Global burden of early-onset osteoarthritis, 1990-2019: results from the Global Burden of Disease Study 2019.

OBJECTIVES: Early-onset osteoarthritis (OA) is an emerging health issue amidst the escalating prevalence of overweight and obesity. However, there are scant data on its disease, economic burden and attributable burden due to high body mass index (BMI). METHODS: Using data from the Global Burden of Diseases Study 2019, we examined the numbers of incident cases, prevalent cases, years lived with disability (YLDs) and corresponding age-standardised rates for early-onset OA (diagnosis before age 55) from 1990 to 2019. The case definition was symptomatic and radiographically confirmed OA in any joint. The average annual percentage changes (AAPCs) of the age-standardised rates were calculated to quantify changes. We estimated the economic burden of early-onset OA and attributable burden to high BMI. RESULTS: From 1990 to 2019, the global incident cases, prevalent cases and YLDs of early-onset OA were doubled. 52.31% of incident OA cases in 2019 were under 55 years. The age-standardised rates of incidence, prevalence and YLDs increased globally and for countries in all Sociodemographic Index (SDI) quintiles (all AAPCs>0, p<0.05), with the fastest increases in low-middle SDI countries. 98.04% of countries exhibited increasing trends in all age-standardised rates. Early-onset OA accounts for US$46.17 billion in healthcare expenditure and US$60.70 billion in productivity loss cost in 2019. The attributable proportion of high BMI for early-onset OA increased globally from 9.41% (1990) to 15.29% (2019). CONCLUSIONS: Early-onset OA is a developing global health problem, causing substantial economic costs in most countries. Targeted implementation of cost-effective policies and preventive intervention is required to address the growing health challenge.

Diagnostic Accuracy of Ultrasound for Assessment of Synovial Abnormalities Among Patients With Knee Pain: A Meta-Analysis.

OBJECTIVE: Synovial abnormalities, which are modifiable treatment targets for knee pain, affect ~25% of adults. Ultrasound is a safe, inexpensive, and easily accessible imaging modality for assessing synovial abnormalities, but its diagnostic accuracy is still controversial. We conducted a meta-analysis by comparing ultrasound with the "reference standard" method, ie, magnetic resonance imaging (MRI), in assessing synovial abnormalities among patients with knee pain. METHODS: PubMed, Embase, and Web of Science were searched from inception to January 7, 2022, to retrieve studies including patients with knee pain for evaluating 1) the diagnostic accuracy of ultrasound versus MRI for synovial abnormalities (synovitis and synovial effusion) and 2) the correlations of synovial abnormalities assessed by ultrasound and MRI. The summary of diagnostic accuracy was analyzed using the bivariate model, and the correlation coefficients were pooled using the random effects model. RESULTS: Fourteen studies were included, representing a total of 755 patients. The pooled sensitivity, specificity, and area under the curve were 0.88 (95% confidence interval [95% CI] 0.65-0.96), 0.70 (95% CI 0.51-0.84), and 0.81 (95% CI 0.77-0.84) for synovitis and 0.90 (95% CI 0.81-0.95), 0.86 (95% CI 0.77-0.92), and 0.94 (95% CI 0.91-0.96) for synovial effusion, respectively. Strong correlations between ultrasound- and MRI-diagnosed synovitis (r = 0.64, 95% CI 0.56-0.71) and synovial effusion (r = 0.63, 95% CI 0.52-0.73) were observed. CONCLUSION: Ultrasound demonstrated a promising accuracy in detecting synovial abnormalities among patients with knee pain. The use of ultrasound provides equivalent synovial information to MRI but is less expensive and more accessible. Therefore, it is recommended as an adjuvant for managing patients with knee pain during diagnostic strategy and individualized treatment decision-making.

Length of stay and inpatient charges of total knee arthroplasty in China: analysis of a national database.

