A platform for microplastic assessment in aquatic environments based on the protein corona-induced aggregation effect.

The environmental hazards of microplastics have received widespread attention. However, the in-situ detection of microplastics, particularly in aquatic environments, has been challenged by the limitations of detection methods, the large-scale instruments, and small size. Herein, a photoelectrochemical sensor based on the protein corona-induced aggregation effect is designed for the detection of polystyrene microplastics. The sensor has advantages of high sensitivity, reproducibility, and detection capability. A linear detection range of 0.5-500 µg mL-1, a method detection limit of 0.06 µg mL-1, and a limit of quantification of 0.14 µg mL-1 are achieved. Furthermore, the relative standard deviations of intra-day and inter-day precision, ranging from 0.56% to 4.63% and 0.84%-3.36% are obtained. A digital multimeter was employed to construct a platform for the real-time detection in real water samples, streamlining the detection process and yielding clear results. We believe this sensor provides new insight for the in-situ real-time detection of microplastics and has broad applications for the analysis of microplastic pollution in aquatic environments.

Healthcare costs after kidney transplantation compared to dialysis based on propensity score methods and real world longitudinal register data from Sweden.

This study aimed to estimate the healthcare costs of kidney transplantation compared with dialysis using a propensity score approach to handle potential treatment selection bias. We included 693 adult wait-listed patients who started renal replacement therapy between 1998 and 2012 in Region Skåne and Stockholm County Council in Sweden. Healthcare costs were measured as annual and monthly healthcare expenditures. In order to match the data structure of the kidney transplantation group, a hypothetical kidney transplant date of persons with dialysis were generated for each dialysis patient using the one-to-one nearest-neighbour propensity score matching method. Applying propensity score matching and inverse probability-weighted regression adjustment models, the potential outcome means and average treatment effect were estimated. The estimated healthcare costs in the first year after kidney transplantation were €57,278 (95% confidence interval (CI) €54,467-60,088) and €47,775 (95% CI €44,313-51,238) for kidney transplantation and dialysis, respectively. Thus, kidney transplantation leads to higher healthcare costs in the first year by €9,502 (p = 0.066) compared to dialysis. In the following two years, kidney transplantation is cost saving [€36,342 (p < 0.001) and €44,882 (p < 0.001)]. For patients with end-stage renal disease, kidney transplantation reduces healthcare costs compared with dialysis over three years after kidney transplantation, even though the healthcare costs are somewhat higher in the first year. Relating the results of existing estimates of costs and health benefits of kidney transplantation shows that kidney transplantation is clearly cost-effective compared to dialysis in Sweden.

Health-related quality of life of Chinese patients with chronic kidney disease: a study based on four EQ-5D-3L value sets.

Provide reference data on which EQ-5D-3L value set should be used with Chinese patients with chronic kidney disease (CKD); assess differences in health-related quality of life (HRQoL) based on the use of the Chinese (from 2014 and 2018), the UK, and the Japanese value sets; and examine differences in utility scores for key preventive influencing factors. Data from 373 patients with CKD recruited for a cross-sectional multicenter HRQoL survey were used. Differences among utility scores based on the four value sets were determined using Wilcoxon signed rank test. Intra-class correlation coefficient (ICCs) and Bland-Altman plots were used to evaluate consistency among utility scores and Tobit regression model was used to analyze the influencing factors of utility scores. There were significant differences between utility scores based on the four value sets, with the Chinese 2018 value set yielding the highest utility (0.957). ICCs between the value sets for China 2014, the UK, and Japan were all greater than 0.9, whereas the ICCs between the value sets for China 2018 and the other three were all less than 0.7. The influencing factors of utility scores included CKD stages, age, education level, city, and primary renal disease. This was the first study to report findings on the health utility of patients with CKD based on the two Chinese EQ-5D-3L value sets. Overall, the Chinese value sets performed similarly to the other two value sets (UK and Japan) commonly used in the Chinese population; however, value sets for different countries were not interchangeable. In Chinese contexts, the two value sets for China were recommended and the choice of which one should consider whether the value set of choice was established with a sample that is consistent with the targeted population.

