Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non-ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project.

BACKGROUND: This study aimed to examine hospital performance on evidence-based management strategies for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and variations across hospitals. METHODS: Improving Care for Cardiovascular Disease in China (CCC)-ACS project is an ongoing registry and quality improvement project, with 150 tertiary hospitals recruited across China. We examined hospital performance on nine management strategies (Class I Recommendations with A Level of Evidence) based on established guidelines. We also evaluated the proportion of patients receiving defect-free care, which was defined as the care that included all the required management strategies for which the patient was eligible. The hospital-level variations in the performance were examined. RESULTS: From 2014 to 2018, 28,170 NSTE-ACS patients were included. Overall, 16% of patients received defect-free care. Higher-performing metrics were statin at discharge (93%), cardiac troponin measurement (92%), dual antiplatelet therapy (DAPT) within 24 hours (90%), and DAPT at discharge (85%). These were followed by metrics of ß-blocker at discharge (69%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) at discharge (59%), and risk stratification (56%). Lower-performing metrics were smoking cessation counseling (35%) and percutaneous coronary intervention (PCI) within recommended times (33%). The proportion of patients receiving defect-free care substantially varied across hospitals, ranging from 0% to 58% (Median (interquartile range):12% (7%-21%)). There were large variations across hospitals in performance on risk stratification, smoking cessation counseling, PCI within recommended times, ACEI/ARB at discharge and ß-blocker at discharge. CONCLUSIONS: About one in six NSTE-ACS patients received defect-free care, and the performance varied across hospitals.

Sex Differences in In-Hospital Management and Outcomes of Patients With Acute Coronary Syndrome.

BACKGROUND: Coronary heart disease is a leading cause of mortality among women. Systematic evaluation of the quality of care and outcomes in women hospitalized for acute coronary syndrome (ACS), an acute manifestation of coronary heart disease, remains lacking in China. METHODS: The CCC-ACS project (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) is an ongoing nationwide registry of the American Heart Association and the Chinese Society of Cardiology. Using data from the CCC-ACS project, we evaluated sex differences in acute management, medical therapies for secondary prevention, and in-hospital mortality in 82 196 patients admitted for ACS at 192 hospitals in China from 2014 to 2018. RESULTS: Women with ACS were older than men (69.0 versus 61.1 years, P<0.001) and had more comorbidities. After multivariable adjustment, eligible women were less likely to receive evidence-based acute treatments for ACS than men, including early dual antiplatelet therapy, heparins during hospitalization, and reperfusion therapy for ST-segment-elevation myocardial infarction. With respect to strategies for secondary prevention, eligible women were less likely to receive dual antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins at discharge, and smoking cessation and cardiac rehabilitation counseling during hospitalization. In-hospital mortality rate was higher in women than in men (2.60% versus 1.50%, P<0.001). The sex difference in in-hospital mortality was no longer observed in patients with ST-segment-elevation myocardial infarction (adjusted odds ratio, 1.18; 95% CI, 1.00 to 1.41; P=0.057) and non-ST-segment elevation ACS (adjusted odds ratio, 0.84; 95% CI, 0.66 to 1.06; P=0.147) after adjustment for clinical characteristics and acute treatments. CONCLUSIONS: Women hospitalized for ACS in China received acute treatments and strategies for secondary prevention less frequently than men. The observed sex differences in in-hospital mortality were mainly attributable to worse clinical profiles and fewer evidence-based acute treatments provided to women with ACS. Specially targeted quality improvement programs may be warranted to narrow sex-related disparities in quality of care and outcomes in patients with ACS. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02306616.

In vitro assessment of the glucose-lowering effects of berberrubine-9-O-ß-D-glucuronide, an active metabolite of berberrubine.

