the median follow-up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C-statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%). DATA CONCLUSION: LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.

Optimizing directional recovery of high-bioavailable phosphorus from human manure: Molecular-level understanding and assessment of application potential.

Phosphorus (P) recovery from human manure (HM) is critical for food production security. For the first time, a one-step hydrothermal carbonation (HTC) treatment of HM was proposed in this study for the targeted high-bioavailable P recovery from P-rich hydrochars (PHCs) for direct soil application. Furthermore, the mechanism for the transformation of P speciation in the derived PHCs was also studied at the molecular level. A high portion of P (80.1∼89.3%) was retained in the solid phase after HTC treatment (120∼240°C) due to high metal contents. The decomposition of organophosphorus (OP) into high-bioavailable orthophosphate (Ortho-P) was accelerated when the HTC temperature was increased, reaching ∼97.1% at 210°C. In addition, due to the high content of Ca (40.45±2.37 g/kg) in HM, the HTC process promoted the conversion of low-bioavailable non-apatite inorganic (NAIP) into high-bioavailable apatite inorganic P (AP). In pot experiments with pea seedling growth, the application of newly obtained PHCs significantly promoted plant growth, including average wet/dry weight and plant height. Producing 1 ton of PHCs (210°C) with the same effective P content as agricultural-type calcium superphosphate could result in a net return of $58.69. More importantly, this pathway for P recovery is predicted to meet ∼38% of the current agricultural demand.

Quantitative assessment of collateral time on perfusion computed tomography in acute ischemic stroke patients.

Background and aim: Good collateral circulation is recognized to maintain perfusion and contribute to favorable clinical outcomes in acute ischemic stroke. This study aimed to derive and validate an optimal collateral time measurement on perfusion computed tomography imaging for patients with acute ischemic stroke. Methods: This study included 106 acute ischemic stroke patients with complete large vessel occlusions. In deriving cohort of 23 patients, the parasagittal region of the ischemic hemisphere was divided into six pial arterial zones according to pial branches of the middle cerebral artery. Within the 85 arterial zones with collateral vessels, the receiver operating characteristic analysis was performed to derive the optimal collateral time threshold for fast collateral flow on perfusion computed tomography. The reference for fast collateral flow was the peak contrast delay on the collateral vessels within each ischemic arterial zone compared to its contralateral normal arterial zone on dynamic computed tomography angiography. The optimal perfusion collateral time threshold was then tested in predicting poor clinical outcomes (modified Rankin score of 5-6) and final infarct volume in the validation cohort of 83 patients. Results: For the derivation cohort of 85 arterial zones, the optimal collateral time threshold for fast collateral flow on perfusion computed tomography was a delay time of 4.04 s [area under the curve = 0.78 (0.67, 0.89), sensitivity = 73%, and specificity = 77%]. Therefore, the delay time of 4 s was used to define the perfusion collateral time. In the validation cohort, the perfusion collateral time showed a slightly higher predicting power than dynamic computed tomography angiography collateral time in poor clinical outcomes (area under the curve = 0.72 vs. 0.67; P < 0.001). Compared to dynamic computed tomography angiography collateral time, the perfusion collateral time also had better performance in predicting final infarct volume (R-squared values = 0.55 vs. 0.23; P < 0.001). Conclusion: Our results indicate that perfusion computed tomography can accurately quantify the collateral time after acute ischemic stroke.

Phosphorus recovery from sewage sludge ash (SSA): An integrated technical, environmental and economic assessment of wet-chemical and thermochemical methods.

Incineration is a promising disposal method for sewage sludge (SS), enriching more than 90% of phosphorus (P) in the influent into the powdered product, sewage sludge ash (SSA), which is convenient for further P recovery. Due to insufficient bioavailable P and enriched heavy metals (HMs) in SSA, it is limited to be used directly as fertilizer. Hence, this paper provides an overview of P transformation in SS incineration, characterization of SSA components, and wet-chemical and thermochemical processes for P recovery with a comprehensive technical, economic, and environmental assessment. P extraction and purification is an important technical step to achieve P recovery from SSA, where the key to all technologies is how to achieve efficient separation of P and HMs at a low economic and environmental cost. It can be clear seen from the review that the economics of P recovery from SSA are often weak due to many factors. For example, the cost of wet-chemical methods is approximately 5∼6 €/kg P, while the cost of recovering P by thermochemical methods is about 2∼3 €/kg P, which is slightly higher than the current P fertilizer (1 €/kg P). So, for now, legislation is significant for promoting P recovery from SSA. In this regard, the relevant experience in Europe is worth learning from countries that have not yet carried out P recovery from SSA, and to develop appropriate policies and legislation according to their own national conditions.