Performance assessment of medical service for organ transplant department based on diagnosis-related groups: A programme incorporating ischemia-free liver transplantation in China.

Background: In July 2017, the first affiliated hospital of Sun Yat-sen university carried out the world's first case of ischemia-free liver transplantation (IFLT). This study aimed to evaluate the performance of medical services pre- and post-IFLT implementation in the organ transplant department of this hospital based on diagnosis-related groups, so as to provide a data basis for the clinical practice of the organ transplant specialty. Methods: The first pages of medical records of inpatients in the organ transplant department from 2016 to 2019 were collected. The China version Diagnosis-related groups (DRGs) were used as a risk adjustment tool to compare the income structure, service availability, service efficiency and service safety of the organ transplant department between the pre- and post-IFLT implementation periods. Results: Income structure of the organ transplant department was more optimized in the post-IFLT period compared with that in the pre-IFLT period. Medical service performance parameters of the organ transplant department in the post-IFLT period were better than those in the pre-IFLT period. Specifically, case mix index values were 2.65 and 2.89 in the pre- and post-IFLT periods, respectively (p = 0.173). Proportions of organ transplantation cases were 14.16 and 18.27%, respectively (p < 0.001). Compared with that in the pre-IFLT period, the average postoperative hospital stay of liver transplants decreased by 11.40% (30.17 vs. 26.73 days, p = 0.006), and the average postoperative hospital stay of renal transplants decreased by 7.61% (25.23 vs.23.31 days, p = 0.092). Cost efficiency index decreased significantly compared with that in the pre-IFLT period (p < 0.001), while time efficiency index fluctuated around 0.83 in the pre- and post-IFLT periods (p = 0.725). Moreover, the average postoperative hospital stay of IFLT cases was significantly shorter than that of conventional liver transplant cases (p = 0.001). Conclusion: The application of IFLT technology could contribute to improving the medical service performance of the organ transplant department. Meanwhile, the DRGs tool may help transplant departments to coordinate the future delivery planning of medical service.

Research on the Equity and Influencing Factors of Medical and Health Resources Allocation in the Context of COVID-19: A Case of Taiyuan, China.

COVID-19 has killed millions of people worldwide. As a result, medical and health resources continue to be strained, posing a great threat to people's safety and economic and social development. This paper built the index system of influencing factors of medical and health resources containing the economy, population and society, and then classified Taiyuan into three types of regions by cluster analysis. The Gini coefficient, Theil index and agglomeration degree were then used to analyze the spatial distribution of medical and health resources allocation, and its influencing factors were studied by grey relational analysis. It was found that the population allocation of medical and health resources in Taiyuan was better than area allocation. Population has the greatest influence on the allocation of medical and health resources, followed by society and the economy. The more developed the regional economy, the more diversified the main influencing factors, and the more adjustment and control choices of medical and health resources allocation. Suggestions for optimal allocation were put forward in order to fully utilize the limited medical and health resources, effectively respond to the epidemic needs, promote the sustainable development of resources, protect the health of residents, and improve social benefits.

Comparative pulmonary toxicities of lunar dusts and terrestrial dusts (TiO2 & SiO2) in rats and an assessment of the impact of particle-generated oxidants on the dusts' toxicities.

