Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle-invasive bladder cancer after surgery.

OBJECTIVES: To build a nomogram prediction model, assess its predictive ability, and perform a survival decision analysis on patients with muscle-invasive bladder cancer (MIBC) to study risk factors affecting overall survival (OS). METHODS: A retrospective analysis was performed on the clinical information of 262 patients with MIBC who underwent radical cystectomy (RC) at the Urology Department of the Second Affiliated Hospital of Kunming Medical University between July 2015 and August 2021. The final model variables that were included were chosen using single-factor stepwise Cox regression, optimal subset regression, and LASSO regression + cross-validation with the minimum AIC value. The next step was to do a multivariate Cox regression analysis. The establishment of a nomogram model by fitting and the screening out of independent risk factors impacting the survival of patients with MIBC having radical resection. Receiver Activity Characteristic curves, C-index, and a calibration plot evaluated the prediction accuracy, validity, and clinical benefit of the model. The 1-, 3-, and 5-year survival rates were then computed for each risk factor using a Kaplan-Meier survival analysis. RESULTS: 262 eligible patients in total were enrolled. With a median follow-up of 32 months, the follow-up period ranged from 2 to 83 months. 171 cases (65.27%) survived while 91 cases (34.73%) perished. Age (HR = 1.06 [1.04; 1.08], p = 0.001), preoperative hydronephrosis (HR = 0.69 [0.46, 1.05], p = 0.087), T stage (HR = 2.06 [1.09, 3.93], p = 0.027), lymphovascular invasion (LVI, HR = 1.73 [1.12, 2.67], p = 0.013), prognostic nutritional index (PNI, HR = 1.70 [1.09, 2.63], p = 0.018), and neutrophil-to-lymphocyte ratio (NLR, HR = 0.52 [0.29, 0.93)], p = 0.026) were independent risk factor for the survival of bladder cancer patients. Create a nomogram based on the aforementioned findings, and then draw the 1-year, 3-year, and 5-year OS receiver operating characteristic curves by the nomogram. The AUC values were 0.811 (95% CI [0.752, 0.869]), 0.814 (95% CI [0.755, 0.873]), and 0.787 (95% CI [0.708, 0.865]), respectively, and the calibration plot matched the predicted value well. The 1-year, 3-year, and 5-year decision curve analyses were higher than the ALL line and None line at threshold values of >5%, 5%-70%, and 20%-70% indicating that the model has good clinical applicability. The calibration plot for the Bootstrap 1000-time resampled validation model was similar to the actual value. Patients with preoperative combination hydronephrosis, higher T-stage, combined LVI, low PNI, and high NLR had worse survival, according to Kaplan-Meier survival analysis for each variable. CONCLUSIONS: This study might conclude that PNI and NLR were separate risk factors that affect a patient's OS after RC for MIBC. The prognosis of bladder cancer may be predicted by PNI and NLR, but additional confirmation in randomized controlled trials is required.

The accuracy of the axial length and axial length/corneal radius ratio for myopia assessment among Chinese children.

Objectives: The aim of this study was to assess the association between axial length/corneal radius ratio (AL/CR ratio), AL, and refractive status and evaluate the accuracy of AL and AL/CR ratio for myopia assessment among Chinese children. Methods: A diagnostic trial was conducted in Shenzhen Eye Hospital from June 2020 to December 2020. Cycloplegic refraction and demographic characteristic survey were carried out, and AL and CR were measured. The Pearson correlation analysis between AL, AL/CR ratio, and spherical equivalent (SE) was carried out. The sensitivity, specificity, Youden index, positive predictive value, and negative predictive value of the AL/CR ratio and AL for myopia assessment were analyzed using cycloplegic refraction as the gold standard by drawing receiver operating characteristic (ROC) curves. Results: A total of 300 children aged 8-18 years participated in this study. The Pearson correlation coefficient between AL and SE was -0.667 (P < 0.05) and -0.754 (P < 0.05) between AL/CR ratio and SE. There were significant differences in SE, AL, and AL/CR ratio among different age groups (p < 0.05). SE decreased by 1.185 diopter (D) for every 1 mm increase in AL and decreased by 0.667 D for every 0.1 increase in the AL/CR ratio. Taking cycloplegic refraction SE ≤ -0.50 D as the gold standard for the diagnosis of myopia, the area under the ROC curve of AL for myopia assessment was 0.836 (95% confidence interval [CI]: 0.767-0.906), with specificity, sensitivity, and Youden index of 0.833, 0.767, and 0.600, respectively. The area under the ROC curve of AL/CR ratio for myopia assessment was 0.937 (95% CI: 0.878-0.996), with specificity, sensitivity, Youden index, positive predictive value, and negative predictive value of 0.703, 0.913, 0.622, 0.956, and 0.771, respectively. The area under the ROC curve of the combination of AL/CR ratio and parental myopia for myopia assessment was 0.976 (95% CI: 0.957-0.996). Conclusion: The correlation between SE and AL/CR ratio was stronger than that between SE and AL in children. The AL/CR ratio may be an alternative indicator for myopia assessment in children, and the combination of demographic factors and AL/CR ratio can improve the accuracy of myopia assessment.

