A study on the influencing factors and response strategies for young teachers from Taiwan to teach in universities in China: a push-pull-mooring model perspective.

Introduction: A growing number of Taiwanese teachers are choosing to teach at universities in mainland China, but their jobs are not always stable. Therefore, this study aims to investigate the factors infuencing young teachers from Taiwan to teach in universities in China. Methods: Twenty-seven young teachers from Taiwan with master's or doctoral degrees who were willing to apply to work at universities in China and who were already teaching in China were invited to conduct in-depth interviews to collect research data.The interview data were coded and analyzed according to the Push-Pull-Mooring (PPM) Model. Results and discussion: The results showed that the understanding of mainland Chinese universities among young Taiwanese teachers is not entirely consistent. Taiwanese teachers who previously studied in mainland China have a more comprehensive understanding of mainland Chinese universities, and some teachers have gained a superfcial understanding through academic exchanges between the two sides and information shared by friends.However,still,7% of the teachers have no understanding at all. Most young Taiwanese teachers indicate that they do not understand the talent recruitment policies of mainland Chinese universities. The push factors that infuence young teachers from Taiwan to teach at mainland universities are: Oversupply of teachers in Taiwan, poor environment for higher education in Taiwan, poor articulation of the cross-strait academic system, and four aspects of teacher retirement and re-employment in Taiwan. The pull factors are: Benefcial policies, salary, living environment, educational advantages and cultural dissemination in 5 areas. Mooring factors are divided into 3 aspects: personal factors, environmental factors and social factors.

Engineering low-salt growth Halomonas Bluephagenesis for cost-effective bioproduction combined with adaptive evolution.

Halophilic Halomonas bluephagenesis has been engineered to produce various added-value bio-compounds with reduced costs. However, the salt-stress regulatory mechanism remained unclear. H. bluephagenesis was randomly mutated to obtain low-salt growing mutants via atmospheric and room temperature plasma (ARTP). The resulted H. bluephagenesis TDH4A1B5 was constructed with the chromosomal integration of polyhydroxyalkanoates (PHA) synthesis operon phaCAB and deletion of phaP1 gene encoding PHA synthesis associated protein phasin, forming H. bluephagenesis TDH4A1B5P, which led to increased production of poly(3-hydroxybutyrate) (PHB) and poly(3-hydroxybutyrate-co-4-hydrobutyrate) (P34HB) by over 1.4-fold. H. bluephagenesis TDH4A1B5P also enhanced production of ectoine and threonine by 50% and 77%, respectively. A total 101 genes related to salinity tolerance was identified and verified via comparative genomic analysis among four ARTP mutated H. bluephagenesis strains. Recombinant H. bluephagenesis TDH4A1B5P was further engineered for PHA production utilizing sodium acetate or gluconate as sole carbon source. Over 33% cost reduction of PHA production could be achieved using recombinant H. bluephagenesis TDH4A1B5P. This study successfully developed a low-salt tolerant chassis H. bluephagenesis TDH4A1B5P and revealed salt-stress related genes of halophilic host strains.

[Ecological Risk Assessment of Microplastics Occurring in Surface Water of Terrestrial Water Systems across China].

To assess the ecological risk of microplastics (MPs) occurring in the surface water of terrestrial water systems across China, this study obtained relevant literature and data by searching keywords including microplastics, urban, and river on websites such as Science Direct and Web of Science. We constructed an evaluation method of ecological risk characterization ratio (RCR) based on chemical hazard data, as well as data of MPs abundance and polymer proportion originating in studies from 2017 to 2021 that covered 33 water bodies in 15 provinces. The results showed that the average abundance of MPs in natural water bodies in China reached (3604.2±5926.4) n·m-3, and the average abundance of MPs in urban water bodies was (7722.6±9505.7) n·m-3. The corresponding average RCR of natural water bodies was 22.09±45.2, and the average RCR of urban water bodies was 15.67±34.8. Therefore, according to the value of RCR, the ecological risk could be rated as four levels. Of these, no significant risk (RCR ≤ 1) was found in 17 water bodies, accounting for 42.5%; low ecological risks (RCR 1-10) were found in 12 water bodies (30%); medium ecological risks (RCR 10-100) were found in 9 water bodies (22.5%); and high ecological risks (RCR>100) were found in 2 water bodies (5%). Data analysis showed a significant correlation between MPs abundance and RCR values in natural water bodies (R2=0.875, P<0.01), though not in urban water bodies. This suggested that the high abundance of MPs could not precisely indicate a high degree of ecological risk in the area. In addition, RCR values were observed to be positively correlated with the watershed area (R2=0.864, P<0.01), and MPs abundance was correlated with GDP (R2=0.679, P<0.05) and watershed resident population (R2=0.922, P<0.05). This study provides baseline data for evaluating the ecological risk of MPs and a feasible method for evaluating the ecological risk of MPs in surface water of terrestrial water systems.

