[Evaluation effect of COMPERA 2.0 risk assessment model on prognosis of Chinese patients with pulmonary arterial hypertension].

Objectives: To clarify the evaluation effect of COMPERA 2.0 risk assessment model on prognosis of pulmonary arterial hypertension (PAH) in China. Methods: Patients with newly diagnosed PAH admitted in Fuwai hospital between April 2019 and March 2022 were enrolled retrospectively and divided in low, intermediate-low, intermediate-high and high strata by scores of COMPERA 2.0 risk assessment model. All the patients were followed up by clinic or telephone. The primary endpoint was defined as a composite of all-cause mortality, exacerbated heart failure and aggravated symptoms. Kaplan-Meier analysis and log-rank trend test were used to determine the risk of endpoints among the 4 groups. Multivariate Cox proportional hazards regression were used to analyze the association between COMPERA 2.0 scores and prognosis in patients with PAH. Results: A total of 951 patients with PAH were enrolled in this study. The age [M (Q1, Q3)] of the patients was 35 (28, 47) years, of which 706 cases (74.2%) were females. A total of 328 cases (34.5%) were assigned in low strata, 264 cases (27.8%) in intermediate-low strata, 193 cases (20.3%) in intermediate-high strata, and 166 cases (17.5%) in high strata. During the duration [M (Q1, Q3)] of follow-up after discharge of 1.8 (1.0, 2.8) years, the primary endpoint was occurred in 12.8% (42/328), 21.2% (56/264), 28.5% (55/193) and 42.8% (71/166) of low, intermediate-low, intermediate-high and high strata, respectively. The rates of primary endpoint were significantly increased with strata rising (P<0.001). Multivariate Cox proportional hazards regression showed that COMPERA 2.0 risk scores were associated with the primary endpoints in PAH patients (HR=1.801, 95%CI: 1.254-2.588, P=0.001) after adjusting confounders. Conclusion: COMPERA 2.0 risk assessment model is a simple and effective tool for evaluating the prognosis of newly diagnosed PAH patients in China.

Old carbon reservoirs were not important in the deglacial methane budget.

Permafrost and methane hydrates are large, climate-sensitive old carbon reservoirs that have the potential to emit large quantities of methane, a potent greenhouse gas, as the Earth continues to warm. We present ice core isotopic measurements of methane (Δ14C, δ13C, and δD) from the last deglaciation, which is a partial analog for modern warming. Our results show that methane emissions from old carbon reservoirs in response to deglacial warming were small (<19 teragrams of methane per year, 95% confidence interval) and argue against similar methane emissions in response to future warming. Our results also indicate that methane emissions from biomass burning in the pre-Industrial Holocene were 22 to 56 teragrams of methane per year (95% confidence interval), which is comparable to today.

The Concept, Status Quo and Forensic Pathology of Karoshi.

ABSTRACT: "Karoshi" originates from Japan's economic take-off period in the 1960s and 1970s. It is generally believed that overwork lead to the accumulation of fatigue, which triggers the outbreak of potential diseases, and results in sudden death. Karoshi causes great harm to both the community and families because it occurs primarily in 30 to 60 year old young adults. Japan put Karoshi into the category of industrial injury for the first time in 2001 and started to undertake a series of studies in the sociological and pathological fields. However, there is a tremendous gap in the forensic pathological diagnosis domain. In China, research on Karoshi started from the 1990s and is closely related to the reform and opening up policy as well as economic development. According to the incomplete statistics, 600 thousand people die from overwork each year in China, the highest in the world. Karoshi has become one of the most serious social problems in China at the present stage, thus a systematic study in the sociology and forensic pathology fields is urgently required. This paper summarizes the past and present status of Karoshi, and puts forward the problems that need attention during the judicial expertise of Karoshi from forensic pathology perspective.

A machine-learning framework for automatic reference-free quality assessment in MRI.

