A systematic review on reporting quality of economic evaluations for negotiated glucose-lowering drugs in China national reimbursement drug list.

BACKGROUND: This study aimed to examine the reporting quality of existing economic evaluations for negotiated glucose-lowering drugs (GLDs) included in China National Reimbursement Drug List (NRDL) using the Consolidated Health Economic Evaluation Reporting Standards 2013 (CHEERS 2013). METHODS: We performed a systematic literature research through 7 databases to identify published economic evaluations for GLDs included in the China NRDL up to March 2021. Reporting quality of identified studies was assessed by two independent reviewers based on the CHEERS checklist. The Kruskal-Wallis test and Mann-Whitney U test were performed to examine the association between reporting quality and characteristics of the identified studies. RESULTS: We have identified 24 studies, which evaluated six GLDs types. The average score rate of the included studies was 77.41% (SD:13.23%, Range 47.62%-91.67%). Among all the required reporting items, characterizing heterogeneity (score rate = 4.17%) was the least satisfied item. Among six parts of CHEERS, results part scored least at 0.55 (score rate = 54.79%) because of the incompleteness of characterizing uncertainty. Results from the Kruskal-Wallis test and Mann-Whitney U test showed that model choice, journal type, type of economic evaluations, and study perspective were associated with the reporting quality of the studies. CONCLUSIONS: There remains room to improve the reporting quality of economic evaluations for GLDs in NRDL. Checklists such as CHEERS should be widely used to improve the reporting quality of economic researches in China.

Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis.

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

[Spatio-temporal Variation in NEP in Ecological Zoning on the Loess Plateau and Its Driving Factors from 2000 to 2021].

Net ecosystem productivity (NEP) is an important index for the quantitative evaluation of carbon sources and sinks in terrestrial ecosystems. Based on MOD17A3 and meteorological data, the vegetation NEP was estimated from 2000 to 2021 in the Loess Plateau (LP) and its six ecological subregions of the LP (loess sorghum gully subregions:A1, A2; loess hilly and gully subregions:B1, B2; sandy land and agricultural irrigation subregion:C; and earth-rock mountain and river valley plain subregion:D). Combined with the terrain, remote sensing, and human activity data, Theil-Sen Median trend analysis, correlation analysis, multiple regression residual analysis, and geographic detector were used, respectively, to explore the spatio-temporal characteristics of NEP and its response mechanism to climate, terrain, and human activity. The results showed that:① On the temporal scale, from 2000 to 2021 the annual mean NEP of the LP region (in terms of C) was 104.62 g·(m2·a)-1. The annual mean NEP for both the whole LP and each of the ecological subregions showed a significant increase trend, and the NEP of the LP increased by 6.10 g·(m2·a)-1 during the study period. The highest growth rate of the NEP was 9.04 g·(m2·a)-1, occurring in the A2 subregion of the loess sorghum gully subregions. The subregion C had the lowest growth rate of 2.74 g·(m2·a)-1. Except for the C subregion, all other ecological subregions (A1, A2, B1, B2, and D) were carbon sinks. ② On the spatial scale, the spatial distribution of annual NEP on the LP was significantly different, with the higher NEP distribution in the southeast of the LP and the lower in the northwest of the LP. The high carbon sink area was mainly distributed in the southern part of the loess sorghum gully subregions, and the carbon source area was mainly distributed in the northern part of the loess sorghum gully subregions and most of the C subregion. The high growth rate was mainly distributed in the central and the southern part of the A2 subregion and the southwest part of the B2 subregion. ③ Human activities had the greatest influence on the temporal variation in NEP in the LP and all the ecological subregions, with the correlation coefficient between human activity data and NEP being above 0.80, and the relative contribution rates of human factors was greater than 50%. The spatial distribution was greatly affected by meteorological factors, among which the precipitation and solar radiation were the main factors affecting the spatial changes in the NEP of the LP. The temporal and spatial variations in the NEP in the LP were influenced by natural and human social factors. To some extent, these results can provide a reference for the terrestrial ecosystem in the LP to reduce emissions and increase sinks and to achieve the goal of double carbon.

Perceived control, self-management efficacy, and quality of life in patients treated with radiation therapy for breast cancer: a longitudinal study.

