Global One Health index for zoonoses: A performance assessment in 160 countries and territories.

The One Health (OH) approach is used to control/prevent zoonotic events. However, there is a lack of tools for systematically assessing OH practices. Here, we applied the Global OH Index (GOHI) to evaluate the global OH performance for zoonoses (GOHI-Zoonoses). The fuzzy analytic hierarchy process algorithm and fuzzy comparison matrix were used to calculate the weights and scores of five key indicators, 16 subindicators, and 31 datasets for 160 countries and territories worldwide. The distribution of GOHI-Zoonoses scores varies significantly across countries and regions, reflecting the strengths and weaknesses in controlling or responding to zoonotic threats. Correlation analyses revealed that the GOHI-Zoonoses score was associated with economic, sociodemographic, environmental, climatic, and zoological factors. Additionally, the Human Development Index had a positive effect on the score. This study provides an evidence-based reference and guidance for global, regional, and country-level efforts to optimize the health of people, animals, and the environment.

Hepatic steatosis assessment using ultrasound homodyned-K parametric imaging: the effects of estimators.

BACKGROUND: The homodyned-K (HK) distribution is an important statistical model for describing ultrasound backscatter envelope statistics. HK parametric imaging has shown potential for characterizing hepatic steatosis. However, the feasibility of HK parametric imaging in assessing human hepatic steatosis in vivo remains unclear. METHODS: In this paper, ultrasound HK µ parametric imaging was proposed for assessing human hepatic steatosis in vivo. Two recent estimators for the HK model, RSK (the level-curve method that uses the signal-to-noise ratio (SNR), skewness, and kurtosis based on the fractional moments of the envelope) and XU (the estimation method based on the first moment of the intensity and two log-moments, namely X- and U-statistics), were investigated. Liver donors (n=72) and patients (n=204) were recruited to evaluate hepatic fat fractions (HFFs) using magnetic resonance spectroscopy and to evaluate the stages of fatty liver disease (normal, mild, moderate, and severe) using liver biopsy with histopathology. Livers were scanned using a 3-MHz ultrasound to construct µ RSK and µ XU images to correlate with HFF analyses and fatty liver stages. The µ RSK and µ XU parametric images were constructed using the sliding window technique with the window side length (WSL) =1-9 pulse lengths (PLs). The diagnostic values of the µ RSK and µ XU parametric imaging methods were evaluated using receiver operating characteristic (ROC) curves. RESULTS: For the 72 participants in Group A, the µ RSK parametric imaging with WSL =2-9 PLs exhibited similar correlation with log10(HFF), and the µ RSK parametric imaging with WSL = 3 PLs had the highest correlation with log10(HFF) (r=0.592); the µ XU parametric imaging with WSL =1-9 PLs exhibited similar correlation with log10(HFF), and the µ XU parametric imaging with WSL =1 PL had the highest correlation with log10(HFF) (r=0.628). For the 204 patients in Group B, the areas under the ROC (AUROCs) obtained using µ RSK for fatty stages ≥ mild (AUROC1), ≥ moderate (AUROC2), and ≥ severe (AUROC3) were (AUROC1, AUROC2, AUROC3) = (0.56, 0.57, 0.53), (0.68, 0.72, 0.75), (0.73, 0.78, 0.80), (0.74, 0.77, 0.79), (0.74, 0.78, 0.79), (0.75, 0.80, 0.82), (0.74, 0.77, 0.83), (0.74, 0.78, 0.84) and (0.73, 0.76, 0.83) for WSL =1, 2, 3, 4, 5, 6, 7, 8 and 9 PLs, respectively. The AUROCs obtained using µ XU for fatty stages ≥ mild, ≥ moderate, and ≥ severe were (AUROC1, AUROC2, AUROC3) = (0.75, 0.83, 0.81), (0.74, 0.80, 0.80), (0.76, 0.82, 0.82), (0.74, 0.80, 0.84), (0.76, 0.80, 0.83), (0.75, 0.80, 0.84), (0.75, 0.79, 0.85), (0.75, 0.80, 0.85) and (0.73, 0.77, 0.83) for WSL = 1, 2, 3, 4, 5, 6, 7, 8 and 9 PLs, respectively. CONCLUSIONS: Both the µ RSK and µ XU parametric images are feasible for evaluating human hepatic steatosis. The WSL exhibits little impact on the diagnosing performance of the µ RSK and µ XU parametric imaging. The µ XU parametric imaging provided improved performance compared to the µ RSK parametric imaging in characterizing human hepatic steatosis in vivo.