Economics of Minimalist Transcatheter Aortic Valve Replacement: Results From the 3M-TAVR Economic Study.

BACKGROUND: The 3M-TAVR trial (3M-Transcatheter Aortic Valve Replacement) demonstrated the feasibility and safety of next-day hospital discharge after transfemoral TAVR with implementation of a minimalist pathway. However, the economic impact of this approach is unknown. Therefore, we evaluated costs for patients undergoing minimalist TAVR compared with conventional TAVR. METHODS: We used propensity matching to compare resource utilization and costs (from a US health care system perspective) for patients in the 3M-TAVR trial with those for transfemoral TAVR patients enrolled in the contemporaneous S3i trial (PARTNER SAPIEN-3 Intermediate Risk). Procedural costs were estimated using measured resource utilization for both groups. For the S3i group, all other costs through 30-day follow-up were assessed by linkage with Medicare claims; for 3M, these costs were assessed using regression models derived from S3i cost and resource utilization data. RESULTS: After 1:1 propensity matching, 351 pairs were included in our study (mean age 82, mean Society of Thoracic Surgery risk score 5.3%). There were no differences in death, stroke, or rehospitalization between the 3M-TAVR and S3i groups through 30-day follow-up. Index hospitalization costs were $10 843/patient lower in the 3M-TAVR cohort, driven by reductions in procedure duration, anesthesia costs, and length of stay. Between discharge and 30 days, costs were similar for the 2 groups such that cumulative 30-day costs were $11 305/patient lower in the 3M-TAVR cohort compared with the S3i cohort ($49 425 versus $60 729, 95% CI for difference $9378 to $13 138; P<0.001). CONCLUSIONS: Compared with conventional transfemoral TAVR, use of a minimalist pathway in intermediate-risk patients was associated with similar clinical outcomes and substantial in-hospital cost savings, which were sustained through 30 days. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02287662.

First-Year College Students' Mental Health in the Post-COVID-19 Era in Guangxi, China: A Study Demands-Resources Model Perspective.

The post-COVID-19 era means that the COVID-19 is basically under control; however, the risk of the pandemic still affects people's work, study, and life, physically and psychologically. In this era, due to the more challenges first-year college students face, more attention should be paid to their mental health. An emerging study demands-resources (SD-R) model can explain the influencing mechanism of college students' mental health. This model suggests that study demands increase the risk of student burnout, which results in mental health problems; meanwhile, study resources reduce student burnout and increase student engagement, thus improving mental health. Based on the SD-R model, this study explores the impacts of time pressure, emotional exhaustion, perceived social support, and student engagement on mental health and provides adequate measures to reduce the risk of mental health problems among first-year students. Time pressure, perceived social support, emotional exhaustion, student engagement, and mental health scales were used to investigate 537 first-year students at three universities in Guangxi, China, of whom 290 (54%) were female, and 247 (46%) were male, and the average age was 18.97 ± 1.01. Results indicated that: (1) Moderate scores on time pressure and emotional exhaustion and slightly-above-the-median scores on perceived social support, student engagement, and mental health were found among first-year students in the post-COVID-19 era. (2) Time pressure had a positive relationship with emotional exhaustion and a negative relationship with mental health. (3) Perceived social support was negatively correlated with emotional exhaustion but positively correlated with student engagement, and thus improved mental health. Results of this study with a sample of first-year college students in China support the hypotheses based on the SD-R model. These findings suggest that increasing perceived social support and student engagement while decreasing time pressure and emotional exhaustion may promote mental health among first-year college students.