Humans will set foot on the Moon again soon. The lunar dust (LD) is potentially reactive and could pose an inhalation hazard to lunar explorers. We elucidated LD toxicity and investigated the toxicological impact of particle surface reactivity (SR) using three LDs, quartz, and TiO2. We first isolated the respirable-size-fraction of an Apollo-14 regolith and ground two coarser samples to produce fine LDs with increased SR. SR measurements of these five respirable-sized dusts, determined by their in-vitro ability to generate hydroxyl radicals (•OH), showed that ground LDs > unground LD ≥ TiO2 ≥ quartz. Rats were each intratracheally instilled with 0, 1, 2.5, or 7.5 mg of a test dust. Toxicity biomarkers and histopathology were assessed up to 13 weeks after the bolus instillation. All dusts caused dose-dependent-increases in pulmonary lesions and toxicity biomarkers. The three LDs, which possessed mineral compositions/properties similar to Arizona volcanic ash, were moderately toxic. Despite a 14-fold •OH difference among these three LDs, their toxicities were indistinguishable. Quartz produced the lowest •OH amount but showed the greatest toxicity. Our results showed no correlation between the toxicity of mineral dusts and their ability to generate free radicals. We also showed that the amounts of oxidants per neutrophil increased with doses, time and the cytotoxicity of the dusts in the lung, which supports our postulation that dust-elicited neutrophilia is the major persistent source of oxidative stress. These results and the discussion of the crucial roles of the short-lived, continuously replenished neutrophils in dust-induced pathogenesis are presented.

Nomograms for predicting difficult airway based on ultrasound assessment.

BACKGROUND: Accurate prediction of the difficult airway (DA) could help to prevent catastrophic consequences in emergency resuscitation, intensive care, and general anesthesia. Until now, there is no nomogram prediction model for DA based on ultrasound assessment. In this study, we aimed to develop a predictive model for difficult tracheal intubation (DTI) and difficult laryngoscopy (DL) using nomogram based on ultrasound measurement. We hypothesized that nomogram could utilize multivariate data to predict DTI and DL. METHODS: A prospective observational DA study was designed. This study included 2254 patients underwent tracheal intubation. Common and airway ultrasound indicators were used for the prediction, including thyromental distance (TMD), modified Mallampati test (MMT) score, upper lip bite test (ULBT) score temporomandibular joint (TMJ) mobility and tongue thickness (TT). Univariate and the Akaike information criterion (AIC) stepwise logistic regression were used to identify independent predictors of DTI and DL. Nomograms were constructed to predict DL and DTL based on the AIC stepwise analysis results. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of the nomograms. RESULTS: Among the 2254 patients enrolled in this study, 142 (6.30%) patients had DL and 51 (2.26%) patients had DTI. After AIC stepwise analysis, ULBT, MMT, sex, TMJ, age, BMI, TMD, IID, and TT were integrated for DL nomogram; ULBT, TMJ, age, IID, TT were integrated for DTI nomogram. The areas under the ROC curves were 0.933 [95% confidence interval (CI), 0.912-0.954] and 0.974 (95% CI, 0.954-0.995) for DL and DTI, respectively. CONCLUSION: Nomograms based on airway ultrasonography could be a reliable tool in predicting DA. TRIAL REGISTRATION: Chinese Clinical Trial Registry (No. ChiCTR-RCS-14004539 ), registered on 13th April 2014.

Risk assessment of coal mine water inrush based on PCA-DBN.

To provide an effective risk assessment of water inrush for coal mine safety production, a BP neural network prediction method for water inrush based on principal component analysis and deep confidence network optimization was proposed. Because deep belief network (DBN) is disadvantaged by a long training time when establishing a high-dimensional data classification model, the principal component analysis (PCA) method is used to reduce the dimensionality of many factors affecting the water inrush of the coal seam floor, thus reducing the number of variables of the research object, redundancy and the difficulty of feature extraction and shortening the training time of the model. Then, a DBN network was used to extract secondary features from the processed nonlinear data, and a more abstract high-level representation was formed by combining low-level features to find the expression of the nonlinear relationship between the characteristics of water in bursts. Finally, a prediction model was established to predict the water inrush in coal mines. The superiority of this method was verified by comparing the prediction of the actual working face with the actual situation in typical mining areas of North China. The prediction accuracy of coal mine water inrush obtained by this algorithm is 94%, while the prediction accuracy of traditional BP algorithm is 70%, and the prediction accuracy of SVM algorithm is 88%.

Prevalence of small for gestational age infants in 21 cities in China, 2014-2019.