OBJECTIVE: This longitudinal study aims to examine the present state of perceived control, self-management efficacy, and overall quality of life (QoL) in patients with breast cancer undergoing radiotherapy, and gain insight into the dynamic trends and factors that influence the quality of life experienced by patients during the course of radiotherapy. METHODS: Participants completed the Cancer Experience and Efficacy Scale (CEES), Strategies Used by People to Promote Health (SUPPH), and Functional Assessment of Cancer Therapy- Breast (FACT-B). The data was analyzed using the software SPSS26.0. Repeated measures analysis of variance (ANOVA) and mixed-effects linear models were used to analyze trends in perceived control, self-management efficacy, and QoL at three-time points, as well as factors affecting QoL during radiotherapy. RESULTS: Perceived control and self-management efficacy were associated with QoL over the course of the radiotherapy. Self-management efficacy (ß = 0.30, P < 0.001), presence of chemotherapy (ß = 18.33, P = 0.024), and duration of illness (ß = 2.25, P = 0.028) had a positive effect on the change in QoL, while time (ß = - 2.95, P < 0.001), cancer experience (ß = - 0.46, P < 0.001), and type of medical insurance (ß = - 2.77, P = 0.021) had the negative effect on the change in QoL. CONCLUSION: The QoL, perceived control, and self-efficacy of patients with breast cancer show dynamic changes during radiotherapy. The higher the self-efficacy, the better the QoL, and the worse the QoL when the sense of disease control is poor. At the same time, more attention should be paid to the QoL of breast cancer radiotherapy patients with a long course of the disease, receiving chemotherapy, and different medical payment methods.

Development of Cost-Effective Fatty Liver Disease Prediction Models in a Chinese Population: Statistical and Machine Learning Approaches.

BACKGROUND: The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) in China presents a significant public health concern. Traditional ultrasound, commonly used for fatty liver screening, often lacks the ability to accurately quantify steatosis, leading to insufficient follow-up for patients with moderate-to-severe steatosis. Transient elastography (TE) provides a more quantitative diagnosis of steatosis and fibrosis, closely aligning with biopsy results. Moreover, machine learning (ML) technology holds promise for developing more precise diagnostic models for NAFLD using a variety of laboratory indicators. OBJECTIVE: This study aims to develop a novel ML-based diagnostic model leveraging TE results for staging hepatic steatosis. The objective was to streamline the model's input features, creating a cost-effective and user-friendly tool to distinguish patients with NAFLD requiring follow-up. This innovative approach merges TE and ML to enhance diagnostic accuracy and efficiency in NAFLD assessment. METHODS: The study involved a comprehensive analysis of health examination records from Suzhou Municipal Hospital, spanning from March to May 2023. Patient data and questionnaire responses were meticulously inputted into Microsoft Excel 2019, followed by thorough data cleaning and model development using Python 3.7, with libraries scikit-learn and numpy to ensure data accuracy. A cohort comprising 978 residents with complete medical records and TE results was included for analysis. Various classification models, including logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost), were constructed and evaluated based on the area under the receiver operating characteristic curve (AUROC). RESULTS: Among the 916 patients included in the study, 273 were diagnosed with moderate-to-severe NAFLD. The concordance rate between traditional ultrasound and TE for detecting moderate-to-severe NAFLD was 84.6% (231/273). The AUROC values for the RF, LightGBM, XGBoost, SVM, KNN, and LR models were 0.91, 0.86, 0.83, 0.88, 0.77, and 0.81, respectively. These models achieved accuracy rates of 84%, 81%, 78%, 81%, 76%, and 77%, respectively. Notably, the RF model exhibited the best performance. A simplified RF model was developed with an AUROC of 0.88, featuring 62% sensitivity and 90% specificity. This simplified model used 6 key features: waist circumference, BMI, fasting plasma glucose, uric acid, total bilirubin, and high-sensitivity C-reactive protein. This approach offers a cost-effective and user-friendly tool while streamlining feature acquisition for training purposes. CONCLUSIONS: The study introduces a groundbreaking, cost-effective ML algorithm that leverages health examination data for identifying moderate-to-severe NAFLD. This model has the potential to significantly impact public health by enabling targeted investigations and interventions for NAFLD. By integrating TE and ML technologies, the study showcases innovative approaches to advancing NAFLD diagnostics.