Cost-Effectiveness of Posaconazole vs. First-Generation Triazoles for the Prevention of Invasive Fungal Infections Among High-Risk Patients With Hematological Malignancies in China.

Background: Posaconazole is confirmed to be more effective for preventing invasive fungal infections (IFIs) than first-generation triazoles (fluconazole and itraconazole), but its economic value has not been comprehensively evaluated in China. This study compared the cost-effectiveness of these two antifungal prophylaxis regimens in hematological-malignancy patients at high risk for IFIs from the Chinese healthcare perspective. Methods: A hybrid decision tree and Markov model were built using published data to estimate the total costs and quality-adjusted life-years (QALYs) of antifungal prophylaxis with posaconazole oral suspension and first-generation triazoles. Regimens with an incremental cost-effectiveness ratio (ICER) lower than the threshold of willingness to pay (WTP) were considered cost-effective. One-way and probabilistic sensitivity analyses were performed to assess model robustness. The regional imbalance of economic development and the tablet formulation of posaconazole were considered in the scenario analyses. Results: In the base-case analysis, posaconazole oral suspension provided an additional 0.109 QALYs at an incremental cost of $954.7, yielding an ICER of $8,784.4/QALY, below the national WTP threshold of $31,315/QALY. One-way and probabilistic sensitivity analyses showed that the results were robust. Scenario analyses showed that the base-case ICER was consistently below the WTP thresholds of all 31 Chinese provinces, with the likelihood of posaconazole being cost-effectiveness ranging from 78.1 to 99.0%. When the posaconazole oral suspension was replaced by the tablet formulation, the ICER increased to $29,214.1/QALY, still below the national WTP threshold and WTP thresholds of 12 provinces. Conclusions: Posaconazole oral suspension is a highly cost-effective regimen for preventing IFI in high-risk hematological-malignancy patients from the Chinese healthcare perspective. Posaconazole tablets may also be considered in some high-income regions of China.

Epidemiological trends of low back pain at the global, regional, and national levels.

PURPOSE: We aimed to assess the global, regional, and national burdens of low back pain (LBP) from 1990 to 2019 by gender, age, and the sociodemographic index (SDI) from the Global Burden of Disease (GBD) 2019 study. METHODS: The number of incident cases, disability-adjusted life years (DALYs), age-standardized incidence rates, and age-standardized DALY rates during 1990-2019 were obtained from the GBD 2019 study. The estimated annual percentage changes (EAPCs) in the age-standardized incidence rates and age-standardized DALY rates were determined to measure the temporal trends of LBP. RESULTS: In 2019, there were an estimated 223.5 million cases of LBP and 63.7 million LBP-related DALYs worldwide. During 1990-2019, the age-standardized incidence rate [EAPC = - 0.41; 95% confidence interval (CI) - 0.46 to - 0.36] and age-standardized DALY rate decreased (EAPC = - 0.51; 95% CI - 0.56 to - 0.46) globally. The age-standardized incidence rate of LBP decreased the most in low-middle SDI regions. The age-standardized incidence rate of LBP decreased the most in South Asia (EAPC, - 1.51), East Asia (EAPC, - 0.68), and Australasia (EAPC, - 0.26). The incidence in male subjects was lower than that in female subjects. The largest decreases in the age-standardized incidence rate and age-standardized DALY rate of LBP were observed in India, and China. CONCLUSIONS: The global age-standardized incidence rate and age-standardized DALY rate of LBP showed a downward trend, especially in East and South Asia. In addition, a heavier burden of LBP was observed in older and female populations.

PROSE: Prospective Randomized Trial of the On-X Mechanical Prosthesis and the St Jude Medical Mechanical Prosthesis Evaluation: Part 2: Study results-prostheses, positions, and economic development.