Infants who are small for gestational age (SGA) are at increased risk of neonatal and infant death, non-communicable diseases and growth retardation. However, the epidemiological characteristics of SGA remain unclear. We aim to explore the prevalence of SGA and to examine its socioeconomic associations by using data from 21 cities. 10,515,494 single live birth records between 2014 and 2019 from the Guangdong Women and Children Health Information System were included in the study. Descriptive statistical methods were used to analyze the prevalence trend of SGA and its distribution. We also analyze the associations between the prevalence of SGA and per-capita GDP. The prevalence of SGA in Guangdong Province from the years 2014-2019 was 13.17%, 12.96%, 11.96%, 12.72%, 11.45%, 11.30% respectively, and the overall prevalence was 12.28%. The prevalence of term SGA infants in Guangdong Province was 12.50%, which was much higher than that of preterm SGA (7.71%). There was a significant negative correlation between the SGA prevalence and per-capita GDP in 21 cities of Guangdong Province. The level of economic development may affect the prevalence of SGA. The prevalence of SGA in full term infants is significantly higher than in premature infants, suggesting that most SGA infants may be born at a later gestational age.

Staged vs simultaneous bilateral unicompartmental knee arthroplasty for clinical outcomes: A protocol of systematic review and meta-analysis.

BACKGROUND: Bilateral unicompartmental knee arthroplasty (UKA) can be divided into one or two stages clinically. Compared with staged bilateral UKA, whether simultaneous bilateral UKA has better clinical efficacy remains to be verified. METHODS: PubMed, EBSCO, and Web of Science were searched by us for meta-analysis. Studies were considered eligible for inclusion if they included simultaneous and staged UKA. We excluded studies unrelated to the research question, studies in non-selected languages, and studies where the full-text was not available. The data were extracted by two independent investigators, and disagreements were resolved through discussions with a third party. If important data or information about the content of the paper were not available, authors were contacted. Publication bias in studies has been assessed. Meta-analysis was done using Review Manager 5.3. RESULTS: The systematic review and meta-analysis identified 3370 trials, of which 8 studies (963 patients) compared simultaneous with staged bilateral UKA. The meta-analysis showed that the clinical outcomes of simultaneous bilateral UKA goes down in operating time (weighted mean difference [WMD] = -19.34, 95% confidence interval [CI] -22.44 to -16.25, P < .00001), postoperative hemoglobin (Std. mean difference [SMD] = -0.46, 95% CI -0.71 to -0.20, P = .0004), length of stay (LOS) (WMD = -4.73, 95% CI -6.39 to -3.06, P < .00001), hospital cost (SMD = -5.42, 95% CI -6.54 to -4.30, P < .00001). There were no significant difference in blood transfusion, venous thrombosis, infection, cardiac complications, pulmonary complications, Oxford Knee Score (OKS) between simultaneous and staged bilateral UKA. CONCLUSION: Simultaneous bilateral UKA can effectively reduce the operating time, LOS, and hospital cost without increasing postoperative complications compared to stage bilateral UKA. REGISTRATION NUMBER: CRD42020160056 (www.crd.york.ac.uk/prospero/).

Clinical outcomes and uroflowmetry assessment in patients with apical prolapse after laparoscopic uterosacral ligament suspension.

OBJECTIVE: The aim was to evaluate the voiding function and voiding dysfunction 3 months after laparoscopic uterosacral ligament suspension (LUSLS). We identified risk factors for postoperative voiding dysfunction. STUDY DESIGN: This retrospective study included 57 women with apical prolapse who underwent LUSLS with stage II or greater apical prolapse and without advanced anterior vaginal prolapse (stage III or IV). Data were collected from electronic medical records. Voiding function was assessed by uroflowmetry, PVR examination, and self-report questionnaires (the Pelvic Floor Distress Inventory-20 and the Urinary Impact Questionnaire) at baseline and 3 months after surgery. Voiding dysfunction was defined as an average flow rate (Qave)＜10 ml/s, a maximum flow rate (Qmax)＜15 ml/s, or a postvoid residual volume (PVR)＞50 ml. Statistical analyses were performed using paired-sample t tests, χ2 tests, and multivariate logistic regression. RESULTS: Thirty-five percent of women suffered from voiding dysfunction preoperatively. Uroflowmetry parameters and PVR, objective symptoms including voiding difficulties, incomplete empty, frequency and urinary incontinence didn't show significant improvement postoperatively (all p＞0.05). Low Qave was identified as an independent risk factor of post voiding dysfunction (odds ratio, 0.558; 95 % CI, 0.324-0.963). CONCLUSIONS: Approximately one-third of women suffering from apical prolapse without advanced anterior vaginal wall had evidence of voiding dysfunction preoperatively. LUSLS has no obvious effect on uroflowmetry parameters and clinical symptoms.