Effect of illness perception on predicting breast cancer-related lymphedema risk management behaviours among breast cancer patients: A comparison between dimensions and profiles.

AIM: This study aimed to explore the utility of latent profile analysis of illness perception, in comparison to treating illness perception as several dimensions, to predict breast cancer-related lymphedema risk management behaviours among Chinese breast cancer patients. METHODS: This is a 3-month longitudinal study. From August 2019 to January 2021, patients who recently underwent breast cancer surgery including axillary lymphadenectomy were recruited. Illness perception and risk management behaviours were measured by breast cancer-related lymphedema specific questionnaires before discharge following surgery (n = 268) and at 3 months postsurgery (n = 213), respectively. RESULTS: Treating illness perception as several dimensions, 'illness coherence' and 'timeline (cyclical)' dimensions were found to be significantly associated with breast cancer-related lymphedema risk management behaviours. Using the latent profile analysis, two illness perception profiles were identified and significant differences were revealed in breast cancer-related lymphedema risk management behaviours between them. Overall, illness perception profiles explained smaller amounts of variability in breast cancer-related lymphedema risk management behaviours than illness perception dimensions. CONCLUSION: Future studies could combine these two different perspectives of illness perception regarding breast cancer-related lymphedema into the design of interventions to improve breast cancer-related lymphedema risk management behaviours.

The impact of investor sentiment on firms' green total factor productivity-facilitator or inhibitor?

Investor sentiment does not only have negative impacts. It may also improve green total factor productivity by invigorating funds. This research constructs a new indicator at the firm level to measure the green total factor productivity of firms. We research the effect of investor sentiment on firms' green total factor productivity using a sample of Chinese heavy polluters listed on Shanghai and Shenzhen A-shares between 2015 and 2019. Through a series of tests, the mediating role of agency costs and financial situations is confirmed. It is discovered that the digitization of businesses facilitates the effect of investor sentiment on the green total factor productivity of businesses. And when managerial competence reaches a certain threshold, the impact of investor sentiment on green total factor productivity is amplified. Tests for heterogeneity reveal that high investor sentiment has a larger impact on green total factor productivity in firms with superior supervision.

Spatial and temporal variations of extreme climate index in the Songhua River Basin during 1961-2020.

Understanding climate change and extreme climate is of great significance for ensuring food security and socio-economic development of the Songhua River Basin. Based on the daily precipitation, maximum temperature and minimum temperature data during 1961-2020 from 69 meteorological stations in and around the Songhua River Basin, we analyzed the temporal and spatial variations of extreme temperature and precipitation in the Songhua River Basin using 27 extreme climate indices recommended by the World Meteorological Organization, and linear trend method, Mann-Kendall trend test and ordinary Kriging interpolation methodology. The results showed that, from 1961 to 2020, except for cold speel duration, the extreme cold index in the study area showed a downward trend, while the extreme warm index, extreme value index and other temperature indices showed an upward trend. The increasing trend of the minimum temperature was greater than that of the maximum temperature. Icing days, cold speel duration and warm speel duration showed an increasing trend from south to north, while the minimum value of maximum temperature and that of minimum temperature showed opposite spatial characteristics. The high value areas of summer days and tropical nights were mainly distributed in the southwestern region, while there was no obvious spatial variations of cool days, warm nights, and warm days. Overall, except for cold speel duration, other extreme cold indices had a rapid decreasing trend in the north and west of the Songhua River Basin. In the warm index, summer days, warm nights, warm days, and warm speel duration had a rapid upward trend in the north and west, and tropical nights had the fastest rise in the southwest. In the extreme value index, the maximum of temperature rose fastest in the northwest, while the minimum rose fastest in the northeast. Except for consecutive dry days, the rest of precipitation indices showed an increasing trend, and the fastest rising areas were mainly in the north-central part of the Nenjiang River Basin, while some areas in the south of the Nenjiang River Basin became dry. Heavy precipitation days, very heavy precipitation days, heaviest precipitation days, consecutive wet days, very wet day precipitation, extremely wet day precipitation, and annual precipitation showed a gradual decreasing pattern from southeast to northwest. Overall, the Songhua River Basin was warming and wetting, but there were some differences among different regions, especially the northern and southern parts of the Nenjiang River Basin.