Magnetic resonance (MR) imaging offers a wide variety of imaging techniques. A large amount of data is created per examination which needs to be checked for sufficient quality in order to derive a meaningful diagnosis. This is a manual process and therefore time- and cost-intensive. Any imaging artifacts originating from scanner hardware, signal processing or induced by the patient may reduce the image quality and complicate the diagnosis or any image post-processing. Therefore, the assessment or the ensurance of sufficient image quality in an automated manner is of high interest. Usually no reference image is available or difficult to define. Therefore, classical reference-based approaches are not applicable. Model observers mimicking the human observers (HO) can assist in this task. Thus, we propose a new machine-learning-based reference-free MR image quality assessment framework which is trained on HO-derived labels to assess MR image quality immediately after each acquisition. We include the concept of active learning and present an efficient blinded reading platform to reduce the effort in the HO labeling procedure. Derived image features and the applied classifiers (support-vector-machine, deep neural network) are investigated for a cohort of 250 patients. The MR image quality assessment framework can achieve a high test accuracy of 93.7% for estimating quality classes on a 5-point Likert-scale. The proposed MR image quality assessment framework is able to provide an accurate and efficient quality estimation which can be used as a prospective quality assurance including automatic acquisition adaptation or guided MR scanner operation, and/or as a retrospective quality assessment including support of diagnostic decisions or quality control in cohort studies.

[Preliminary study on assessment of lexiscan-induced blood-brain barrier opening and its level by CT perfusion imaging].

Objective: To evaluate the level of lexiscan-induced blood-brain barrier opening of healthy rabbits via CT perfusion weighted imaging (PWI) scan. Methods: Between November 2014 and May 2015, thirty New Zealand white rabbits were randomly assigned into three groups: the experimental group A1 which received one injection of lexiscan(1 ml/kg); the experimental group A2 which received three times injection of lexiscan(total dose: 1.5 ml/kg), finished within 15 minutes; the control group B which was injected the same volume normal saline(1 ml/kg), after 30 minutes, CT PWI scan was performed. Then cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and permeability surface(PS) of the region of interest of each group were acquired and compared statistically. Five cases of each group were injected with 2% Evans blue intravenously posterior to imaging. After one hour of infusion, all the animals were killed. Their brains were examined for the determination of Evans blue distribution. Results: Both the values of CBF and CBV and the staining with Evans blue of the group A1(CBF: (89.88±2.21), (81.42±4.28) ml·(100 g)-1·min-1; CBV: (3.97±0.43), (3.66±0.16) ml/g)and group A2 (CBF: (75.16±0.84), (63.66±7.21) ml·(100 g)-1·min-1; CBV: (4.07±0.01), (3.75±0.05) ml/g) were higher than those of the group B(CBF: (20.08±5.08), (14.58±8.62) ml·(100 g)-1·min-1; CBV: (0.85±0.04), (0.65±0.17) ml/g), the differences were all statistically significant (all P<0.01). While there was no statistically difference between group A1 and group A2(P>0.05). The value of PS of the group A2((22.43±8.09), (20.20±7.01)ml·(100 g)-1·min-1 )was higher than that of group A1((13.82±4.44), (10.12±2.44)ml·(100 g)-1·min-1) and group B(0.00, 0.00)(the lowest one), the differences were all statistically significant(all P<0.01). The value of MTT of the group A1((2.50±0.82, 2.47±0.10) s) had no statistical difference with group A2 and group B, while the value of group A2((4.50±0.17), (4.72±0.15) s) was higher than that of group B((1.88±0.09), (1.99±0.00) s), the differences were all statistically significant (P<0.05). Conclusion: Changes in hemodynamics of lexiscan-induced blood-brain barrier opening can be monitored by CT PWI scan. When the total dose of lexiscan increasing, the level of the BBB opening is higher with significantly increased CBF, CBV, PS and MTT.

An in vivo and in vitro assessment of the anti-inflammatory, antinociceptive, and immunomodulatory activities of Clematis terniflora DC. extract, participation of aurantiamide acetate.