A comprehensive approach to quantify the source identification and human health risk assessment of toxic elements in park dust.

In this research, enrichment factor (EF) and pollution load index were utilized to explore the contamination characteristics of toxic elements (TEs) in park dust. The results exhibited that park dust in the study area was mainly moderately polluted, and the EF values of dust Cd, Zn, Pb, Cu and Sb were all > 1. The concentrations of Cr, Cu, Zn and Pb increased with the decrease of dust particle size. The investigation results of chemical speciation and bioavailability of TEs showed that Zn had the highest bioavailability. Three sources of TEs were determined by positive matrix factorization model, Pearson correlation analysis and geostatistical analysis, comprising factor 1 mixed sources of industrial and transportation activities (46.62%), factor 2 natural source (25.56%) and factor 3 mixed source of agricultural activities and the aging of park infrastructures (27.82%). Potential ecological risk (PER) and human health risk (HHR) models based on source apportionment were exploited to estimate PER and HHR of TEs from different sources. The mean PER value of TEs in the park dust was 114, indicating that ecological risk in the study area was relatively high. Factor 1 contributed the most to PER, and the pollution of Cd was the most serious. There were no significant carcinogenic and non-carcinogenic risks for children and adults in the study area. And factor 3 was the biggest source of non-carcinogenic risk, and As, Cr and Pb were the chief contributor to non-carcinogenic risk. The primary source of carcinogenic risk was factor 2, and Cr was the cardinal cancer risk element.

Trends in Medically Integrated Dispensing Among Oncology Practices.

PURPOSE: The integration of pharmacies with oncology practices-known as medically integrated dispensing or in-office dispensing-could improve care coordination but may incentivize overprescribing or inappropriate prescribing. Because little is known about this emerging phenomenon, we analyzed historical trends in medically integrated dispensing. METHODS: Annual IQVIA data on oncologists were linked to 2010-2019 National Council for Prescription Drug Programs pharmacy data; data on commercially insured patients diagnosed with any of six common cancer types; and summary data on providers' Medicare billing. We calculated the national prevalence of medically integrated dispensing among community and hospital-based oncologists. We also analyzed the characteristics of the oncologists and patients affected by this care model. RESULTS: Between 2010 and 2019, the percentage of oncologists in practices with medically integrated dispensing increased from 12.8% to 32.1%. The share of community oncologists in dispensing practices increased from 7.6% to 28.3%, whereas the share of hospital-based oncologists in dispensing practices increased from 18.3% to 33.4%. Rates of medically integrated dispensing varied considerably across states. Oncologists who dispensed had higher patient volumes (P < .001) and a smaller share of Medicare beneficiaries (P < .001) than physicians who did not dispense. Patients treated by dispensing oncologists had higher risk and comorbidity scores (P < .001) and lived in areas with a higher % Black population (P < .001) than patients treated by nondispensing oncologists. CONCLUSION: Medically integrated dispensing has increased significantly among oncology practices over the past 10 years. The reach, clinical impact, and economic implications of medically integrated dispensing should be evaluated on an ongoing basis.

Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing.

IMPORTANCE: The new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time. OBJECTIVE: To assess the baseline performance and improvement over time of SNFs in the SNF VBP program. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019. MAIN OUTCOMES AND MEASURES: Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores. RESULTS: Of 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], -0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]). CONCLUSIONS AND RELEVANCE: This cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.

A comprehensive exploration on the health risk quantification assessment of soil potentially toxic elements from different sources around large-scale smelting area.