A Habitable Earth and Carbon Neutrality: Mission and Challenges Facing Resources and the Environment in China-An Overview.

Since the Industrial Revolution, the impacts of human activities have changed the global climate system, and climate warming has had rapid and widespread effects on the planet. At present, the world is experiencing a series of natural disasters, such as climate change, environmental pollution, biodiversity loss, and sea level rise, which pose a serious threat to the livability of the Earth. An international consensus has been reached that achieving carbon neutrality is the key to tackling climate change; it is also crucial to building a livable planet. To achieve carbon neutrality, energy is the main aspect, for which technology regarding resources and the environment is essential. In this context, we collected data, performed an in-depth analysis of the basic and structural characteristics of the development of the coal industry and environmental remediation, studied and judged the trends in regional economic development and demand growth, and closely examined the requirements of China's development strategy, which focuses on the ideas of carbon peak and carbon neutralization in line with local development trends and economic system characteristics. We must build a livable Earth, promote the green and low-carbon transformation of regional energy, promote high-quality economic development, and ensure the safe supply of energy.

[Technical system, strategy and development trend of excipient innovation research for pediatric preparations].

Under the background of the "14th Five-Year Plan" industry development, the pharmaceutical industry has ushered in a critical period of strategic transformation. Pharmaceutical excipients are a major categoryin drugs in addition tomedicinal substances, and the research and development of industrial technologies and innovative products play a decisive role in the development of high-quality drugs. The special drug for children is the focus ofthe pharmaceutical industry in the new era, and the application of standar-dized excipients is a key step indistinguishingbetween adult drugs and special drugs for children. In the context of the policy background in China, this paper reviewed the status quo of excipient industry, technical bottlenecks, application problems of pediatric excipients, and their development hotspots, interpreted the strategic layout of excipient innovation research and development suitable for pediatric preparations, and put forward prospects for their future development technicalroutes to lay a solid foundation for the industry transformation.

Exploration of the Implementation of Carbon Neutralization in the Field of Natural Resources under the Background of Sustainable Development-An Overview.

On 15 March 2021, Chinese President Xi Jinping pointed out that "achieving carbon peak and carbon neutrality is a broad and profound economic and social systemic change" and called for "putting energy and resources conservation in the first place". Natural resources are the material basis, space carrier and energy source of high-quality development. The source of carbon emissions is resource utilization, and carbon reduction and removal also depend on resources. The improvement of carbon sink capacity is inseparable from natural resources. To achieve the goal of "double carbon", it is necessary to consolidate the carbon sink capacity of the ecosystem, as well as enhancing its carbon sink increment. Among natural resources, forest carbon sinks, soil carbon sinks and karst carbon sinks have significant emission reduction potential and cost advantages, representing important means to deal with climate change. This paper reviews the relevant research results at home and abroad, summarizes the carbon sink estimation, carbon sink potential, carbon sink influencing factors, ecological compensation mechanism and other aspects, analyzes the path selection of establishing carbon sink green development, and puts forward corresponding policies and suggestions, providing a theoretical reference for the achievement of the carbon neutrality goal in the field of natural resources in China.

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia.

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

Societal drivers of human echinococcosis in China.

BACKGROUND: Echinococcosis is a parasitic zoonotic disease that threatens human health and economic development. In China, 370 counties are endemic for echinococcosis. Qinghai-Tibet Plateau has the most patients and people at risk. Therefore, analyzing the societal factors related to susceptibility to the disease is critical for efficient prevention and control of echinococcosis. METHODS: The demographic characteristics and lifestyle of echinococcosis cases were clustered using K-means cluster analysis to determine the main factors of risk of echinococcosis. RESULTS: Middle-aged and young people as well as those with a low education level and herdsmen are at risk of contracting echinococcosis. Nomadism, domestic and feral dogs in the surrounding environment, and drinking heavily polluted natural surface water are the main behavioral risk factors. The cystic echinococcosis (CE) and alveolar echinococcosis (AE) cluster analysis focused on female, middle-aged, and young people, winter settlement and summer nomadism, and domestic and feral dogs in the surrounding environment. There were significant differences in lifestyle between Qinghai-Tibet Plateau cases and non-Qinghai-Tibet-Plateau cases. CONCLUSION: According to the distribution of cases and CE and AE, this study identified the factors of risk of echinococcosis in the Qinghai-Tibet Plateau and non-Qinghai-Tibet Plateau. Adapted control techniques appropriate for the various epidemic areas should be established to serve as a reference for echinococcosis prevention.