AIM: Clematis terniflora DC. has been widely used as a traditional Chinese medicine for the treatment of tonsillitis, rheumatoid arthritis, and prostatitis. Despite its widespread use in China, there are currently no studies systematically examined its therapeutic effects and mechanism of action. As such, the present study was conducted to evaluate the anti-inflammatory, antinociceptive, and immunomodulatory effects of C. terniflora DC. using rodent and cellular models. METHODS: The anti-inflammatory properties of the 70% ethanol eluted fraction of the 70% ethanol extract of C. terniflora DC. (EECTD) were evaluated using the xylene-induced ear swelling test, the carrageenan-induced edema model, and the cotton pellet granuloma method. Its antinociceptive activities were determined using both the acetic acid-induced writhing test and the hot plate assay. In parallel, we conducted an in vitro assay in LPS-induced RAW264.7 cells to examine the anti-inflammatory effects of EECTD and its purified form, aurantiamide acetate (AA) on inhibition of nitric oxide (NO) and prostaglandin E2 (PGE2) release. RESULTS: EECTD (300mg/kg) significantly reduced the number of writhing, extended the pain response latency, and suppressed xylene-induced ear swelling. Each EECTD treatment group also had significant inhibition of cotton granulation formation in addition to reduced carrageenan-induced paw edema. EECTD was also shown to alleviate signs of inflammation in histopathological paw sections. However, it had a less noticeable effect on mouse ear swelling in the delayed type hypersensitivity test. A purified compound was isolated from EECTD and its structure was identified as AA. In vitro experimental results showed that both EECTD and AA were able to significantly inhibit the release of pro-inflammatory cytokines NO and PGE2 on LPS-induced RAW264.7 cells. CONCLUSION: These results suggest that EECTD has significant anti-inflammatory and antinociceptive activities, partially related to one of the active substances identified as AA. We hypothesize that these effects are related to its ability to inhibit the production of cytokines NO and PGE2. However, further work will be needed to determine its exact mechanism of action.

A physiologically based pharmacokinetic model for the prediction of the depletion of methyl-3-quinoxaline-2-carboxylic acid, the marker residue of olaquindox, in the edible tissues of pigs.

To estimate the consumer exposure to olaquindox (OLA) residues in porcine edible tissues, a physiologically based pharmacokinetic (PBPK) model for methyl-3-quinoxaline-2-carboxylic acid (MQCA), the marker residue of OLA, was developed in pigs based on the assumptions of the flow-limited distribution, hepatic metabolism, and renal excretion. The model included separate compartments corresponding to blood, muscle, liver, kidney, adipose, and an extra compartment representing the remaining carcass. Physiological parameters were determined from literatures. Plasma protein binding, partition coefficients, and renal clearance for MQCA were determined in in vitro and in vivo studies. The metabolic conversion of OLA to MQCA was assumed as a simple, one-step process, and an apparent first-order rate constant (k) was employed to describe this metabolic process. The PBPK model was optimized and validated with plasma and tissue data from literatures and our study. Sensitivity analysis and Monte Carlo simulation were also implemented to estimate the influence of model parameters on the goodness of fit. When compared with the observed data, the PBPK model underestimated the MQCA level in all compartments at the early time points, whereas gave excellent predictions of MQCA concentration in porcine edible tissues at later time points. The correlation coefficients between the predicted and observed values were over 0.88. The consistency between the model predictions and the real residues of OLA in pigs proved the good applicability of our model in food safety risk assessment.

Evaluation of gadolinium-enhanced T1-weighted magnetic resonance imaging in the preoperative assessment of local staging in rectal cancer.

AIM: The aim of this study was to determine whether gadolinium-enhanced T1-weighted magnetic resonance (MR) sequence is beneficial in the preoperative assessment of tumour and nodal staging in patients with primary rectal cancer. METHOD: Eighty-eight patients with primary rectal cancer underwent preoperative MR imaging, followed by surgical resection. Two radiologists independently reviewed (i) T2-weighted MR images (T2WI); (ii) gadolinium-enhanced T1-weighted MR images (T1 + Gd); (iii) MR combined with T2WI and T1 + Gd for the prediction of tumour and nodal stage compared with histopathologic findings as the end point. Differences in the diagnostic performance of T2WI only, T1 + Gd image only and combined T2WI and T1 + Gd MR images were analyzed by comparing areas under receiver operating characteristic curves (Az) for each reader. Interobserver agreement was also calculated. RESULTS: There was no significant difference in the Az values of T2WI only, T1 + Gd image only and combined T2WI and T1 + Gd images for the prediction of tumour staging (Az of T2WI, T1 + Gd and combined MR images for reader 1, 0.80, 0.76 and 0.85; reader 2, 0.83, 0.82 and 0.87) and nodal staging (Az for reader 1, 0.73, 0.73 and 0.81; reader 2, 0.79, 0.80 and 0.83). Interobserver agreement for the prediction of tumour staging was moderate to substantial, while only fair agreement was noted for the prediction of nodal staging. CONCLUSION: Gadolinium-enhanced T1-weighted MRI did not increase the diagnostic yield for tumour and nodal staging, and may be omitted in the MR protocol for preoperative assessment of primary rectal cancer.

Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China.

BACKGROUND: Many people with epilepsy need not experience further seizures if the diagnosis and treatment are correct. Most epilepsy patients have convulsions, which are usually fairly easy to diagnose. This study tested a model for treatment of people with convulsive forms of epilepsy at primary health-care level in rural areas of China. METHODS: Patients with convulsive epilepsy were identified at primary care level and provided with phenobarbital monotherapy. Local physicians, who were provided with special training, carried out screening, treatment, and follow-up. A local neurologist confirmed the diagnoses. Efficacy was assessed from the percentage reduction in seizure frequency from baseline and the retention of patients on treatment. FINDINGS: The study enrolled 2455 patients. In 68% of patients who completed 12 months' treatment, seizure frequency was decreased by at least 50%, and a third of patients were seizure free. 72% of patients who completed 24 months' treatment had reduction of seizure frequency of at least 50% and a quarter of patients remained seizure free. Probability of retention was 0.84 at 1 year, and 0.76 at 2 years. Medication was well tolerated and reported adverse events were mild; only 32 patients (1%) discontinued medication because of side-effects. INTERPRETATION: This pragmatic study confirmed that this simple protocol was suitable for the treatment of convulsive forms of epilepsy in rural areas of China. Physicians with basic training could treat epilepsy patients with phenobarbital, with beneficial effects for most patients with convulsive seizures. Few cognitive or behavioural adverse events were noted, but formal psychometric testing was not done.

Primary cutaneous follicular lymphoma: an assessment of clinical, histopathologic, immunophenotypic, and molecular features.

PURPOSE: Unlike nodal follicular lymphoma (NFL), Primary cutaneous follicular lymphomas (PCFLs) rarely express Bcl-2 protein or t(14;18)(q32;q21) (Bcl-2/IgH). The aim of this study was to further characterize PCFL in a large series from North America. PATIENTS AND METHODS: Clinical data and archival formalin-fixed, paraffin-embedded tissue were obtained from 32 patients. PCFL was defined as follicular lymphoma limited to the skin at the time of diagnosis and within the first 6 months after diagnosis. Specimens were analyzed for the expression of CD3, CD10, CD20, Bcl-2, and Bcl-6 proteins by immunohistochemistry as well as for the presence of t(14;18)(q32;q21) by polymerase chain reaction. RESULTS: The male-to-female ratio was 1.5:1, with a median age of 60 years. Twenty-four patients had lesions on the head and neck, five had lesions on the trunk, and three had lesions on both head and trunk. Follow-up data were available in all cases, with a mean length of 35.8 months. The majority of the patients were treated with radiation therapy. All patients were alive at last follow-up except one. Recurrence was noted in seven patients (22%), after a mean disease-free survival time of 17.7 months. CD10 and Bcl-6 expression were seen in 29 (91%) of 32 and 31 (97%) of 32 cases, respectively. Bcl-2 expression was noted in 13 (41%) of 32 cases. PCR results for t(14;18)(q32;q21) were positive in 11 (34%) of 32 patients and showed correlation with Bcl-2 protein expression. The sequencing of the t(14;18)(q32;q21) amplicons confirmed unique breakpoints in each of the seven tested cases. Comparison between the Bcl-2 and/or t(14;18)(q32;q21)-positive and t(14;18)(q32;q21)-negative cases revealed no significant difference in age, site, clinical course, or outcome. CONCLUSION: We demonstrated Bcl-2 protein expression and t(14;18)(q32;q21) in a significant minority of cases, suggesting a relationship with NFL. It remains to be seen whether, on longer follow-up, there is any clinical difference in cases with and without t(14;18)(q32;q21).

The effects of tibial rotation on the patellofemoral joint: assessment of the changes in in situ strain in the peripatellar retinaculum and the patellofemoral contact pressures and areas.

The objective of this study was to determine the effects of tibial rotation on in situ strain in the peripatellar retinaculum and patellofemoral contact pressures and areas. Patellofemoral joint biomechanics demonstrate a strong correlation with the etiology of patellofemoral disorders, such as chondromalacia, and are significantly influenced by tibial rotation. Six human cadaveric knees were used along with a patellofemoral joint testing jig that permits physiological loading of the knee extensor muscles. Patellofemoral contact pressures and areas were measured with a Fuji pressure-sensitive film, and the changes in in situ strain in the peripatellar retinaculum were measured with four differential variable reluctance transducers. Tibial rotation had a significant effect on patellofemoral joint biomechanics. The data showed an inverse relationship between increasing knee flexion angles and the change in patellofemoral contact pressures and in situ strain with tibial rotation. At higher knee flexion angles, the patella is well-seated in the trochlear groove and the function of the peripatellar retinaculum is minimized and less affected by tibial rotations.