Non-ferrous metal smelting activities have always been considered as one of the foremost anthropogenic sources of potentially toxic elements (PTEs). The enrichment factor (EF) and pollution load index (PLI) were used to evaluate the pollution level of soil PTEs; positive matrix factorization (PMF), correlation analysis, and geostatistics were utilized to quantify the sources of soil PTEs; and potential ecological risk (PER) and human health risk (HHR) of different sources from farmland, construction land, and natural land were quantifiably determined via combined PTE sources with PER and HHR assessment models. Taking the smelting area of Daye City as an example, the evaluation results of EF and PLI showed that the soil PTE pollution in the study area was serious, especially Cd and Cu. And four sources were quantitatively allocated as agricultural practices (12.14%), traffic emissions (23.07%), natural sources (33.46%), and industrial activities (31.33%). For PER, industrial activities were the largest contributor to PER, accounting for 55.66%, 56.30%, and 55.36% of farmland, construction land, and natural land, respectively, and Cd was the most dangerous element. In terms of HHR, industrial activities were also the cardinal contributors under the three land use types. Children were exposed to serious non-carcinogenic risks under three land use patterns and slight carcinogenic risk in construction land (1.06E - 04). Significantly, the carcinogenic risk of children in farmland (9.06 × 10-5) was very close to the threshold (1 × 10-4), which requires attention. Both non-carcinogenic and carcinogenic risk for adults were all at acceptable levels. The health risks (carcinogenic and non-carcinogenic risks) of children from four different sources were distinctly higher than those of adults. Consequently, strict management and control of industrial activities should be given priority, and the management of agricultural practices should not be ignored.

Development of a GPU-accelerated Monte Carlo dose calculation module for nuclear medicine, ARCHER-NM: demonstration for a PET/CT imaging procedure.

Objective.This paper describes the development and validation of a GPU-accelerated Monte Carlo (MC) dose computing module dedicated to organ dose calculations of individual patients undergoing nuclear medicine (NM) internal radiation exposures involving PET/CT examination.Approach. This new module extends the more-than-10-years-long ARCHER project that developed a GPU-accelerated MC dose engine by adding dedicated NM source-definition features. To validate the code, we compared dose distributions from the point ion source, including18F,11C,15O, and68Ga, calculated for a water phantom against a well-tested MC code, GATE. To demonstrate the clinical utility and advantage of ARCHER-NM, one set of18F-FDG PET/CT data for an adult male NM patient is calculated using the new code. Radiosensitive organs in the CT dataset are segmented using a CNN-based tool called DeepViewer. The PET image intensity maps are converted to radioactivity distributions to allow for MC radiation transport dose calculations at the voxel level. The dose rate maps and corresponding statistical uncertainties were calculated at the acquisition time of PET image.Main results.The water-phantom results show excellent agreement, suggesting that the radiation physics module in the new NM code is adequate. The dose rate results of the18F-FDG PET imaging patient show that ARCHER-NM's results agree very well with those of the GATE within -2.45% to 2.58% (for a total of 28 organs considered in this study). Most impressively, ARCHER-NM obtains such results in 22 s while it takes GATE about 180 min for the same number of 5 × 108simulated decay events.Significance.This is the first study presenting GPU-accelerated patient-specific MC internal radiation dose rate calculations for clinically realistic18F-FDG PET/CT imaging case involving autosegmentation of whole-body PET/CT images. This study suggests that the proposed computing tools-ARCHER-NM- are accurate and fast enough for routine internal dosimetry in NM clinics.

Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia.

OBJECTIVES: Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely understood. We sought to describe post-acute care utilization in skilled nursing facilities (SNFs) and from home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia. DESIGN: Retrospective, observational study using 100% sample of Medicare beneficiaries from 2013 to 2016. SETTING AND PARTICIPANTS: We identified hospitalizations and diagnoses using Medicare Provider Analysis and Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary Summary File Chronic Conditions segment. METHODS: We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage). RESULTS: Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute care use were similar over time. More beneficiaries with a diagnosis of dementia received post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%). Overall use and trends were similar in the Medicare Advantage population. CONCLUSIONS AND IMPLICATIONS: One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia.

Postacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementia.