Objectives: The Prospective Randomized On-X Mechanical Prosthesis Versus St Jude Medical Mechanical Prosthesis Evaluation (PROSE) trial purpose was to investigate whether a current-generation mechanical prosthesis (On-X; On-X Life Technologies/Artivion Inc) reduced the incidence of thromboembolic-related complications compared with a previous-generation mechanical prosthesis (St Jude Medical Mechanical Prosthesis; Abbott/St Jude Medical). This second report documents the valve-related complications by individual prostheses and by Western and Developing populations. Methods: The PROSE trial study was conducted in 28 worldwide centers and incorporated 855 subjects randomized between 2003 and 2016. The study enrollment was discontinued on August 31, 2016. The study protocol, and analyses of 10 demographic variables and 24 risk factors were published in detail in 2021. Results: The total patient population (N = 855) included patients receiving an On-X valve (n = 462) and a St Jude Medical valve (n = 393). The overall freedom evaluation showed no differences at 5 years between the prostheses for thromboembolism or for valve thrombosis. There were also no differences in mortality. There were several differences between Developing and Western populations. The freedom relations at 5 years for mortality favored Western over Developing populations. Valve thrombosis was differentiated by position and site: aortic < mitral (P = .007) and Western < Developing (P = .005). In the mitral position there were no cases in Western populations, whereas there were 8 in Developing populations (P = .217). Conclusions: The On-X valve and St Jude Medical valve performed equally well in the study with no differences found. The only differentiation occurred with valve thrombosis in the mitral position more than the aortic position and occurring in Developing more than Western populations. The occurrence of valve thrombosis was also related to a younger population possibly due to anticoagulation compliance based on record review.

H-scan, Shear Wave and Bioluminescent Assessment of the Progression of Pancreatic Cancer Metastases in the Liver.

The non-invasive quantification of tumor burden and the response to therapies remain an important objective for imaging modalities. To characterize the performance of two newly optimized ultrasound-based analyses, we applied shear wave and H-scan scattering analyses to repeated trans-abdominal ultrasound scans of a murine model of metastatic pancreatic cancer. In addition, bioluminescence measurements were obtained as an alternative reference. The tumor metastases grow aggressively and result in death at approximately 4 wk if untreated, but longer for those treated with chemotherapy. We found that our three imaging methods (shear wave speed, H-scan, bioluminescence) trended toward increasing output measures with time during tumor growth, and these measures were delayed for the group receiving chemotherapy. The relative sensitivity of H-scan tracked closely with bioluminescence measurements, particularly in the early to mid-stages of tumor growth. The correlation between H-scan and bioluminescence was found to be strong, with a Spearman's rank correlation coefficient greater than 0.7 across the entire series. These preliminary results suggest that non-invasive ultrasound imaging analyses are capable of tracking the response of tumor models to therapeutic agents.

Modernizing Education of the Pediatric Anesthesiologist.

This article discusses modernizing the education of pediatric anesthesiologists in the United States. First, the current education requirements to become an American Board of Anesthesiology certified pediatric anesthesiologist are detailed and then, through a historical lens, the development of the subspecialty is examined. Gaps and challenges in the current training system are identified and interventions for improvement discussed. Additionally, suggestions are made and questions posed on how to move from a time-based model towards a competency-based curriculum.

Longitudinal behavioral and fMRI-based assessment of inhibitory control in heroin addicts on methadone maintenance treatment.

The objective of the present study was to determine whether methadone maintenance treatment (MMT) in heroin-dependent patients affects inhibitory control, whether any MMT-induced changes correlate with methadone dose and MMT duration, and whether these changes depend on the psychological characteristics of patients, such as depression, anxiety and impulsivity. Response inhibition in the GO/NO-GO test was combined with functional magnetic resonance imaging (fMRI) scanning data to examine whether MMT affects inhibitory control in 21 heroin-addicted patients who had already undergone at least three months of MMT. Patients were evaluated one year prior to and after the MMT period. Participants exhibited no difference in their GO/NO-GO reaction time and accuracy rate, or in their false alarm rate under NO-GO conditions. However, increased activation was detected in numerous brain regions in their 12-month fMRI scans, although these were not in the frontal-striatal loop. Increased fMRI activation in the left precentral gyrus and superior temporal gyrus were negatively correlated with the daily methadone dose and total methadone dose during the one-year study period. In conclusion, these results suggested that MMT over one year does not significantly change the behavioral indicators of inhibitory control function in heroin-dependent patients. The increase in activation leads to the hypothesis that MMT over one year may increase cognitive inhibitory control, which may be the result of the combined negative effect of methadone and the positive effect of functional recovery after withdrawal of heroin.