Aberrant gray matter volume and functional connectivity in Parkinson's disease with minor hallucination.

Background: Minor hallucination (MH) is the most common psychotic symptom in Parkinson's disease (PD); it can develop into well-structured visual hallucination (VH), suggesting that MH may be a staccato form of well-structured VH. However, it remains unclear whether the pathogenesis is the same. Therefore, the aim of this study was to investigate the altered gray matter volume (GMV) and functional connectivity (FC) of MH in PD to further understand the complex mechanisms. Materials and methods: We included 67 PD patients who attended the outpatient clinic of Nanjing Medical University Affiliated Brain Hospital and recruited 31 healthy controls (HC). Demographic data and clinical characteristics of all subjects were recorded, and cranial structural magnetic resonance imaging (MRI) and resting-state functional MRI data were acquired. Patients were classified into the PD with MH (PD-MH) group and PD without hallucinations or delusions (PD-NH) group. Voxel-based morphometry was used to analyze the differences in GMV in the structural pattern. Seed-based FC was used to analyze the functional pattern. Gaussian random field correction was used, with voxel level P < 0.001 and cluster level P < 0.05 representing statistically significant differences. Finally, the correlation between FC values and scores on the clinical characteristics assessment scale was analyzed. Results: In the GMV analysis, compared to the PD-NH group, the PD-MH group had reduced GMV in the medial superior frontal gyrus (SFGmed). In the FC analysis, the FC between the SFGmed and the left middle occipital gyrus and right calcarine sulcus decreased in the PD-MH group compared with the PD-NH group, while the FC between SFGmed and the left middle temporal gyrus increased. Correlation analysis revealed that the FC values of the SFGmed and right calcarine sulcus were correlated with the assessment scores for anxiety and sleep symptoms. The FC values of the SFGmed and left middle occipital gyrus were correlated with assessment scores for rapid eye movement disorder. Conclusion: The aberrant structure and function of the default mode network and visual processing areas seems to facilitate the generation of MH in PD, as the alteration was previously found in well-structured VH, suggesting that the two hallucinations have similar pathophysiological mechanisms.

Study on the Application of Sediment-Based Embankment Building and Ultra-High-Performance Concrete (UHPC) Preparation in the Resource Utilization of Yellow River Sediment.

The Yellow River is difficult to control. Little water and a large amount of sediment results in sediment accumulation in its lower reaches as sediment inflow exceeds transport capacity. Reducing this sediment deposition is essential for harnessing the Yellow River. Included in this process is the rational use of the sediment. Many researchers have investigated usage of Yellow River sediment as an aggregate material for concrete production, but there are still some problems (e.g., low resource utilization and low strength of the concrete made from Yellow River sediment). To make up the deficiency in the existing research, this study proposes two methods of sediment utilization. One is to use Yellow River sediment to build embankments, and the other is to use ultra-fine Yellow River sand to prepare ultra-high-performance concrete (UHPC). Test results reveal that the prepared high-strength concrete performs well in each test, including: fluidity, mechanical properties, pore structure, ecological evaluation, microscopic measurement of the interface transition zone, and economic analysis.

PaCAR: COVID-19 Pandemic Control Decision Making via Large-Scale Agent-Based Modeling and Deep Reinforcement Learning.