OBJECTIVE: To compare the outcomes of postacute care between home health (HH) and skilled nursing facilities (SNFs) following hospitalization among Medicare beneficiaries with a diagnosis of dementia. DATA SOURCES: 100% MedPAR data, Minimum Data Set, and Outcome and Assessment Information Set assessment data from January 1, 2015 to December 31, 2016. STUDY DESIGN: Retrospective cohort analysis using an instrumental variable design to compare outcomes (30-day readmission and mortality, 100-day mortality) of HH versus SNF following acute hospitalization. We used the differential distance between patients' home and the closest HH agency and SNF to instrument for nonrandom allocation of patients. DATA COLLECTION/EXTRACTION METHODS: We identified hospital discharges followed by SNF and HH stays for Medicare fee-for-service beneficiaries with dementia. We excluded beneficiaries younger than age 65, admitted to the hospital from a nursing home, or enrolled in hospice. We identified dementia using validated diagnostic codes with a 3-year look-back. PRINCIPAL FINDINGS: Our sample included 977,946 beneficiaries with a diagnosis of dementia; 297,732 (30.4%) received HH, while 680,214 (69.6%) went to SNF. Overall, 16.8% were readmitted to the hospital and 6.1% died within 30 days, while 15.4% died within 100 days of hospital discharge. In the instrumental variable analysis, there were no differences in any outcome between the two postacute care settings. CONCLUSIONS: Medicare beneficiaries with a diagnosis of dementia receiving postacute care in HH or SNF experienced similar rates of readmission and mortality across settings. This finding raises important questions about current postacute care referral patterns, given 7 in 10 patients with a diagnosis of dementia in our sample were discharged to SNF.

Assessment of Myocardial Work in Cancer Therapy-Related Cardiac Dysfunction and Analysis of CTRCD Prediction by Echocardiography.

No study has examined myocardial work in subjects with cancer therapy-related cardiac dysfunction (CTRCD). Myocardial work, as a new ultrasonic indicator, reflects the metabolism and oxygen consumption of the left ventricle. The aim of this study was to test the relative value of new indices of myocardial work and global longitudinal strain (GLS) in detecting changes in myocardial function during the treatment of breast cancer by two-dimensional and three-dimensional echocardiography. We enrolled 79 breast cancer patients undergoing different tumor treatment regimens. Follow-up observation was conducted before and after chemotherapy. The effects of breast cancer chemotherapy and targeted therapy on the development of CTRCD [defined as an absolute reduction in left ventricular ejection fraction (LVEF) of >5% to <53%] were detected by two-dimensional and three-dimensional speckle tracking echocardiography. Our findings further indicate that LVEF, myocardial work index (GWI) and myocardial work efficiency (GWE) showed significant changes after the T6 cycle, and GLS showed significant changes after the T4 cycle (p < 0.05). The three-dimensional strain changes after T6 and T8 had no advantages compared with GLS. Body mass index (BMI), the GLS change rate after the second cycle of chemotherapy (G2v) and the 3D-GCS change rate after the second cycle of chemotherapy (C2v) were independent factors that could predict the occurrence of CTRCD during follow-up, among which BMI was the best predictor (area under the curve, 0.922). In conclusion, the current study determined that GLS was superior to GWI in predicting cardiac function in patients with tumors with little variation in blood pressure. BMI, G2v and C2v can be used to predict the occurrence of CTRCD.

Outcomes of post-acute care in skilled nursing facilities in Medicare beneficiaries with and without a diagnosis of dementia.

BACKGROUND: More than 600,000 Medicare beneficiaries with a diagnosis of dementia are discharged to skilled nursing facilities (SNFs) after hospitalization annually. However, it is unclear how their risks and benefits of a SNF stay compare to beneficiaries without a diagnosis of dementia. DESIGN: Retrospective analysis comparing SNF outcomes for Medicare beneficiaries with and without a diagnosis of dementia. SETTING: One hundred percent sample of Medicare beneficiaries from 2015 to 2016. PARTICIPANTS: Dementia was identified using validated diagnosis codes. In beneficiaries who had an acute hospitalization followed by SNF stay, we used propensity score matching to balance demographics, comorbidities, characteristics of the index hospital stay, prior hospital and SNF utilization, and cognitive status on SNF admission. MEASUREMENTS: Outcomes included unplanned hospital readmission, community discharge rate, and mortality during the SNF stay. Multivariate models were adjusted for hospital and SNF characteristics. RESULTS: Our sample included 2,418,853 Medicare beneficiaries discharged from hospital to SNF; 830,524 (34.3%) carried a diagnosis of dementia. Overall, 14.7% of the sample had a hospital readmission, 5.0% died, and 61.5% were successfully discharged to the community. In the propensity-matched cohort, beneficiaries with a diagnosis of dementia had a lower odds ratio of mortality (OR 0.87; 95% confidence interval [CI] 0.86-0.89), similar odds of hospital readmission (OR 0.99; 95% CI 0.98-1.00), and reduced odds of discharge to the community (OR 0.92; 95% CI 0.91-0.93). However, these findings varied by the severity of cognitive impairment on SNF admission: in beneficiaries with no impairment, those with a diagnosis of dementia had higher odds of adverse outcomes. In beneficiaries with severe impairment, beneficiaries with a diagnosis of dementia had lower odds of adverse outcomes. CONCLUSIONS: Cognitive dysfunction on SNF admission is a stronger predictor of outcomes than a diagnosis of dementia, suggesting the need to individualize decisions about the benefits and risks of SNF care in populations with cognitive impairment.

