A new proposal for phenotypic classification and outcome assessment of dermatomyositis based on clinical manifestations and serological testing.

BACKGROUND: Dermatomyositis (DM) is an infrequent disease subgroup of idiopathic inflammatory myopathies characterized by distinct skin lesions. However, high heterogeneity makes clinical diagnosis and treatment of DM very challenging. OBJECTIVES: Unsupervised classification in DM patients and analysis of key factors related to clinical outcomes. METHODS: This retrospective study was conducted between 2017 and 2022 at the Department of Rheumatology, Xiangya Hospital, Central South University. 162 DM patients were enrolled for unsupervised hierarchical cluster analysis. In addition, we divided the clinical outcomes of DM patients into four subgroups: withdrawal, stabilization, aggravation, and death, and compared the clinical profiles amongst the subgroups. RESULTS: Out of 162 DM patients, three clusters were defined. Cluster 1 (n = 40) was mainly grouped by patients with prominent muscular involvement and mild Interstitial Lung Disease (ILD). Cluster 2 (n = 72) grouped patients with skin rash, anti-Melanoma Differentiation Associated protein 5 positive (anti-MDA5+), and Rapid Progressive Interstitial Lung Disease (RP-ILD). Cluster 3 (n = 50) grouped patients with the mildest symptoms. The proportion of death increased across the three clusters (cluster 3 < cluster 1 < cluster 2). STUDY LIMITATIONS: The number of cases was limited for the subsequent construction and validation of predictive models. We did not review all skin symptoms or pathological changes in detail. CONCLUSIONS: We reclassified DM into three clusters with different risks for poor outcome based on diverse clinical profiles. Clinical serological testing and cluster analysis are necessary to help clinicians evaluate patients during follow-up and conduct phenotype-based personalized care in DM.

Stabilization of heavy metals in municipal solid waste incineration fly ash using organic chelating agents: Insight into risk assessment and function mechanism.

Landfill treatment of municipal solid waste incineration fly ash (MSWI FA) after stabilization is the primary disposal technology. However, only few studies have assessed the stability of MSWI-FA-chelated products in different landfill scenarios. In this study, three commonly used dithiocarbamate (DTC)-based organic chelating agents (CAs) (TS-300, SDD, and PD) were selected to stabilize heavy metals (HMs) in MSWI FA. In addition, the leaching toxicity and environmental risks of the chelated products were assessed in different disposal environments. The results demonstrate that the HM leaching concentrations of the chelated products met the concentration limits of the sanitary landfill standard (GB16889-2008; mixed Landfill Scenario) for the three CAs at a low additive level (0.3 %). However, in the compartmentalized landfill scenario (the leaching agent was acid rain), the leaching of HMs from the chelated products met the standard when TS-300, SDD, and PD were added at 1.5 %, 6.0 %, and 8.0 %, respectively. Additionally, Pb, Zn, and Cd in the chelated products from the 1.5 %-TS-300 and 6.0 %-SDD groups met the leaching limits within the pH ranges 6-12 and 7-12, 6-12 and 7-12, and 8-12 and 8-12, respectively. This was primarily due of TS-300's multiple DTC groups forming stable chain-like macromolecular chelates with Pb. However, although the environmental risks associated with Pb, Zn, and Cd in the initial (0-d) chelated products of the 1.5 %-TS-300 and 6.0 %-SDD groups were minimized to low and negligible levels, there was a significant increase in the leaching of the three HMs after 28 d of storage. Therefore, with appropriate CA addition, although the leaching concentration of HMs in the chelated product may comply with the GB16889-2008 standards, it remains essential to consider its environmental risk, particularly in highly acidic or alkaline environments and during prolonged storage of the product.

Solidification/stabilization and risk assessment of heavy metals in municipal solid waste incineration fly ash: A review.

Incineration is currently the most common method of treating municipal solid waste. Municipal solid waste incineration fly ash (MSWI FA) contains a high concentration of toxic heavy metals (HMs), making it a hazardous waste. A series of detoxification treatments are required to reduce the toxicity of fly ash. Furthermore, the environmental risk of MSWI FA after treatment is becoming a cause of concern. This paper reviews the primary ash properties, pH, liquid-solid ratio, and other factors (microorganism, type of leaching agents, etc.) that affect the leaching of HMs from MSWI FA, compares and summarizes the most widely applied solidification/stabilization (S/S) techniques. In particular, models and methods for the environmental risk assessment and prediction of HMs are classified and described in detail. Finally, the inadequacy of current S/S techniques for MSWI FA is pointed out, which may be useful for upcoming studies on this topic.