The impact of economic crisis on health-care consumption in Korea.

This study uses urban household income-expenditure survey data, national health insurance claims data, and public health centre surveys to examine the impact of economic crisis on the consumption of health services in Korea. The analysis shows that the health-care consumption of Korean households has been adversely affected by the recent economic crisis, as measured by amount of expenditure on health. Distributional implications for health sector use are also found. Whereas the use of medical services by upper income groups is only slightly affected by the economic crisis, lower income groups are spending relatively less on medical services. Of all households, unemployed households are hit hardest by the crisis. Analysis shows that for all households, the rate of expenditure decrease is relatively higher for drug expenditure than for expenditure on medical services. That is, facing declining income, people cut their spending in the area where the need is non-essential or less inevitable.

Suicide as an indicator of quality of life: apparent conflict between microeconomic and macroeconomic approaches.

While a low incidence of suicide may indicate a high quality of life for individuals, the reverse may be true at the societal level.

Economic evaluation of the societal costs of hepatitis B in South Korea.

BACKGROUND AND AIMS: Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). METHODS: The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. RESULTS: The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. CONCLUSIONS: This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.

Monte Carlo studies of model Langmuir monolayers.

This paper examines some of the basic properties of a model Langmuir monolayer, consisting of surfactant molecules deposited onto a water subphase. The surfactants are modeled as rigid rods composed of a head and tail segment of diameters sigma(hh) and sigma(tt), respectively. The tails consist of n(t) approximately 4-7 effective monomers representing methylene groups. These rigid rods interact via site-site Lennard-Jones potentials with different interaction parameters for the tail-tail, head-tail, and head-head interactions. In a previous paper, we studied the ground-state properties of this system using a Landau approach. In the present paper, Monte Carlo simulations were performed in the canonical ensemble to elucidate the finite-temperature behavior of this system. Simulation techniques, incorporating a system of dynamic filters, allow us to decrease CPU time with negligible statistical error. This paper focuses on several of the key parameters, such as density, head-tail diameter mismatch, and chain length, responsible for driving transitions from uniformly tilted to untilted phases and between different tilt-ordered phases. Upon varying the density of the system, with sigma(hh)=sigma(tt), we observe a transition from a tilted (NNN)-condensed phase to an untilted-liquid phase and, upon comparison with recent experiments with fatty acid-alcohol and fatty acid-ester mixtures [M. C. Shih, M. K. Durbin, A. Malik, P. Zschack, and P. Dutta, J. Chem. Phys. 101, 9132 (1994); E. Teer, C. M. Knobler, C. Lautz, S. Wurlitzer, J. Kildae, and T. M. Fischer, J. Chem. Phys. 106, 1913 (1997)], we identify this as the L'(2)/Ov-L1 phase boundary. By varying the head-tail diameter ratio, we observe a decrease in T(c) with increasing mismatch. However, as the chain length was increased we observed that the transition temperatures increased and differences in T(c) due to head-tail diameter mismatch were diminished. In most of the present research, the water was treated as a hard surface, whereby the surfactants are only allowed to move within the plane of this surface. However, we have also utilized a more realistic model for the surfactant-water interactions, developed by Karaborni and Toxvaerd, in order to examine the role which the coupled effects of head group size and head group-subphase interactions plays in determining tilt ordering and on the stability of the monolayer. It is found that increasing the head diameter results in a widening of the air-water interface and an associated destruction of orientational order. Furthermore, the onset of capillary waves at lower temperatures for larger head diameters implies that the L2-L1 phase boundary for acids and acetates should move to lower temperatures relative to the L'(2)/Ov-L1 phase boundary for alcohols and esters. This feature has yet to be seen in experimental studies.

Predicting the number of credit cards held by college students.

In a sample of 186 undergraduate students, the number of credit cards they held was associated with sex, their affective attitude toward credit cards, and an attitude of being careful with money.

Culture and the economy.

In a sample of 18 industrialized nations, measures of national character did not improve the power of socioeconomic variables in predicting unemployment rates.