The Gender Difference in Association between Home-Based Environment and Different Physical Behaviors of Chinese Adolescents.

PURPOSE: The aim of this study was to evaluate the home-based physical activity (PA) environmental characteristics, and different types of physical behavior level of adolescents in different genders, and explore the impact of different domains of home-based PA environmental factors on different physical behaviors of adolescents in different genders. METHODS: Five hundred forty-four adolescents aged from 12 to 18 years old (males: n = 358, females: n = 186) and their parents were analyzed in this cross-sectional survey. The volume of various physical behaviors of all adolescent subjects were measured by the ActiGraph wGT3X-BT accelerometer, and the level in different domains of home-based environmental characteristics were assessed by the Gattshall's home-based PA environment questionnaire, which was answered by adolescents' parents. The difference in the volume of different physical behaviors was examined using Kruskal-Wallis analysis. The difference in home physical environment and home social environment for adolescents was examined using one-way analysis of variance (ANOVA). Multiple linear regression analysis in the adjusted model was used to evaluate the influence of different home-based PA environmental domains (PA availability, PA accessibility, Parental role-modeling of PA, and Parental policies around PA) on different physical behaviors (sedentary behavior, SB; light-intensity physical activity, LPA; and moderate-vigorous physical activity, MVPA) of adolescents (boys and girls). RESULTS: The volume of LPA and MVPA, the score of PA accessibility in the home physical environment, and the score of home social environment of boys are significantly higher than those of girls, while the SB volume of boys is significantly lower than that of girls. The PA availability, the parents' role-modeling of PA in same-sex parent-child dyads, and the parents' policies around PA in opposite-sex parent-child dyads are significantly associated with adolescents' decreased SB and increased LPA and MVPA. CONCLUSION: There is significant gender difference in adolescents' physical behaviors and home-based environmental characteristics, as well as in the association between adolescents' physical behaviors and their home-based environment. The PA availability, the parents' role-modeling of PA in same-sex parent-child dyads, and the parents' policies around PA in opposite-sex parent-child dyads can significantly promote adolescents' healthy physical behaviors.

Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis.

BACKGROUND: As an emerging technology, robot-assisted surgical system has some potential merits in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted liver resection is still a controversial problem on its advantages compared with laparoscopic liver resection. We aimed to perform the meta-analysis to assess and compare the clinical outcomes of robot-assisted and laparoscopic liver resection. METHODS: We searched PubMed, Cochrane Library, Embase databases, Clinicaltrials, and Opengrey through March 24, 2020, including references of qualifying articles. English-language, original investigations in humans about robot-assisted and laparoscopic hepatectomy were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Continuous and dichotomous variables were compared by the weighted mean difference (WMD) and odds ratio (OR), respectively. RESULTS: Of 936 titles identified in our original search, 28 articles met our criteria, involving 3544 patients. Compared with laparoscopy, the robot-assisted groups had longer operative time (WMD: 36.93; 95% CI, 19.74-54.12; P < 0.001), lower conversion rate (OR: 0.63; 95% CI, 0.46-0.87; P = 0.005), higher transfusion rate (WMD: 2.39; 95% CI, 1.51-3.76; P < 0.001) and higher total cost (WMD:0.49; 95% CI, 0.42-0.55; P < 0.001). In addition, the baseline characteristics of patients about largest tumor size was larger (WMD: 0.36; 95% CI, 0.16-0.56; P < 0.001) and malignant lesions rate was higher (WMD: 1.50; 95% CI, 1.21-1.86; P < 0.001) in the robot-assisted versus laparoscopic hepatectomy. The subgroup analysis of minor hepatectomy showed robot-assisted was associated with longer operative time (WMD: 36.00; 95% CI, 12.59-59.41; P = 0.003), longer length of stay (WMD: 0.51; 95% CI, 0.02-1.01; p = 0.04) and higher total cost (WMD: 0.48; 95% CI, 0.25-0.72; P < 0.001) (Table 3); while the subgroup analysis of major hepatectomy showed robot-assisted was associated with lower estimated blood loss (WMD: -122.43; 95% CI, -151.78--93.08; P < 0.001). CONCLUSIONS: Our meta-analysis revealed that robot-assisted was associated with longer operative time, lower conversion rate, higher transfusion rate and total cost, and robot-assisted has certain advantages in major hepatectomy compared with laparoscopic hepatectomy.