Computed tomography assessment for transcatheter aortic valve in valve implantation: The vancouver approach to predict anatomical risk for coronary obstruction and other considerations.

Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves.

Viability assessment of magnetic resonance spectroscopy for the detection of minimal hepatic encephalopathy severity.

OBJECTIVE: To evaluate regional cerebral metabolic changes in minimal hepatic encephalopathy (MHE) patients using magnetic resonance spectroscopy (MRS) in 3T scanner. MATERIALS AND METHODS: This study comprised 30 cirrhotic patients with MHE, 29 cirrhotic patients without MHE and 30 healthy volunteers. Single-voxel proton MRS data in the anterior cingulate cortex (ACC) and basal ganglia were acquired using a 3-T scanner. The concentrations of N-acetylaspartate (NAA), mI (myo-inositol), glutamate (Glu), glutamine (Gln) and creatine (Cr) were obtained by LC-model software. Statistical analysis was performed to evaluate the differences between the three groups. RESULTS: There was a significant increase in Glu for the cirrhotic patients, particularly the MHE patients. There was an elevation of Gln in the cirrhotic patients, but not in all cirrhotic patients or controls. There was a significant decrease in mI for the cirrhotic patients, but no significant difference between the two cirrhosis groups. There was no significant difference in NAA between the three groups. CONCLUSIONS: MRS using a 3-T MR scanner could detect cerebral metabolic changes in cirrhotic patients with MHE. Glu levels were elevated in cirrhotic patients with MHE; Glu levels could be used as a sensitive indicator to evaluate the severity of MHE in patients with cirrhosis.

Regional Systems of Care to Optimize Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement.

OBJECTIVES: This study sought to describe the development of a multicenter, transcatheter aortic valve replacement program and regional systems of care intended to optimize coordinated, efficient, and appropriate delivery of this new therapy. BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become an accepted treatment option for patients with severe aortic stenosis who are at high surgical risk. Regional systems of care have led to improvements in outcomes for patients undergoing intervention for myocardial infarction, cardiac arrest, and stroke. We implemented a regional system of care for patients undergoing TAVR in British Columbia, Canada. METHODS: We describe a prospective observational cohort of 583 patients who underwent TAVR in British Columbia between 2012 and 2014. Regionalization of TAVR care in British Columbia refers to a centrally coordinated, funded, and evaluated program led by a medical director and a multidisciplinary advisory group that oversees planning, access to care, and quality of outcomes at the 4 provincial sites. Risk-stratified case selection for transfemoral TAVR is performed by heart teams at each site on the basis of consensus provincial indications. Referrals for lower volume and more complicated TAVR, including nontransfemoral access and valve-in-valve procedures, are concentrated at a single site. In-hospital and 30-day outcomes are reported. RESULTS: The median age was 83 years (interquartile range [IQR]: 78 to 87 years) and median STS score was 6% (IQR: 4% to 8%). Transfemoral access was performed in 499 (85.6%) cases and nontransfemoral in 84 (14.4%). Transcatheter valve-in-valve procedures in for failed bioprosthetic valves were performed in 43 patients (7.4%). A balloon-expandable valve was inserted in 386 (66.2%) and a self-expanding valve in 189 (32.4%). All-cause 30-day mortality was 3.5%. All-cause in-hospital mortality and disabling stroke occurred in 3.1% and 1.9%, respectively. Median length of stay was 3 days (IQR: 3 to 6 days), with 92.8% of patients discharged directly home. CONCLUSIONS: This experience demonstrates the potential benefits of a regional system of care for TAVR. Excellent outcomes were demonstrated: most patients had short in-hospital stays and were discharged directly home.