BACKGROUND: Policy makers are facing more complicated challenges to balance saving lives and economic development in the post-vaccination era during a pandemic. Epidemic simulation models and pandemic control methods are designed to tackle this problem. However, most of the existing approaches cannot be applied to real-world cases due to the lack of adaptability to new scenarios and micro representational ability (especially for system dynamics models), the huge computation demand, and the inefficient use of historical information. METHODS: We propose a novel Pandemic Control decision making framework via large-scale Agent-based modeling and deep Reinforcement learning (PaCAR) to search optimal control policies that can simultaneously minimize the spread of infection and the government restrictions. In the framework, we develop a new large-scale agent-based simulator with vaccine settings implemented to be calibrated and serve as a realistic environment for a city or a state. We also design a novel reinforcement learning architecture applicable to the pandemic control problem, with a reward carefully designed by the net monetary benefit framework and a sequence learning network to extract information from the sequential epidemiological observations, such as number of cases, vaccination, and so forth. RESULTS: Our approach outperforms the baselines designed by experts or adopted by real-world governments and is flexible in dealing with different variants, such as Alpha and Delta in COVID-19. PaCAR succeeds in controlling the pandemic with the lowest economic costs and relatively short epidemic duration and few cases. We further conduct extensive experiments to analyze the reasoning behind the resulting policy sequence and try to conclude this as an informative reference for policy makers in the post-vaccination era of COVID-19 and beyond. LIMITATIONS: The modeling of economic costs, which are directly estimated by the level of government restrictions, is rather simple. This article mainly focuses on several specific control methods and single-wave pandemic control. CONCLUSIONS: The proposed framework PaCAR can offer adaptive pandemic control recommendations on different variants and population sizes. Intelligent pandemic control empowered by artificial intelligence may help us make it through the current COVID-19 and other possible pandemics in the future with less cost both of lives and economy. HIGHLIGHTS: We introduce a new efficient, large-scale agent-based epidemic simulator in our framework PaCAR, which can be applied to train reinforcement learning networks in a real-world scenario with a population of more than 10,000,000.We develop a novel learning mechanism in PaCAR, which augments reinforcement learning with sequence learning, to learn the tradeoff policy decision of saving lives and economic development in the post-vaccination era.We demonstrate that the policy learned by PaCAR outperforms different benchmark policies under various reality conditions during COVID-19.We analyze the resulting policy given by PaCAR, and the lessons may shed light on better pandemic preparedness plans in the future.

Illness perceptions and adherence to breast cancer-related lymphedema risk management behaviours among breast cancer survivors.

PURPOSE: To describe illness perceptions of breast cancer-related lymphedema (BCRL) and adherence to BCRL risk management behaviours and analyse the relationship between these factors in postoperative breast cancer survivors in China. METHODS: A cross-sectional study was conducted in the first half of 2019 using 281 breast cancer survivors. Participants' illness perceptions and adherence to BCRL risk management behaviours at the 3rd month after surgery were investigated using the Revised Illness Perception Questionnaire for BCRL (IPQ-R [BCRL]), Lymphedema Risk Management Behaviour Questionnaire (LRMBQ), and Functional Exercise Adherence Scale (FEAS). The relationship between these variables was studied using correlation analysis and multiple linear regression analysis. RESULTS: Among the four dimensions of the LRMBQ, the mean score of our respondents received in "skin care" was 3.63 (S.D. 0.67), which was the lowest on the dimension, demonstrating the worst performance in this aspect. Regarding the FEAS results, better functional exercise adherence was observed in our sample compared to previous Chinese research. The results also showed that adherence to BCRL risk management behaviours was related to patient age and degree of education. Furthermore, other dimensions of illness perceptions, such as consequence, timeline acute/chronic, illness coherence and identity, follow their multiple linear regression equations with their corresponding BCRL risk management behaviour adherence. CONCLUSIONS: Our findings confirmed the importance of illness perceptions for adherence to BCRL risk management behaviours, suggesting that we need to pay attention to patients' cognition in this respect and supply necessary interventions.

In vivo real-time assessment of the anastomotic blood supply in colorectal surgery using confocal laser endomicroscopy in an anastomotic model.

BACKGROUND AND STUDY AIMS: Anastomotic ischemia can affect healing and eventually lead to anastomotic leakage, and confocal laser endomicroscopy (CLE) can offer detailed observations at the subcellular level. We aimed to evaluate the anastomotic microcirculation in different anastomotic perfusion models using CLE. METHODS: Anastomotic perfusion models were established using twelve rabbits distributed into two groups: group A (good perfusion, n = 6) and group B (poor perfusion, n = 6). Afterward, intraoperative detection of anastomotic perfusion was carried out using CLE, and quantitative analysis of blood cells was performed. Rabbits that satisfied the criteria underwent a second exploratory operation and specimens were stained by hematoxylin and eosin. RESULTS: Enhanced with fluorescein sodium, capillaries were obviously highlighted in group A, while few capillaries were viewed in group B. Delayed development of fluorescence occurred in group B. The average flow of blood cells was 37.0 ± 5.93 per minute in group A and 6.33 ± 2.16 per minute in group B (p < 0.001). In addition, during the second exploratory surgery, rabbits with inadequate anastomotic perfusion exhibited more serious intestinal adhesion and ischemia. Anastomotic leakage and abdominal infection occurred in all rabbits in group B. CONCLUSION: CLE can realize real-time imaging of the anastomotic microcirculation and is a feasible technique for performing intraoperative evaluation in different anastomotic perfusion situations. This animal experiment provides the groundwork for future in vivo research in humans.