[Evaluation and Source Analysis of Heavy Metal Pollution in Sediments of the Yellow River Basin Based on Monte Carlo Simulation and PMF Model].

As sediment is an essential component of rivers, the enrichment of heavy metals in sediment presents a serious threat to the aquatic environment. Many industrial cities are located along the Yellow River, and heavy metal pollution is a prominent problem in these areas. Thus, the study of heavy metal pollution in sediments of the Yellow River basin is of vital significance to the safety of the Yellow River basin ecosystem. In this study, we collected data on the concentrations of heavy metals (Pb, Cd, Cr, As, Zn, Cu, Ni, and Hg) in the sediments of the Yellow River basin from 2000 to 2020. We first analyzed the spatial distribution characteristics of heavy metals based on descriptive statistics and geostatistics and then used the Monte Carlo method to evaluate the probability of the ground accumulation index(Igeo), potential ecological risk, and toxicity units. Finally, the number of pollution sources and their contribution rates were determined by combining the positive definite matrix factor (PMF) decomposition model and Pearson correlation analysis. It was found that the mean values of ω(Pb), ω(As), ω(Zn), ω(Ni), ω(Cu), ω(Hg), ω(Cr), and ω(Cd) in the Yellow River basin sediments were 26.92, 11.78, 87.17, 31.13, 24.96, 0.07, 73.36, and 0.58 mg·kg-1, which exceeded the mean soil background values in the Yellow River basin provinces by 1.27, 1.08, 1.26, 1.05, 1.09, 2.32, 1.14, and 5.95 times, respectively, among which Cd exceeded the standard by the largest factor and should be taken seriously. The Igeo was ranked as Cd>Hg>Cr>Cu>Pb>Zn>As>Ni, and Cd and Hg showed medium-severe pollution. The proportions of heavy ecological risk in sediments in the upper, middle, and lower reaches of the Yellow River basin were 18.6%, 15.7%, and 7.1%, respectively, with a decreasing trend. Heavy metals in the sediments of the Yellow River basin were in a low-toxicity state. The PMF-Pearson correlation analysis showed that the four sources of heavy metals in the Yellow River basin sediments were mining sources (42.2%), natural activities (38.3%), agricultural activities (11.6%), and electroplating wastewater (7.9%). The results of this study can provide a basis for developing relevant pollution prevention and control measures in the Yellow River basin.

Does Descending Resources Reform Improve Patient Satisfaction and Reshape Choice of Care Providers? A Cross-Sectional Study in Zhejiang, China.

Patient satisfaction and choice of care providers have been the core concerns of China's descending resources reform launched in 2013. This health care reform attempts to improve low-level hospitals' capability and patient satisfaction through compulsory descending of doctors from high-level hospitals, thereby reshaping patients' behavior (loyalty). The goal of this paper is to explore the determinants of patient satisfaction, and its impact on patient loyalty with an emphasis on low-level hospitals in the reform context. By using a self-made 5-point scale that incorporates socio-demographic variables, reform, and revealed preference into the European Consumer Satisfaction Index model (ECSI), cross-sectional data from 17 hospitals, and 1287 questionnaires in Zhejiang province is collected to conduct empirical research. Satisfaction is measured as ordinary variables with the reform and with the low-level hospitals, respectively. Loyalty is measured by patients' willingness to choose low-level hospitals when suffering illness or severe illness. Analysis of variance and multiple comparisons are utilized to examine the different level of hospitals. An ordered logit model and ordinary least squares regression are applied to examine the determinants of satisfaction and loyalty. The results indicate that patient satisfaction can be explained by variables of perceived quality, patient expectations, and corporate image. Socio-demographic variable, providers, and the reform also have significant effects. Patients' satisfaction plays a pronounced role on improving their loyalty. The descending resources reform positively affects low-level hospitals' capability and patient satisfaction. The cost reduction and convenience significantly increase the reform satisfaction. Capability, medical environment, and accessibility of descending doctors are positively associated with the satisfaction with low-level hospitals. This paper evidences that the descending resources reform is an effective way to reallocate resources in supply side of health service market and reshape patients' choice of care providers with the accessibility and spillover of descending human capital.