Berberrubine (BRB) is the primary metabolite of berberine (BBR) that has shown a stronger glucose-lowering effect than BBR in vivo. On the other hand, BRB is quickly and extensively metabolized into berberrubine-9-O-ß-D-glucuronide (BRBG) in rats after oral administration. In this study we compared the pharmacokinetic properties of BRB and BRBG in rats, and explored the mechanisms underlying their glucose-lowering activities. C57BL/6 mice with HFD-induced hyperglycemia were administered BRB (50 mg·kg-1·d-1, ig) for 6 weeks, which caused greater reduction in the plasma glucose levels than those caused by BBR (120 mg·kg-1·d-1) or BRB (25 mg·kg-1·d-1). In addition, BRB dose-dependently decreased the activity of α-glucosidase in gut of the mice. After oral administration of BRB in rats, the exposures of BRBG in plasma at 3 different dosages (10, 40, 80 mg/kg) and in urine at different time intervals (0-4, 4-10, 10-24 h) were dramatically greater than those of BRB. In order to determine the effectiveness of BRBG in reducing glucose levels, we prepared BRBG from the urine pool of rats, and identified and confirmed it through LC-MS-IT-TOF and NMR spectra. In human normal liver cell line L-O2 in vitro, treatment with BRB or BRBG (5, 20, 50 µmol/L) increased glucose consumption, enhanced glycogenesis, stimulated the uptake of the glucose analog 2-NBDG, and modulated the mRNA levels of glucose-6-phosphatase and hexokinase. However, both BBR and BRB improved 2-NBDG uptake in insulin-resistant L-O2 cells, while BRBG has no effect. In conclusion, BRB exerts a stronger glucose-lowering effect than BBR in HFD-induced hyperglycemia mice. Although BRB significantly stimulated the insulin sensitivity and glycolysis in vitro, BRBG may have a greater contribution to the glucose-lowering effect because it has much greater system exposure than BRB after oral administration of BRB. The results suggest that BRBG is a potential agent for reducing glucose levels.

Sensitive analysis and simultaneous assessment of pharmacokinetic properties of crocin and crocetin after oral administration in rats.

Crocin and crocetin in rat plasma were simultaneously analysed using ultra-performance liquid chromatography tandem mass spectroscopy (UPLC-MS/MS), and method was fully validated. For the first time, levels of both crocin and crocetin in plasma were profiled after oral administration of crocin, and this UPLC-MS/MS approach was applied to evaluate pharmacokinetics and relative bioavailability of crocin and crocetin in rats. It was shown that crocin transformed into crocetin quickly in the gastrointestinal tract, and crocetin was 56-81 fold higher exposed in rat plasma than crocin after oral administration of crocin. A comparison study revealed that an oral administration of equal molar crocin achieved higher exposure of crocetin in rat plasma than that of crocetin. It was suggested that oral administration of crocin has the advantages over crocetin, and crocetin may be the active component potentially responsible for the pharmacological effect of crocin.

A Forecasting Model for Feed Grain Demand Based on Combined Dynamic Model.

In order to improve the long-term prediction accuracy of feed grain demand, a dynamic forecast model of long-term feed grain demand is realized with joint multivariate regression model, of which the correlation between the feed grain demand and its influence factors is analyzed firstly; then the change trend of various factors that affect the feed grain demand is predicted by using ARIMA model. The simulation results show that the accuracy of proposed combined dynamic forecasting model is obviously higher than that of the grey system model. Thus, it indicates that the proposed algorithm is effective.

Environmental impact assessment on the construction and operation of municipal solid waste sanitary landfills in developing countries: China case study.