The cost of obsessive-compulsive disorder (OCD) in China: a multi-center cross-sectional survey based on hospitals.

BACKGROUND: Obsessive-compulsive disorder (OCD) is considered a very debilitating disorder with severe loss of quality of life and income. AIMS: This study estimates the quality of life and economic consequences of OCD in China. METHODS: The research team interviewed 639 patients with OCD in 13 hospitals in 12 cities in China. The direct method was used to get the direct cost of OCD. Indirect costs associated with OCD were estimated using the human capital approach. Linear regression analysis was conducted for quality of life and generalised linear model analysis was conducted for total cost. Sensitivity analysis was used to analyse the uncertainty of total cost. RESULTS: The mean quality of life score for OCD was 52.78 (20.46). The annual total cost of OCD per capita was 24 503.78 (95% CI: 22 621.53 to 26 386.03) renminbi (RMB) (US$3465.88 (95% CI: US$3199.65 to US$3732.11)). The annual cost of OCD in China was estimated to be 37.74 billion (95% CI: 34.95 billion to 40.53 billion) RMB (equal to US$5.34 billion (95% CI: US$4.94 billion to US$5.73 billion)). Sensitivity analysis showed that the total annual cost of OCD in China was between 23.15 billion RMB (US$3.27 billion) and 370.00 billion RMB (US$52.33 billion). Worse social function status, more psychiatric symptoms and higher Yale Brown Obsessive-Compulsive Scale (Y-BOCS) score were associated with worse quality of life. The numbers of clinic visits and hospitalisations, socioeconomic status, education, Y-BOCS scores and age were found to be significantly associated with total cost. CONCLUSIONS: OCD is associated with low quality of life and high costs in China. The findings call for concerted efforts to improve services for patients with OCD.Improvements may include early detection and diagnosis, the provision of evidence-based treatments and relapse prevention strategies.

The spatial-temporal evolution of heavy metal accumulation in the offshore sediments along the Shandong Peninsula over the last 100 years: Anthropogenic and natural impacts.

The anthropogenic and natural impacts on the temporal and spatial variations of heavy metals in sediments under the Shandong Peninsula coastal current are still unclear. Here, the concentrations\burial fluxes of Cr, Cu, Zn, As, and Pb in three sediment cores retrieved from the Bohai Sea and the Yellow Sea along the Shandong Peninsula were analyzed to study the spatial-temporal variability of heavy metal accumulation over the last century. The results showed that the buried heavy metal fluxes were relatively low at the end of the Shandong Peninsula coastal current. The enrichment factor (EF) and geoaccumulation index (Igeo) indicated that those metals did not severely pollute the sediments except As that reached a moderate enrichment. Principal component analysis (PCA) revealed that Cr, Cu, Zn, and Pb were mainly derived from natural weathering and As was determined by anthropogenic contamination. The strength of the Shandong Peninsula coastal current, the Yellow River estuary location, and sediment discharge load significantly influenced the concentrations of natural-origin heavy metals by affecting sediment grain size and the source-sink process. The emission of pollutants from agricultural and industrial activities in the Shandong Peninsula region resulted in As enrichment since the 1950s. Moreover, the EF values of heavy metals in sediment cores from China's coastal seas showed apparent spatial variations of heavy metal pollution but had coherent temporal variability with China's economic development process. Heavy metals pollution has weakened in most coastal seas since the 2000s, likely due to the extensive industrial upgrading and the implementation of pollution control. These results have a reference significance for studying the evolution and source-sink process of the heavy metals in offshore sediments and tracing anthropogenic impacts in different periods.