A retrospective study of hospitalized pneumonia in two Polish counties (2006-2008).

INTRODUCTION: In Poland, multi-cause pneumonia is not well characterized, and there is limited pneumococcal vaccination in the youngest and oldest age groups. The goal of this study was to assess hospitalized pneumonia across all age groups in two Polish counties. MATERIAL AND METHODS: Using electronic administrative databases, cases were identified as county residents hospitalized at Chrzanów and Inowroclaw County Hospitals from 2006-2008, assigned a diagnosis of pneumonia. Calculations by admission year, sex, and age category were: hospitalization rates per 1000 persons; in-hospital mortality rates per 100 persons; and median length of stay (LOS). RESULTS: There were 1444 and 2956 hospitalizations for new episodes of pneumonia with rates of 3.76 (95% confidence interval [CI] 3.57-3.96) and 5.99 (95% CI 5.77-6.21) per 1000 persons in Chrzanów and Inowroclaw counties, respectively. In combined data, the highest hospitalization rate was among patients aged 0-4 years (30.77; 95% CI 29.06-32.55) followed by those aged ≥ 75 years (25.39; 95% CI 24.01-26.83). In-hospital mortality rates increased with age at both sites. The median LOS was 8 days. CONCLUSIONS: Pneumonia hospitalizations were substantial, especially for the youngest and oldest age groups. Future public health interventions aimed at these age groups might improve disease outlook.

Assessment of the feeding arteries by three-dimensional computed tomography angiography prior to multi-arterial infusion chemotherapy for lung cancer.

The aim of this study was to evaluate the efficacy of multi-detector row helical computed tomography (MDCT) angiography in the detection of feeding arteries prior to multi-arterial infusion for lung cancer. A total of 59 consecutive patients (44 males and 15 females; age range, 27-86 years; median age, 62 years) with non-small cell lung cancer underwent MDCT angiography of the thorax prior to multi-arterial infusion for lung cancer. Findings on CT angiograms, including CT scans, maximum intensity projections and three-dimensional volume-rendered images, were used to evaluate the depiction of bronchial and non-bronchial systemic arteries. The results of detecting the feeding arteries for lung cancer by MDCT angiography and conventional angiography were compared. Among the 59 patients treated with multi-arterial infusion chemotherapy, a total of 80 feeding arteries (62 bronchial feeding arteries and 18 non-bronchial systemic arteries) were detected by conventional angiography and/or MDCT angiography. In 56 (70%) feeding arteries (including 44 bronchial feeding arteries and 12 non-bronchial systemic arteries) for lung cancers, concordant findings were observed with the two modalities. In 23 (29%) cases, MDCT angiography could not be used to define feeding arteries, but was used to identify the ostia of these feeding arteries. In one (1/80, 1.3%) case, the CT-defined feeding artery was not selectively catheterized. MDCT angiography of the chest is able to provide an overview for successful catheterization in multi-arterial infusion chemotherapy for lung cancer.

The effect of health insurance reform on the number of cataract surgeries in Chongqing, China.

BACKGROUND: Cataracts are the leading cause of blindness in China, and poverty is a major barrier to having cataract surgery. In 2003, the Chinese government began a series of new national health insurance reforms, including the New Cooperative Medical Scheme (NCMS) and the Urban Resident Basic Health Insurance scheme (URBMI). These two programs, combined with the previously existing Urban Employee Basic Health Insurance (UEBMI) program, aimed to make it easier for individuals to receive medical treatment. This study reports cataract surgery numbers in rural and urban populations and the proportion of these who had health insurance in Chongqing, China from 2003 to 2008. METHODS: The medical records of a consecutive case series, including 14,700 eyes of 13,262 patients who underwent age-related cataract surgery in eight hospitals in Chongqing from January 1, 2003, to December 31, 2008, were analysed retrospectively via multi-stage cluster sampling. RESULTS: In the past six years, the total number of cataract surgeries had increased each year as had the number of patients with insurance. Both the number of surgeries and the number of insured patients were much higher in the urban group than in the rural group. The rate of increase in the rural group however was much higher than in the urban group, especially in 2007 and 2008. The odds ratios of having health insurance for urban vs. rural individuals were relatively stable from 2003 to 2006, but it decreased in 2007 and was significantly lower in 2008. CONCLUSIONS: Health insurance appears to be an important factor associated with increased cataract surgery in Chongqing, China. With the implementation of health insurance, the number of Chongqing's cataract surgeries was increased year by year.