An inventory of material and energy consumption during the construction and operation (C&O) of a typical sanitary landfill site in China was calculated based on Chinese industrial standards for landfill management and design reports. The environmental impacts of landfill C&O were evaluated through life cycle assessment (LCA). The amounts of materials and energy used during this type of undertaking in China are comparable to those in developed countries, except that the consumption of concrete and asphalt is significantly higher in China. A comparison of the normalized impact potential between landfill C&O and the total landfilling technology implies that the contribution of C&O to overall landfill emissions is not negligible. The non-toxic impacts induced by C&O can be attributed mainly to the consumption of diesel used for daily operation, while the toxic impacts are primarily due to the use of mineral materials. To test the influences of different landfill C&O approaches on environmental impacts, six baseline alternatives were assessed through sensitivity analysis. If geomembranes and geonets were utilized to replace daily and intermediate soil covers and gravel drainage systems, respectively, the environmental burdens of C&O could be mitigated by between 2% and 27%. During the LCA of landfill C&O, the research scope or system boundary has to be declared when referring to material consumption values taken from the literature; for example, the misapplication of data could lead to an underestimation of diesel consumption by 60-80%.

Gaseous pollutants emitted from a mechanical biological treatment plant for municipal solid waste: odor assessment and photochemical reactivity.

The concentrations and chromatographic profiles of gaseous pollutants emitted from a municipal solid waste (MSW) biological treatment plant were investigated to identify the major odor substances and atmospheric photochemical reactive species (PRS). Four methods were used to measure different gaseous pollutants in this study, including colorimetric tubes, gas chromatography with mass spectrometry/flame ionization detection/pulsed flame photometric detection (GC-MS/FID/PFPD) preceded by cold trap concentration, GC-FID preceded by solid-phase microextraction (SPME), and high-performance liquid chromatography (HPLC) after derivation by 2,4-dinitrophenylhydrazine (DNPH). Seventy-five gaseous compounds belonging to nine groups (nitrogen compounds, sulfur compounds, alkanes, alkenes, aromatics, terpenes, alcohols, carbonyls, and volatile fatty acids [VFAs]) were identified. In the pre-biotreatment facility, the total concentration of the gaseous pollutants reached the maximum value on day 7 (317 ppm). During the post-biotreatment process, the total concentration of gaseous pollutants decreased from 331 ppm at the beginning to 162 ppm in the end. The group with the greatest decrease was carbonyls, from 64 to 7.4 ppm, followed by alcohols, from 40 to 4.5 ppm, which were both oxygenated compounds. The proportion of aromatics was notably high in the pre-mechanical treatment facility, accounting for 50.6% of the total, revealing the xenobiotic compounds disseminated by stirring and agitating the waste in the initial stage. The proportions of nitrogen compounds were lower in the pre- and post-mechanical treatment facilities (1.5% and 6.9%) than in the pre- and post-biotreatment facilities (11.9% and 13:8%), suggesting that their generation was closely associated with waste degradation. The major odor compounds in the facilities were acetic acid, butyric acid, valeric acid, isovaleric acid, and dimethyl sulfide. The major PRS in the facilities were aromatics, acetaldehyde, butyraldehyde, hexanal, isopentyl aldehyde, alcohol, alpha-pinene, limonene, and terpinene. Outside the facilities, VFAs and aromatics were the most important compounds causing an environmental impact.

Low-cost production of 6G-fructofuranosidase with high value-added astaxanthin by Xanthophyllomyces dendrorhous.

The effects of medium composition and culture conditions on the production of (6)G-fructofuranosidase with value-added astaxanthin were investigated to reduce the capital cost of neo-fructooligosaccharides (neo-FOS) production by Xanthophyllomyces dendrorhous. The sucrose and corn steep liquor (CSL) were found to be the optimal carbon source and nitrogen source, respectively. CSL and initial pH were selected as the critical factors using Plackett-Burman design. Maximum (6)G-fructofuranosidase 242.57 U/mL with 5.23 mg/L value-added astaxanthin was obtained at CSL 52.5 mL/L and pH 7.89 by central composite design. Neo-FOS yield could reach 238.12 g/L under the optimized medium conditions. Cost analysis suggested 66.3% of substrate cost was reduced compared with that before optimization. These results demonstrated that the optimized medium and culture conditions could significantly enhance the production of (6)G-fructofuranosidase with value-added astaxanthin and remarkably decrease the substrate cost, which opened up possibilities to produce neo-FOS industrially.