Pollution Levels and Risk Assessment of Heavy Metals in the Soil of a Landfill Site: A Case Study in Lhasa, Tibet.

As an important ecological security barrier in China, the ecological environment of Tibet has aroused widespread concern domestically and overseas. Landfills are a major solid waste treatment approach in Tibet but also cause severe environmental pollution. To date, there are no studies related to the pollution risk of landfills in Tibetan areas. This study investigated the pollution levels, ecological risk, health risk, and possible pollution sources of eight heavy metals in the soils around a landfill site in Lhasa, Tibet. The results indicated that the concentrations of heavy metals in soil were relatively low, only cadmium (Cd), arsenic (As), copper (Cu), chromium (Cr), zinc (Zn), nickel (Ni), and lead (Pb) were 1-2 times higher than the corresponding background value. The values of the single pollution index and geo-accumulation index show that the study area is most seriously polluted by Cd and As. Based on the Nemerow pollution index and the pollution load index, over 83.3% and 8.33% of soil sampling sites had light and moderate contamination levels. According to the results of potential ecological risk evaluation, the potential ecological risk of heavy metals in soil was very low, and only one out of the 72 sampling sites exhibited considerable ecological risk. Cd, As, and mercury (Hg) served as the dominant ecological risk contributors and contributed over 45.0%, 14.1%, and 18% of the ecological risk. The results of the health risk evaluation showed that adults have a higher risk of cancer (1.73 × 10-5), while the non-carcinogenic risk for adults was low. Waste disposal activities and construction activities have a significant influence on soil heavy metal concentrations, causing a higher pollution level in the southeast part of the landfill site in Lhasa.

Effects of nitrogen dioxide exposure on the risk of eye and adnexa diseases among children in Shenzhen, China: an assessment using the generalized additive modeling approach.

This study aimed to assess the relationship between nitrogen dioxide (NO2) exposure and the risk of eye and adnexa diseases (EADs) among children in Shenzhen, China. Information about the daily number of outpatients with EADs and the concentration of air pollutants and meteorological data were collected. A generalized additive model was used to assess the effect of NO2 exposure on the risk of EADs during outpatient visits. An increase in NO2 level by 10 µg/m3 was related to an increase in the daily number of outpatients by 5.43% (95% confidence interval [CI]: 2.25%, 8.70%) at lag0, by 4.35% (95% CI: 1.15%, 7.66%) at lag1, and by 3.21% (95% CI: 0.05%, 6.47%) at lag3. In addition, the relationship between NO2 exposure and the risk of dacryoadenitis was the strongest, with an estimated value of 15.0% (95% CI: 7.99%, 22.5%) at lag0. Moreover, the association between NO2 exposure and the risk of EADs among children in Shenzhen was confirmed in this study. Therefore, the government should introduce stringent environmental policies to control air pollution and protect human health, particularly that of the vulnerable population.

Global burden of acute viral hepatitis and its association with socioeconomic development status, 1990-2019.

BACKGROUND & AIMS: Acute viral hepatitis (AVH) represents an important global health problem; however, the progress in understanding AVH is limited because of the priority of combating persistent HBV and HCV infections. Therefore, an improved understanding of the burden of AVH is required to help design strategies for global intervention. METHODS: Data on 4 major AVH types, including acute hepatitis A, B, C, and E, excluding D, were collected by the Global Burden of Disease (GBD) 2019 database. Age-standardized incidence rates and disability-adjusted life year (DALY) rates for AVH were extracted from GBD 2019 and stratified by sex, level of socio-demographic index (SDI), country, and territory. The association between the burden of AVH and socioeconomic development status, as represented by the SDI, was described. RESULTS: In 2019, there was an age-standardized incidence rate of 3,615.9 (95% CI 3,360.5-3,888.3) and an age-standardized DALY rate of 58.0 (47.3-70.0) per 100,000 person-years for the 4 major types of AVH. Among the major AVH types, acute hepatitis A caused the heaviest burden. There was a significant downward trend in age-standardized DALY rates caused by major incidences of AVH between 1990 and 2019. In 2019, regions or countries located in West and East Africa exhibited the highest age-standardized incidence rates of the 4 major AVH types. These rates were stratified by SDI: high SDI and high-middle SDI locations recorded the lowest incidence and DALY rates of AVH, whereas the low-middle SDI and low SDI locations showed the highest burden of AVH. CONCLUSIONS: The socioeconomic development status and burden of AVH are associated. Therefore, the GBD 2019 data should be used by policymakers to guide cost-effective interventions for AVH. LAY SUMMARY: We identified a negative association between socioeconomic development status and the burden of acute viral hepatitis. The lowest burden of acute viral hepatitis was noted for rich countries, whereas the highest burden of acute viral hepatitis was noted for poor countries.