Metabolic Engineering of a Homoserine-Derived Non-Natural Pathway for the De Novo Production of 1,3-Propanediol from Glucose.

Engineering a homoserine-derived non-natural pathway allows heterologous production of 1,3-propanediol (1,3-PDO) from glucose without adding expensive vitamin B12. Due to the lack of efficient enzymes to catalyze the deamination of homoserine and the decarboxylation of 4-hydroxy-2-ketobutyrate, the previously engineered strain can only produce 51.5 mg/L 1,3-PDO using homoserine and glucose as cosubstrates. In this study, we systematically screened the enzymes from different protein families to catalyze the two corresponding reactions and further optimized the selected enzymes by protein engineering. Together with the improvement of homoserine supply by systematic metabolic engineering, an engineered Escherichia coli strain with an optimal combination of aspartate transaminase ( aspC) from E. coli, pyruvate decarboxylase ( pdc) from Zymomonas mobiliz, and alcohol dehydrogenase yqhD from E. coli can produce 0.32 g/L 1,3-PDO from glucose in shake flask cultivation. The titer of 1,3-PDO was further increased to 0.49 g/L or 0.63 g/L by introducing a point mutation of I472A into pdc gene or constructing a fusion protein between aspC and pdc. This study lays the basis for developing a potential process for 1,3-PDO production from sugars without using expensive coenzyme B12.

Reimagining Health Communication: A Noninferiority Randomized Controlled Trial of Crowdsourced Intervention in China.

BACKGROUND: Crowdsourcing, the process of shifting individual tasks to a large group, may be useful for health communication, making it more people-centered. We aimed to evaluate whether a crowdsourced video is noninferior to a social marketing video in promoting condom use. METHODS: Men who have sex with men (≥16 years old, had condomless sex within 3 months) were recruited and randomly assigned to watch 1 of the 2 videos in 2015. The crowdsourced video was developed through an open contest, and the social marketing video was designed by using social marketing principles. Participants completed a baseline survey and follow-up surveys at 3 weeks and 3 months postintervention. The outcome was compared with a noninferiority margin of +10%. RESULTS: Among the 1173 participants, 907 (77%) and 791 (67%) completed the 3-week and 3-month follow-ups. At 3 weeks, condomless sex was reported by 146 (33.6%) of 434 participants and 153 (32.3%) 473 participants in the crowdsourced and social marketing arms, respectively. The crowdsourced intervention achieved noninferiority (estimated difference, +1.3%; 95% confidence interval, -4.8% to 7.4%). At 3 months, 196 (52.1%) of 376 individuals and 206 (49.6%) of 415 individuals reported condomless sex in the crowdsourced and social-marketing arms (estimated difference: +2.5%, 95% confidence interval, -4.5 to 9.5%). The 2 arms also had similar human immunodeficiency virus testing rates and other condom-related secondary outcomes. CONCLUSIONS: Our study demonstrates that crowdsourced message is noninferior to a social marketing intervention in promoting condom use among Chinese men who have sex with men. Crowdsourcing contests could have a wider reach than other approaches and create more people-centered intervention tools for human immunodeficiency virus control.

Decisions of the Dual-Channel Supply Chain under Double Policy Considering Remanufacturing.