BACKGROUND: There are limited data on the resource utilization of total knee arthroplasty (TKA) in China. This study aimed to examine the length of stay (LOS) and inpatient charges of TKA in China, and to investigate their determinants. METHODS: We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019. LOS and inpatient charges were obtained, and their associated factors were further assessed using multivariable linear regression. RESULTS: A total of 184,363 TKAs were included. The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019. The admission-to-surgery interval decreased from 4.6 to 4.2 days. The mean inpatient charges were 61,208.3 Chinese Yuan. Inpatient charges reached a peak in 2016, after which a gradual decrease was observed. Implant and material charges accounted for a dominating percentage, but they exhibited a downward trend, whereas labor-related charges gradually increased. Single marital status, non-osteoarthritis indication, and comorbidity were associated with longer LOS and higher inpatient charges. Female sex and younger age were associated with higher inpatient charges. There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals, hospitals with various TKA volume, or in different geographic regions. CONCLUSIONS: The LOS following TKA in China appeared to be long, but it was shortened during the time period of 2013 to 2019. The inpatient charges dominated by implant and material charges exhibited a downward trend. However, there were apparent sociodemographic and hospital-related discrepancies of resource utilization. The observed statistics can lead to more efficient resource utilization of TKA in China.

Rural-urban differences in characteristics, postoperative outcomes, and costs for patients undergoing knee arthroplasty: a national retrospective propensity score matched cohort study.

BACKGROUND: The rural-urban disparities in postoperative complications and costs among patients undergoing knee arthroplasty (KA) have not been thoroughly explored. This study aimed to determine whether such differences exist in this patient population. MATERIAL AND METHODS: The study was conducted using data from the national Hospital Quality Monitoring System of China. Hospitalized patients undergoing KA from 2013 to 2019 were enrolled. Patient and hospital characteristics were compared between rural and urban patients, and differences in postoperative complications, readmissions, and hospitalization costs were analyzed using propensity score matching. RESULTS: Of the 146 877 KA cases analyzed, 71.4% (104 920) were urban patients and 28.6% (41 957) were rural patients. Rural patients tended to be younger (64.4±7.7 years vs. 68.0±8.0 years; P <0.001) and had fewer comorbidities. In the matched cohort of 36 482 participants per group, rural patients were found to be more likely to experience deep vein thrombosis (OR: 1.31, 95% CI: 1.17-1.46; P <0.001) and require red blood cell (RBC) transfusion (OR: 1.38, 95% CI: 1.31-1.46; P <0.001). However, they had a lower incidence of readmission within 30 days (OR: 0.65, 95% CI: 0.59-0.72; P <0.001) and readmission within 90 days (OR: 0.61, 95% CI: 0.57-0.66; P <0.001) than their urban counterparts. In addition, rural patients incurred lower hospitalization costs than urban patients (57 396.2 Chinese Yuan vs. 60 844.3 Chinese Yuan; P <0.001). CONCLUSION: Rural KA patients had different clinical characteristics compared with urban patients. While they had a higher likelihood of deep vein thrombosis and RBC transfusion following KA than urban patients, they had fewer readmissions and lower hospitalization costs. Targeted clinical management strategies are needed for rural patients.

Drivers' visual-distracted take-over performance model and its application on adaptive adjustment of time budget.

There are certain situations that automated driving (AD) systems are still unable to handle, preventing the implementation of Level 5 AD. Thus, a transition of control, colloquially known as take-over of the vehicle, is required when the system sends a take-over request (TOR) upon exiting the operational design domain (ODD). An adaptive TOR along with good take-over performance requires adjusting the time budget (TB) to drivers' visual distraction state, adhering to a reliable visual-distraction-based take-over performance model. Based on a number of driving simulator experiments, the percentage of face orientation to distraction area (PFODA) and time to boundary at take-over timing (TTBT) were proposed to accurately evaluate the degree of visual distraction based on merely face orientation under naturalistic non-driving related tasks (NDRTs) and to evaluate take-over performance, respectively. In order to elucidate the safety boundary, this study also proposed an algorithm to set a suitable minimum value of the TTBT. Finally, a multiple regression model was built to describe the relationship among PFODA, TB and TTBT along with a corrected coefficient of determination of 0.748. Based on the model, this study proposed an adaptive TB adjustment method for the take-over system.

Cytotoxicity Assessment of Gallium- and Indium-Based Nanoparticles Toward Human Bronchial Epithelial Cells Using an Impedance-Based Real-Time Cell Analyzer.

The semiconductor manufacturing sector plans to introduce III/V film structures (eg, gallium arsenide (GaAs), indium arsenide (InAs) onto silicon wafers due to their high electron mobility and low power consumption. Aqueous solutions generated during chemical and mechanical planarization of silicon wafers can contain a mixture of metal oxide nanoparticles (NPs) and soluble indium, gallium, and arsenic. In this work, the cytotoxicity induced by Ga- and In-based NPs (GaAs, InAs, Ga2O3, In2O3) and soluble III-V salts on human bronchial epithelial cells (16HBE14o-) was evaluated using a cell impedance real-time cell analysis (RTCA) system. The RTCA system provided inhibition data at different concentrations for multiple time points, for example, GaAs (25 mg/L) caused 60% inhibition after 8 hours of exposure and 100% growth inhibition after 24 hours. Direct testing of As(III) and As(V) demonstrated significant cytotoxicity with 50% growth inhibition concentrations after 16-hour exposure (IC50) of 2.4 and 4.5 mg/L, respectively. Cell signaling with rapid rise and decrease in signal was unique to arsenic cytotoxicity, a precursor of strong cytotoxicity over the longer term. In contrast with arsenic, soluble gallium(III) and indium(III) were less toxic. Whereas the oxide NPs caused low cytotoxicity, the arsenide compounds were highly inhibitory (IC50 of GaAs and InAs = 6.2 and 68 mg/L, respectively). Dissolution experiments over 7 days revealed that arsenic was fully leached from GaAs NPs, whereas only 10% of the arsenic was leached out of InAs NPs. These results indicate that the cytotoxicity of GaAs and InAs NPs is largely due to the dissolution of toxic arsenic species.

Integration of Remote Sensing and Social Sensing Data in a Deep Learning Framework for Hourly Urban PM2.5 Mapping.

Fine spatiotemporal mapping of PM2.5 concentration in urban areas is of great significance in epidemiologic research. However, both the diversity and the complex nonlinear relationships of PM2.5 influencing factors pose challenges for accurate mapping. To address these issues, we innovatively combined social sensing data with remote sensing data and other auxiliary variables, which can bring both natural and social factors into the modeling; meanwhile, we used a deep learning method to learn the nonlinear relationships. The geospatial analysis methods were applied to realize effective feature extraction of the social sensing data and a grid matching process was carried out to integrate the spatiotemporal multi-source heterogeneous data. Based on this research strategy, we finally generated hourly PM2.5 concentration data at a spatial resolution of 0.01°. This method was successfully applied to the central urban area of Wuhan in China, which the optimal result of the 10-fold cross-validation R2 was 0.832. Our work indicated that the real-time check-in and traffic index variables can improve both quantitative and mapping results. The mapping results could be potentially applied for urban environmental monitoring, pollution exposure assessment, and health risk research.

Ecotoxicity assessment of ionic As(III), As(V), In(III) and Ga(III) species potentially released from novel III-V semiconductor materials.

III-V materials such as indium arsenide (InAs) and gallium arsenide (GaAs) are increasingly used in electronic and photovoltaic devices. The extensive application of these materials may lead to release of III-V ionic species during semiconductor manufacturing or disposal of decommissioned devices into the environment. Although arsenic is recognized as an important contaminant due to its high toxicity, there is a lack of information about the toxic effects of indium and gallium ions. In this study, acute toxicity of As(III), As(V), In(III) and Ga(III) species was evaluated using two microbial assays testing for methanogenic activity and O2 uptake, as well as two bioassays targeting aquatic organisms, including the marine bacterium Aliivibrio fischeri (bioluminescence inhibition) and the crustacean Daphnia magna (mortality). The most noteworthy finding was that the toxicity is mostly impacted by the element tested. Secondarily, the toxicity of these species also depended on the bioassay target. In(III) and Ga(III) were not or only mildly toxic in the experiments. D. magna was the most sensitive organism for In(III) and Ga(III) with 50% lethal concentrations of 0.5 and 3.4mM, respectively. On the other hand, As(III) and As(V) caused clear inhibitory effects, particularly in the methanogenic toxicity bioassay. The 50% inhibitory concentrations of both arsenic species towards methanogens were about 0.02mM, which is lower than the regulated maximum allowable daily effluent discharge concentration (2.09mg/L or 0.03mM) for facilities manufacturing electronic components in the US. Overall, the results indicate that the ecotoxicity of In(III) and Ga(III) is much lower than that of the As species tested. This finding is important in filling the knowledge gap regarding the ecotoxicology of In and Ga.