[Risk Assessment and Source Analysis of Heavy Metals in the River of a Typical Bay Watershed].

Based on the survey data of eight kinds of heavy metals in the Xiangshan Bay watershed during the flood season, the pollution status of heavy metals in water was analyzed. The potential ecological risks of heavy metals were evaluated based on the single factor pollution index (Pi), the Nemero comprehensive pollution index (Pn), and the heavy metal pollution index (HPI). Based on the correlation between land-use types and heavy metal concentrations, the sources of heavy metals were analyzed. The results show that the average concentration of heavy metals is in the order Fe > Mn > Zn > Cu > As > Cr > Pb > Cd. All heavy metal concentrations, except those of Mn and Fe, conform to the class I surface water environment quality standard. The risk level of heavy metals is low, and there is no pollution, but some contamination. Agricultural non-point source pollution is the main factor in the contamination of heavy metals. Overall, the heavy metals in the region have not reached the risk threshold. To reasonably avoid the risk of heavy metal pollution in the urban development process, it is important to strengthen the supervision of pollution sources based on agricultural non-point sources.

Carbon footprint assessment for a local branded pure milk product: a lifecycle based approach

Abstract This paper provides a simplified life cycle based assessment for a local branded pure milk product, to measure its related carbon footprint, including production of raw milk, dairy processing, transportation of milk product and disposal of packaging waste. The results show that the total carbon footprint of the pure milk is 1120g CO2/L. The production of raw milk is identified as the major contributor to the carbon footprint. This contribution has amounted to 843 g of CO2 per liter of pure milk, accounted for 75.27% of the total carbon footprint. The carbon footprint of product transportation is 38 g of CO2 per liter, which accounts for 3.39% of the total. The carbon footprint related to the dairy processing and disposal of waste packaging is 173 g of CO2 per liter and 66 g of CO2 per liter, accounting for 15.45% and 5.89% of the total, respectively. The carbon footprint assessment intends to help dairy enterprises identify the intensive sectors of carbon emissions, and provides insight into improvement of product environmental performances.

Contrast-enhanced ultrasonography for assessment of tubular atrophy/interstitial fibrosis in immunoglobulin A nephropathy: a preliminary clinical study.

PURPOSE: To investigate the potential of contrast-enhanced ultrasonography (CEUS) for evaluating the severity of tubular atrophy/interstitial fibrosis (TA/IF) in immunoglobulin A nephropathy (IgAN) patients. MATERIALS AND METHODS: A total of 80 patients with IgAN and 33 healthy adults were investigated. Patients were divided into three groups according to the TA/IF (T) grade of the Oxford classification: T0 (n = 28), T1 (n = 35), and T2 (n = 17). Patients and control subjects underwent conventional ultrasound (US) and CEUS. Time-intensity curves of CEUS were drawn for regions of interest located in the renal cortex and medulla using QLab software. Conventional US and CEUS quantitative parameters were analyzed. One-way analysis of variance (ANOVA), binary logistic regression, and receiver operating characteristic (ROC) curves were used. RESULTS: There were no significant differences in renal size, cortical thickness, and medullary perfusion parameters (P > 0.05), whereas the differences in peak intensity (PI), area under the time-intensity curve (AUC) and wash-in slope (WIS) of cortical perfusion parameters between the control subjects and patients were significant (P < 0.05). PI was significantly lower with the increasing degree of T (P < 0.05). PI was associated independently with the degree of T in IgAN patients (P < 0.05). ROC analysis revealed that using the optimal cutoff values of 15.38 dB for diagnosis of T0-T1 (sensitivity 83.30% and specificity 63.00%) and 14.69 dB for diagnosis of T2 (sensitivity 100.00% and specificity 66.70%), the corresponding areas under the ROC curve were found to be 0.782 and 0.952, respectively. CONCLUSIONS: CEUS can potentially be used as a noninvasive imaging marker to evaluate the severity of TA/IF in IgAN patients.