Factors that influence public awareness of domestic waste characteristics and management in rural areas.

Public awareness of domestic waste characteristics and management (PADWCM) is a prerequisite for a domestic waste management (DWM) plan. In this study, we considered China as a typical example of developing countries to investigate the public perception of environmental pollution (PEP), its PADWCM, and its socioeconomic factors, using questionnaires and statistical methods. The results indicated that the public PEP was mainly due to obvious environmental contamination in local villages, and the PADWCM is still inadequate in rural areas. However, 83.9% of the respondents agreed that DWM is highly necessary. The PADWCM, including the hazard, recyclability, and characteristic pollution caused by domestic waste, was learned mainly from people's direct PEP, experiences, and repurchasing by recyclers. Education period had highly significant positive correlations and regressions with PEP and PADWCM, respectively. Additionally, education directly affected public awareness in different income and age groups. Demonstration projects had a significant positive effect on the awareness of characteristic pollution caused by domestic waste, which was readily perceived. Propaganda had a significant positive influence on the awareness of treatment necessity. Age and gender had no obvious effects on public PEP and PADWCM. Some aspects of PADWCM requiring a deep understanding became stronger as income increased; however, the PADWCM located close to poor people became weaker. Some aspects of PEP could significantly influence the awareness of characteristic pollution caused by domestic waste and awareness of treatment necessity. Therefore, improving environmental education, performing demonstration projects and effective environmental propaganda, increasing people's income, and attracting young people to participate in DWM will be important for enhancing environmental awareness and DWM in rural areas. Integr Environ Assess Manag 2018;14:395-406. © 2018 SETAC.

Influencing factors of domestic waste characteristics in rural areas of developing countries.

Waste management in rural areas has become a major challenge for governments of developing countries. The success of waste management decisions directly lies in the accuracy and reliability of the data on which choices are based; many factors influence these data. Here, we examined the factors influencing domestic waste in rural areas of developing countries (RADIC), using both field surveys and by reviewing previous literature. The social factors included population, education and culture. There was a positive linear relationship between waste generation amount and population size (R2 = 0.9405). Environmental education, training and demonstration projects played a positive role in improving people's awareness of the benefits of recycling and reducing waste. Traditional and national cultures, consumption and living habits contributed to variations in the generation and composition of domestic waste. Generally, practices related to conservation of and reverence for nature and green consumption encourage people to reduce, reuse and recycle waste in their daily life. Economic factors included household income and expenditure, energy and fuel structure, and types of industry that occurred in villages. A Kuznets inverted "U" curve relationship existed between domestic waste generation and people's income in rural areas of China. However, the waste generation rate had a linear relationship with the gross national income per capita in RADIC. The composition, bulk density and calorific value of domestic waste were variously affected by the energy and fuel structure and the types of industry that occurred. The natural factors included geography and climate (including rainfall, humidity, temperature and harvest seasons). The moisture content of waste was directly influenced by rainfall and humidity. Temperature affected waste characteristics by influencing residential heating modes. The waste characteristics were also influenced by the mixing of agricultural and aquacultural waste into domestic waste in the harvesting season. In different geographies, significant differences of domestic waste characteristics were observed as a result of comprehensive effects caused by multiple factors. Other factors included the administrative levels of communities and survey methods. The characteristics of domestic waste in towns or central villages were similar with those in cities, but were different from those in common villages (the smallest type of community). The domestic waste sampled in households indicated a lower rate of generation and lower ash content than when the waste was sampled at transfer stations or dumping sites. Based on the above analysis, the factors influencing domestic waste must be considered in order to optimize the design of waste management strategies in the RADIC. Furthermore, it is valuable and important to obtain more accurate data about waste characteristics.