Considering the preference of green consumers for remanufactured products, a dual-sale-channel supply chain model with government non-intervention, government remanufacturing subsidy policy, and carbon tax policy is constructed, respectively. The difference of the optimal decision between the firm and the government under the two policies is discussed in this paper. Meanwhile, we analyze the influence of green consumers on the government's optimal decision, based on social welfare maximization. It is found that without government intervention, social welfare is the lowest. The carbon tax policy is better when the proportion of green consumers and the environmental coefficient are extreme or moderate at the same time. Otherwise, the subsidy policy is better. The carbon tax policy is more effective than the subsidy policy in controlling carbon emissions. Profit-sharing contracts should be established by enterprises and governments to achieve win⁻win results.

Clinical characteristics and medical service utilization of lung cancer in China, 2005-2014: Overall design and results from a multicenter retrospective epidemiologic survey.

OBJECTIVES: This study aimed to explore the clinical profile and its trajectory of lung cancer on clinicopathological characteristics and medical service utilization in China. METHODS: Patients diagnosed with primary lung cancer in tertiary hospitals during 2005-14 were selected from seven geographic regions of China. Data on clinical characteristics and medical service utilization was extracted from medical record, and the ten-year trends were explored. RESULTS: A total of 7184 patients were included, the mean age was 58.3 years and the male-to-female-ratio was 2.7. From 2005 to 2014, the proportion of ≥60 year-old patients increased from 41.2% to 56.2% (p < 0.001). The smoking rate decreased from 62.9% to 51.1% (p < 0.001) and the proportion of females increased from 23.5% to 31.9% (p < 0.001). The proportion of advanced stage increased from 41.9% to 47.4% (p < 0.001). Adenocarcinoma's proportion increased from 36.4% to 53.5% (p < 0.001) while that of squamous carcinoma decreased from 45.4% to 34.4% (p < 0.001). The application of chest X-ray dropped from 50.2% to 31.0% (p < 0.001) but that of chest CT increased from 65.8% to 81.4% (p < 0.001). As two main treatment options, chemotherapy (p = 0.290) and surgery (p = 0.497) remained stable. The medical expenditure per patient increased from 40,508 to 66,020 Chinese Yuan (p < 0.001). CONCLUSIONS: The sustaining high smoking exposure, increasing proportion of female patients, advancing clinical stage, shifting of predominant pathology and increasing medical expenditure demonstrate potential challenges and directions on lung cancer prevention and control in China. Despite substantial changes of clinical characteristics, main treatment options remained unchanged, which needs further investigation.

Evaluation of the ray-casting analytical algorithm for pencil beam scanning proton therapy.

For pencil beam scanned (PBS) proton therapy, analytical dose calculation engines are still typically used for the optimisation process, and often for the final evaluation of the plan. Recently however, the suitability of analytical calculations for planning PBS treatments has been questioned. Conceptually, the two main approaches for these analytical dose calculations are the ray-casting (RC) and the pencil-beam (PB) method. In this study, we compare dose distributions and dosimetric indices, calculated on both the clinical dose calculation grid and as a function of dose grid resolution, to Monte Carlo (MC) calculations. The analysis is done using a comprehensive set of clinical plans which represent a wide choice of treatment sites. When analysing dose difference histograms for relative treatment plans, pencil beam calculations with double grid resolution perform best, with on average 97.7%/91.9% (RC), 97.9%/92.7% (RC, double grid resolution), 97.6%/91.0% (PB) and 98.6%/94.0% (PB, double grid resolution) of voxels agreeing within ±5%/± 3% between the analytical and the MC calculations. Even though these point-to-point dose comparison shows differences between analytical and MC calculations, for all algorithms, clinically relevant dosimetric indices agree within ±4% for the PTV and within ±5% for critical organs. While the clinical agreement depends on the treatment site, there is no substantial difference of indices between the different algorithms. The pencil-beam approach however comes at a higher computational cost than the ray-casting calculation. In conclusion, we would recommend using the ray-casting algorithm for fast dose optimization and subsequently combine it with one MC calculation to scale the absolute dose and assure the quality of the treatment plan.