Effect of prosthesis-patient mismatch on long-term survival with aortic valve replacement: assessment to 15 years.

BACKGROUND: The effect of prosthesis-patient mismatch on long-term survival after aortic valve replacement has received considerable attention but there remains controversy. This study was performed to determine the predictors of mortality after aortic valve replacement and influence of prosthesis-patient mismatch on survival. METHODS: Contemporary mechanical prostheses and bioprostheses were implanted in 3,343 patients with aortic valve replacement between 1982 and 2003. The mean age was 68.06 +/- 11.20 years (median 70.06; range, 19 to 94), and the mean follow-up was 6.18 +/- 4.96 years, for a total of 20,666 years of follow-up. Prosthesis-patient mismatch was classified by effective orifice area index categories: normal (> 0.85 cm(2)/m(2)), 1,547 (46.3%); mild-to-moderate (> 0.65 cm(2)/m(2) to < or = 0.85 cm(2)/m(2)), 1,584 (47.4%); and severe (< 0.65 cm(2)/m(2)), 212 (6.3%). RESULTS: The predictors of overall mortality were age, age categorization, New York Heart Association functional class III/IV, concomitant coronary artery bypass graft surgery, prosthesis type, preoperative congestive heart failure, diabetes mellitus, renal failure, and chronic obstructive pulmonary disease. All categories of effective orifice area indexes were not predictive of overall mortality, late mortality, or early mortality. The 15-year overall survival was differentiated by effective orifice area index categories: 38.1% +/- 2.1%, 37.0% +/- 2.2%, and 22.1% +/- 6.5%, respectively, for the three categories. Survival adjusted for the covariates (effective orifice area index, age, basal mass index, and ejection fraction) determined no effect except severe effective orifice area index when adjusted for ejection fraction more than 50% (p = 0.049). CONCLUSIONS: Prosthesis-patient mismatch is not a predictor of overall standard unadjusted mortality to 15 years after aortic valve replacement, regardless of the category of effective orifice area index.

[Risk assessment of H5N1 human infection after an outbreak of avian influenza in water fowl].

OBJECTIVE: To evaluate the risk of human infection after the outbreak of avian influenza H5N1 in animals, and probe the possibility for virus transmission. METHODS: By means of field epidemiological study, molecular epidemiology, serology and emergency surveillance, persons who had ever closely contacted with sick or dead poultry were observed. While, the RT-PCR and gene sequencing method were used to detect H5 nucleic acid from environmental swabs from 4 epidemic spots, and hemagglutination inhibition assay was also used to detect H5 antibody. RESULTS: Of 22 environmental swabs detected from 4 epidemic spots, one was positive for H5 nucleic acid, and the homogeneity was 95.9% as compared with H5N1 virus A/China/GD01/2006 (H5N1) found in Guangzhou in 2006 by gene sequence analysis. 62 environmental swabs from live poultry stalls of food markets near epidemic spot were detected negative. Six of 68 blood samples of contacts were positive for H9 antibody, and all were negative for H5 antibody. 68 throat swabs of contacts were detected negative for H5 nucleic acid. No close contact was found abnormal after 7 days medical observation. 337 influenza-like cases were reported in emergency surveillance, and no suspicious case was found. CONCLUSION: The current outbreak of H5N1 avian influenza in water fowls has not yet caused further transmission, and human avian influenza case has not been observed. It indicates that the ability of H5N1 virus to transmit to human is not strong yet, and the risk of human infection for H5N1 is still low.