The efficiency of continuous regional intra-arterial infusion in the treatment of infected pancreatic necrosis.

OBJECTIVE: Our aim was to investigate the efficiency of continuous regional intra-arterial infusion (CRAI) with antisecretory agents and antibiotics in the treatment of infected pancreatic necrosis. MATERIALS AND METHODS: CRAI was used as a new clinical technique to treat acute pancreatitis patients during a 4-year period at the First Affiliated Hospital, Wenzhou Medical College, China. In this retrospective study, thirty-four patients with proven infected pancreatic necrosis were included. Twelve patients were treated with CRAI, and were matched according to age, sex, APACHE II scores, Ranson scores and remote organ dysfunction, with 22 patients with IPN treated surgically. The clinical outcome following surgery and CRAI were compared. RESULTS: No difference was found between the two groups when comparing age, gender, APACHE II scores, Ranson scores and remote organ dysfunction (p > 0.05). The patients treated with CRAI had a lower incidence of complications (33.3% vs 72.7%), duration of hospitalization (27.1 ± 4.7 days vs 43.0 ± 12.0 days) and cost of hospitalization (4.09 ± 1.64 thousand RMB vs 8.77 ± 3.74 thousand RMB) as compared to patients treated with surgery (p < 0.05). The survival rate was significantly higher in the CRAI group as compared to the surgical group (91.7% vs 63.6%; p < 0.01). However, the two groups had similar rates of concomitant operative treatment and incidence of remote organ dysfunction (p > 0.05). CONCLUSIONS: CRAI or CRAI in combination with abscess drainage seemingly improve the clinical outcome in patients with infected pancreatic necrosis. Further confirmative prospective randomized multicenter studies are warranted prior to broad introduction of the CRAI concept.

Implementation of a fast-track clinical pathway decreases postoperative length of stay and hospital charges for liver resection.

A fast-track clinical pathway is designed to streamline patient care delivery and maximize cost effectiveness. It has decreased postoperative length of stay (LOS) and hospital charges for many surgical procedures. However, data on clinical pathways after liver surgery are sparse. This study examined whether use of a fast-track clinical pathway for patients undergoing elective liver resection affected postoperative LOS and hospital charges. A fast-track clinical pathway was developed and implemented by a multidisciplinary team for patients undergoing liver resection. Between July, 2007 and May, 2008, a total of 117 patients underwent elective liver resection: the fast-track clinical pathway (education of patients and families, earlier oral feeding, earlier discontinuation of intravenous fluid, no drains or nasogastric tubes, early ambulation, use of a urinary catheter for less than 24 h and planned discharge 6 days after surgery) was studied prospectively in 56 patients (postpathway group). These patients were compared with the remainder who had usual care (prepathway group). Outcome measures were postoperative LOS, perioperative hospital charges, intraoperative and postoperative complications, mortality, and readmission rate. Among all patients, 69 (59%) had complicating diseases and/or a history of surgery and 24 patients belonged to American Society of Anesthesiologists grade III-IV. Compared with the prepathway group, the postpathway group had a significantly shorter postoperative LOS (7 vs. 11 days, P < 0.01). The average perioperative hospital charges were RMB 26,626 for patients in the prepathway group and only RMB 21,004 for those in the postpathway group (P < 0.05), with no differences in intraoperative and postoperative complications (P = 0.814), mortality (P = 0.606), and readmission rate (P = 0.424). Implementation of the fast-track clinical pathway is an effective and safe method for reducing postoperative LOS and hospital charges for high-risk patients undergoing elective liver resection. The result supports the further development of fast-track clinical pathways for liver surgical procedures.