Assessment of dosimetric errors induced by deformable image registration methods in 4D pencil beam scanned proton treatment planning for liver tumours.

PURPOSE: Respiratory impacts in pencil beam scanned proton therapy (PBS-PT) are accounted by extensive 4D dose calculations, where deformable image registration (DIR) is necessary for estimating deformation vector fields (DVFs). We aim here to evaluate the dosimetric errors induced by different DIR algorithms in their resulting 4D dose calculations by using ground truth(GT)-DVFs from 4DMRI. MATERIALS AND METHODS: Six DIR methods: ANACONDA, Morfeus, B-splines, Demons, CT Deformable, and Total Variation, were respectively applied to nine 4DCT-MRI liver data sets. The derived DVFs were then used as input for 4D dose calculation. The DIR induced dosimetric error was assessed by individually comparing the resultant 4D dose distributions to those obtained with GT-DVFs. Both single-/three-field plans and single/rescanned strategies were investigated. RESULTS: Differences in 4D dose distributions among different DIR algorithms, and compared to the results using GT-DVFs, were pronounced. Up to 40 % of clinically relevant dose calculation points showed dose differences of 10 % or more between the GT. Differences in V95(CTV) reached up to 11.34 ±â€¯12.57 %. The dosimetric errors became in general less substantial when applying multiple-field plans or using rescanning. CONCLUSION: Intrinsic geometric errors by DIR can influence the clinical evaluation of liver 4D PBS-PT plans. We recommend the use of an error bar for correctly interpreting individual 4D dose distributions.

Assessment of the mitral valve coaptation zone with 2D and 3D transesophageal echocardiography before and after mitral valve repair.

BACKGROUND: Mitral valve (MV) coaptation is very important in MV repair patients. But accurate quantitation of the degree of MV coaptation remains challenging. This study aimed to evaluate the utility of two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) to assess MV coaptation before and after MV repair. METHODS: Forty-eight patients [(age: 52.23±13.31 years; 26 men (54.17%)] undergoing MV repair for mitral regurgitation (MR) were studied. We assessed the utility of 2D and 3D TEE to assess MV coaptation before and after MV repair. Complete conventional 2D and 3D TEE studies were performed, and the degree of the MV coaptation defect before and after surgery was assessed by measuring the MV coaptation length (CL) and length index (CLI) with 2D TEE, and the coaptation area (CA) and coaptation area index (CAI) with 3D TEE. RESULTS: CL and CLI were measured successfully in 46 (95.83%) patients and CA and CAI in 39 (81.25%). Compared with preoperatively, postoperative CL, CLI, CA, and CAI were significantly increased (CL: 4.99±0.79 to 9.66±1.09 mm, P<0.05; CLI: 9.30%±2.66% to 38.24%±3.82%, P<0.05; CA: 158.49±64.17 to 371.33±143.57 mm2, P<0.05; CAI: 9.71%±2.76% to 36.24%±7.26%, P<0.05). Spearman's rank correlation analysis revealed that the CLI and CAI had a significant negative correlation with the degree of MR (r=-0.97, P<0.01; r=-0.92, P<0.01, respectively). Furthermore, Pearson's correlation analysis revealed that the CLI was significantly correlated with the CAI both preoperatively (r=-0.66, P<0.01) and postoperatively (r=-0.67, P<0.01). CONCLUSIONS: The coaptation variables increased significantly in patients undergoing MV repair. The CLI and CAI significantly correlated with MR severity. The CL and CLI determined with 2D TEE are more feasible than the CA and CAI determined with 3D TEE. Both 2D and 3D variables may complement each other for aiding MV repair. 2D CLI is an alternative to 3D CAI due to its simplicity.

Socioeconomic Inequalities in the Kidney Transplantation Process: A Registry-Based Study in Sweden.

BACKGROUND: Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. METHODS: The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. RESULTS: Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates, patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest income quintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. CONCLUSIONS: Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities.