Ecological risk assessment of heavy metals in desulfurized seawater discharged from a coal-fired power plant in Qingdao.

Despite the prevalence of discharge of large volumes of heavy-metal-bearing seawater from coal-fired power plants into adjacent seas, studies on the associated ecological risks remain limited. This study continuously monitored concentrations of seven heavy metals (i.e. As, Cd, Cr, Cu, Hg, Pb, and Zn) in surface seawater near the outfall of a coal-fired power plant in Qingdao, China over three years. The results showed average concentrations of As, Cd, Cr, Cu, Hg, Pb, and Zn of 2.63, 0.33, 2.97, 4.63, 0.008, 0.85, and 25.00 µg/L, respectively. Given the lack of data on metal toxicity to local species, this study investigated species composition and biomass near discharge outfalls and constructed species sensitivity distribution (SSD) curves with biological flora characteristics. Hazardous concentrations for 5% of species (HC5) for As, Cd, Cr, Cu, Hg, Pb, and Zn derived from SSDs constructed from chronic toxicity data for native species were 3.23, 2.22, 0.06, 2.83, 0.66, 4.70, and 11.07 µg/L, respectively. This study further assessed ecological risk of heavy metals by applying the Hazard Quotient (HQ) and Joint Probability Curve (JPC) based on long-term heavy metal exposure data and chronic toxicity data for local species. The results revealed acceptable levels of ecological risk for As, Cd, Hg, and Pb, but unacceptable levels for Cr, Cu, and Zn. The order of studied heavy metals in terms of ecological risk was Cr > Cu ≈ Zn > As > Cd ≈ Pb > Hg. The results of this study can guide the assessment of ecological risk at heavy metal contaminated sites characterized by relatively low heavy metal concentrations and high discharge volumes, such as receiving waters of coal-fired power plant effluents.

Total per-visit medical expenses incurred by outpatients with diabetes-Evidence from six provinces in eastern China.

BACKGROUND: Chronic diseases associated with diabetes threaten the health of Chinese people and contribute to poverty. METHODS: Medical service utilization records of 78 124 visits by outpatients with diabetes to medical institutions in China's eastern region between 2013 and 2015 were randomly selected from the Medical Insurance Department (MID) database. One-way analysis of variance (ANOVA) was used to compare the average total per-visit, out-of-pocket (OOP), and medical insurance (MI) fund expenses between variables. Multiple linear regression analysis was performed to identify possible risk factors affecting total per-visit medical expenses. RESULTS: Average total per-visit medical expenses were 244.59, 285.56, and 435.33 yuan in primary, secondary, and tertiary medical institutions, respectively. Significant differences were found for average total per-visit medical expenses by year of visit, age, type of medical insurance, and levels of medical institutions. No significant differences were found for average total per-visit medical expenses by gender. CONCLUSION: The functions of medical networks at all levels should be clarified and the Urban Resident Basic Medical Insurance (URBMI) reimbursement ratio improved to ensure equal access to medical services irrespective of medical insurance type. Patients with chronic diseases should be encouraged to visit primary medical institutions to reduce medical expenses.

Factors influencing residents' decision to sign with family doctors under the new health care reform in China.

BACKGROUND: As an important means through which to promote Chinese health care reform, the family doctor policy has attracted attention from various fields. This study aimed to explore the factors influencing residents' decision to sign with family doctors, with a view to informing the changes necessary to encourage additional residents to do so, thereby enhancing the efficacy of primary health care system reform. METHODS: The residents of five communities in Xianning, Hubei Province, were selected, by convenience sampling, to participate in the study. We developed and administered a questionnaire to collect data, from which we obtained 725 valid response sets. Socio-demographic characteristics were summarized using descriptive statistics; and Pearson chi-squared test and binary logistic regression were performed to identify the factors influencing residents' decision to sign with family doctors. RESULTS: We found that the factors influencing residents' decision to sign include their education level, medical insurance, chronic diseases, medical treatment habits, awareness of the family doctor policy, perception of the medical skills of family doctors, and attitudes towards family doctors' signing services (P < .05). CONCLUSION: To encourage more residents to sign with family doctors, we recommend the implementation of the following: increasing publicity for the family doctor policy, promoting the reasonable distribution of high-quality resources, augmenting the standard of general medical education, and improving the skills and competencies of family doctors.

Patterns of cognitive function in middle-aged and elderly Chinese adults-findings from the EMCOA study.

BACKGROUND: The principal aim of this study was to demonstrate the gender-specific cognitive patterns among middle-aged and elderly Chinese adults, investigate the risk factors on global and domain-specific cognitive performance in men and women, respectively, and report demographically adjusted norms for cognitive tests. METHODS: The Effects and Mechanism of Cholesterol and Oxysterol on Alzheimer's disease (EMCOA) study enrolled 4573 participants aged 50-70 years in three Chinese cities. All participants underwent an extensive neuropsychological test battery. Composite scores for specific domains were derived from principal component analysis (PCA). Multivariate linear regression models were used to determine gender-specific risk factors and demographically adjusted normative data. RESULTS: Three cognitive domains of verbal memory, attention/processing speed/executive function, and cognitive flexibility were extracted. A female advantage in verbal memory was observed regardless of age, whereas men tended to outperform women in global cognition and attention/processing speed/executive function. The effects of education on women were more substantial than men for general cognition and attention/processing speed/executive function. For all the cognitive tests, regression-based and demographically adjusted normative data were calculated. CONCLUSIONS: There is a need for gender-specific intervention strategies for operationalizing cognitive impairment. TRIAL REGISTRATION: EMCOA, ChiCTR-OOC-17011882 . Retrospectively registered on 5 July 2017.

Relative Contributions of Different Lifestyle Factors to Health-Related Quality of Life in the Elderly.

Much of the previous literature has studied the relationship between individual lifestyle factors and the health-related quality of life (HRQOL). However, only a few studies combined them to explore their relative importance to the HRQOL in the elderly. This study assesses the HRQOL of the urban, rural, and institutionalized Chinese elderly and explores the relative contributions of different lifestyle factors to their HRQOL. The SF-36v2 Health Survey, the WHOQOL-OLD module, and the socio-demographic and lifestyle questionnaire were utilized in this study. Hierarchical regression was performed in order to analyze the results. The physical and mental component scores of the SF-36v2 survey were 47.05 ± 9.95 and 54.92 ± 9.92, respectively. The total score for the WHOQOL-OLD module was 73.01 ± 11.99, with institutionalized persons reporting lower scores. For the physical component of the elderly participants' HRQOL, the R² value changed the most (0.116) when exercise-and-labor-related factors were added in. For the mental component, sleep-related (0.054), and leisure-time-activity-related factors (0.053) caused the largest change of the R² value. For the elderly-specific HRQOL, measured by the WHOQOL-OLD module, the leisure-time-activity-related factors caused the largest change in the R² value (0.119), followed by exercise-and-labor-related factors (0.078). Heterogeneity was present among the three subgroups. In sum, compared with their community-dwelling counterparts, the HRQOL of institutionalized older people was relatively poor and different lifestyle factors contributed to the HRQOL differently.

Quantitative assessment of the effect of FGF20 rs12720208 variant on the risk of Parkinson's disease: a meta-analysis.

OBJECTIVES: Many studies have investigated the association between fibroblast growth factor 20(FGF20) rs12720208(C/T) polymorphism and the susceptibility of Parkinson's disease (PD). However, published data are still controversial. Here, we performed a meta-analysis to evaluate the association of rs12720208 polymorphism with the risk of PD. METHODS: Up to April 2016, Pubmed, EMbase, Web of science, the Chinese National Knowledge Infrastructure, and Wanfang Medicine were reviewed to identify appropriate documents. A total of seven papers involving 11 studies with 3360 PD cases and 3681 controls were included based on the strict inclusion and exclusion standards. And STATA 12.0 statistics software was used to calculate available data from each study. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated to assess the association between FGF20 rs12720208 polymorphism and PD risk. RESULTS: When all studies were pooled into this meta-analysis, neither the minor T allele frequencies nor the genotypic distributions were different between PD cases and controls. But the subgroup analysis stratified by ethnicity showed FGF20 rs12720208 polymorphism was associated with increased risk in the allele model (T vs. C:OR = 1.167, 95% CI = 1.020-1.335) and dominant model (TT + TC vs. CC:OR = 1.156, 95% CI = 1.001-1.335) in Caucasians but not in Asians. CONCLUSIONS: This meta-analysis indicates that rs12720208 C/T variant might be associated with PD susceptibility in Caucasians.

Assessment of IL-28: rs12979860 and rs8099917 Polymorphisms in a Cohort of Cuban Chronic HCV Genotype 1b Patients.

Hepatitis C virus (HCV) is a significant global public health problem with >185 million infections worldwide. A series of genome-wide association studies (GWAS) has identified IL-28B polymorphisms as a predictor of sustained virologic response (SVR), as well as spontaneous clearance in chronic HCV genotype 1 patients. The objective of this work was to evaluate the prevalence of IL-28B rs12979860 and rs8099917 polymorphisms in Cuban chronic HCV patients. The study cohort included 73 chronic HCV patients treated with concomitant administration of CIGB-230 and nonpegylated IFN-α plus ribavirin (non-pegIFN-α/R) antiviral therapy. The genotype distribution of IL-28B rs12979860CC, -CT, and -TT was 29, 41, and 30%, respectively, and the distribution for rs8099917TT, -TG, and -GG was 63, 31, and 5%, respectively. The allele frequencies for rs12979860C and -T alleles were 51 and 49%, respectively, and for rs8099917G and -T alleles, the values were 21 and 79%, respectively. SVR rates were 55, 42, and 35% for rs12979860CC, -CT, and -TT, respectively, and 52, 30, and 25% for rs8099917TT, -GT, and -GG, respectively. The combined assessment of both single nucleotide polymorphisms (SNPs) resulted in 3 major genotypes (rs12979860CC/rs8099917TT, rs12979860CT/rs8099917TT, and rs12979860CT/rs8099917GG) with a frequency of 30.1, 21.9, and 20.5%, respectively. In patients with heterozygous variant rs12979860CT, the additional genotyping of rs8099917 contributed to increase the SVR rate. It is concluded that in Cuban HCV-infected patients, the responder homogeneous variant rs8099917TT is the most frequent genotype. The simultaneous genotyping of 2 IL-28B SNPs could improve the prediction of SVR contributing to better therapeutic decisions and treatment management.

Thyroid disruption in male goldfish (Carassius auratus) exposed to leachate from a municipal waste treatment plant: Assessment combining chemical analysis and in vivo bioassay.

Several classes of thyroid-disrupting chemicals (TDCs) have been found in refuse leachate, but the potential impacts of leachate on the thyroid cascade of aquatic organisms are yet not known. In this study, we chemically analyzed frequently reported TDCs, as well as conducted a bioassay, to evaluate the potential thyroid-disrupting effects of leachate. We used radioimmunoassay to determine the effects of leachate exposure on plasma 3,3',5-triiodo-l-thyronine (T3), 3,3',5,5'-l-thyroxine (T4), and thyroid-stimulating hormone (TSH) levels in adult male goldfish (Carassius auratus). We also investigated the impacts of leachate treatment on hepatic and gonadal deiodinases [types I (D1), II (D2), and III (D3)] and gonadal thyroid receptor (TRα-1 and TRß) mRNA expressions by using real-time polymerase chain reaction. The results indicated the presence of five TDCs (bisphenol A, 4-t-octylphenol, di-n-butyl phthalate, di-n-octyl phthalate, and diethylhexyl phthalate); their mean concentrations in the leachate were 18.11, 2.76, 4.86, 0.21, and 9.16 µg/L, respectively. Leachate exposure induced plasma T3 and TSH levels in male fish, without influencing the plasma T4 levels. The highly elevated D2 mRNA levels in the liver were speculated to be the primary reason for the induction of plasma T3 levels. Disruption of thyroid functions by leachate was also suggested by the up-regulation of D1 and D2 as well as TRα-1 mRNA levels in the gonads. Prominent thyroid disruptions despite the very low TDC concentrations in the exposure media used in the bioassay strongly indicated the existence of unidentified TDCs in the leachate. Our study indicated the necessity of conducting in vivo bioassays to detect thyroid dysfunctions caused by leachate.

Assessment of coronary stents by 64-slice computed tomography: in-stent lumen visibility and patency.

OBJECTIVE: To assess lumen visibility of coronary stents by 64-slice computed tomography (CT) coronary angiography, and determine the value of 64-slice CT in non-invasive detecting of in-stent restenosis after coronary artery stent implantation. METHODS: Totally, 60 patients (54 males, aged 57.0+/-12.7 years) and 105 stents were investigated by 64-slice CT at a mean interval of 20.0+/-16.6 months after coronary stents implantation. Axial multi-planar reconstruction images of the stents and curved-planar reconstruction images through the median of the stents were reconstructed for evaluating stent image quality on a 5-point scale (1=excellent, 5=non-assessable), and stent lumen diameter was detected. Conventional coronary angiography was performed in 18 patients, and 32 stents were evaluated. RESULTS: Image quality was good to excellent on average (score 1.71+/-0.76). Stent image quality score was correlated to heart rate (r=0.281, P<0.01) and stent diameter (r=-0.480, P<0.001). All the stents were assessable in lumen visibility with an average visible lumen diameter percentage of 60.7%+/-13.6%. Visible lumen diameter percentage was correlated to heart rate (r=-0.193, P<0.05), stent diameter (r=0.403, P<0.001), and stent image quality score (r=-0.500, P<0.001). Visible lumen diameter percentage also varied depending on the stent type. In comparison with the conventional coronary angiography, 4 of 6 in-stent stenoses were correctly detected. The sensitivity and specificity for the detection of in-stent stenosis were 66.7% and 84.6%, respectively. CONCLUSIONS: Using a 64-slice CT, the stent lumen is partly visible in most of the stents. And 64-slice CT may be useful in the assessment of stent patency.