Potential risk assessment and occurrence characteristic of heavy metals based on artificial neural network model along the Yangtze River Estuary, China.

Pollution from heavy metals in estuaries poses potential risks to the aquatic environment and public health. The complexity of the estuarine water environment limits the accurate understanding of its pollution prediction. Field observations were conducted at seven sampling sites along the Yangtze River Estuary (YRE) during summer, autumn, and winter 2021 to analyze the concentrations of seven heavy metals (As, Cd, Cr, Pb, Cu, Ni, Zn) in water and surface sediments. The order of heavy metal concentrations in water samples from highest to lowest was Zn > As > Cu > Ni > Cr > Pb > Cd, while that in surface sediments samples was Zn > Cr > As > Ni > Pb > Cu > Cd. Human health risk assessment of the heavy metals in water samples indicated a chronic and carcinogenic risk associated with As. The risks of heavy metals in surface sediments were evaluated using the geo-accumulation index (Igeo) and potential ecological risk index (RI). Among the seven heavy metals, As and Cd were highly polluted, with Cd being the main contributor to potential ecological risks. Principal component analysis (PCA) was employed to identify the sources of the different heavy metals, revealing that As originated primarily from anthropogenic emissions, while Cd was primarily from atmospheric deposition. To further analyze the influence of water quality indicators on heavy metal pollution, an artificial neural network (ANN) model was utilized. A modified model was proposed, incorporating biochemical parameters to predict the level of heavy metal pollution, achieving an accuracy of 95.1%. This accuracy was 22.5% higher than that of the traditional model and particularly effective in predicting the maximum 20% of values. Results in this paper highlight the pollution of As and Cd along the YRE, and the proposed model provides valuable information for estimating heavy metal pollution in estuarine water environments, facilitating pollution prevention efforts.

Preliminary assessment of carbonic acid dissociation constants: Insights from observations in China's east coastal oceans.

Based on observations in China's east coastal oceans, we conducted a preliminary assessment of 16 sets of carbonic acid dissociation constants (K1* and K2*) by comparing spectrophotometrically measured pH values at 25 °C with those calculated from total alkalinity and dissolved inorganic carbon. We obtained that K1* and K2* often performed differently within different salinity ranges, and that the constants of Millero et al. (2002) (M02) demonstrated the best performance for the salinity range of 24-35. In contrast, the often recommended constants of Mehrbach et al. (1973) refit by Dickson and Millero (1987) (DM87-M) and Lucker et al. (2000) (L00) would underestimate pH at salinities of 24-30. This was mainly associated with the higher product of K1* and K2* by DM87-M and L00 than by M02 at this salinity range. Also, we found almost no differences between pH values calculated with DM87-M and L00.

Urban nitrogen budgets: Evaluating and comparing the path of nitrogen through cities for improved management.

Reactive nitrogen (Nr) released to the environment is a cause of multiple environmental threats. While Nr flows are often only analyzed in an agricultural context, consumption and emission takes place in the urban environment, and opportunities for Nr recycling and effective policy implementation for mitigation often appear in cities. Since little information is available on the bigger picture of Nr flows through the urban environment, these opportunities often remain unexploited. Here we developed a framework to model Nr pathways through urban and surrounding areas, which we applied to four test areas (Beijing and Shijiazhuang (China), Vienna (Austria), and Zielona Góra (Poland)). Using indicators such as recycling rates and Nr surplus, we estimated environmental risks and recycling potentials based on Nr flows and their entry and exit points. Our findings show marked differences between the core and surrounding areas of each city, with the former being a site of Nr consumption with largest flows associated with households, and the latter a site of (agricultural) production with largest flows associated with industry (fertilizers) and urban plants. As a result, Nr transgresses the core areas in a rather linear manner with only 0-5 % being re-used, with inputs from Nr contained in food and fuels and outputs most commonly as non-reactive N2 emissions to the atmosphere from wastewater treatment and combustion processes. While the peri-urban areas show a higher Nr recycling rate (6-14 %), Nr accumulation and emissions from cultivated land pose significant environmental challenges, indicating the need for mitigation measures. We found potential to increase nitrogen use efficiency through improved Nr management on cultivated areas and to increase Nr recycling using urine and sewage sludge as synthetic fertilizer substitutes. Hence our framework for urban nitrogen budgets not only allows for consistent budgeting but helps identify common patterns, potentially harmful flows and Nr recycling potential.

Assessment of HER2 in Gastric-Type Endocervical Adenocarcinoma and its Prognostic Significance.

As the most common type of human papillomavirus-independent endocervical adenocarcinomas (ECAs), gastric-type endocervical adenocarcinomas (GEAs) account for approximately 10% of all ECAs. Although anti-HER2 therapy has been proven effective in many cancers, it has not been used in ECAs, including GEAs, which is at least partly due to the lack of a well-defined guideline. Limited available data regarding HER2 in GEAs and ECAs have considerable variations likely caused by variations in the tumor type selection, testing methods, and scoring criteria. Here, we selected 58 GEA cases to examine the HER2 status using immunohistochemistry and fluorescent in situ hybridization and investigate the prognostic value and their association with other known or potential prognostic factors. When strong complete or lateral/basolateral membranous reactivity in ≥10% tumor cells was used to define HER2 positivity, relatively high prevalence of HER2 overexpression (10/58[17.2%]) and amplification (9/58 [15.5%]), as well as high immunohistochemistry-fluorescent in situ hybridization concordance rate (9/10 [90%]) was found in GEAs. A lateral/basolateral staining pattern ("U-shaped") was observed, at least focally, in most of HER2-positive (3+) and equivocal (2+) tumors. Notably, considerable heterogeneity of HER2 expression was observed in HER2 positive and equivocal cases (80.0% and 83.3%, respectively). HER2 overexpression and amplification were associated with worse progression-free survival (P = .047 and P = .032, respectively). Programmed death-ligand 1 expression was associated with worse progression-free survival (P = .032), whereas mutant-type p53 demonstrated no prognostic significance. Our work laid a solid foundation for the eventual development of a future standard HER2 testing guideline for GEAs.

Quantitative Analysis of Sulfur Dioxide Emissions in the Yangtze River Economic Belt from 1997 to 2017, China.

Economic development is responsible for excessive sulfur dioxide (SO2) emissions, environmental pressure increases, and human and environmental risks. This study used spatial autocorrelation, the Environmental Kuznets Curve (EKC), and the Logarithmic Mean Divisia Index model to study the spatiotemporal variation characteristics and influencing factors of SO2 emissions in the Yangtze River Economic Belt (YREB) from 1997 to 2017. Our results show that the total SO2 emissions in the YREB rose from 513.14 × 104 t to 974.00 × 104 t before dropping to 321.97 × 104 t. The SO2 emissions from 11 provinces first increased and then decreased, each with different turning points. For example, the emission trends changed in Yunnan in 2011 and in Anhui in 2015, while the other nine provinces saw their emission trends change during 2005-2006. Furthermore, the SO2 emissions in the YREB showed a significant agglomeration phenomenon, with a Moran index of approximately 0.233-0.987. Moreover, the EKC of SO2 emissions and per capita GDP in the YREB was N-shaped. The EKCs of eight of the 11 provinces were N-shaped (Shanghai, Zhejiang, Anhui, Jiangxi, Sichuan, Guizhou, Hunan, and Chongqing) and those of the other three were inverted U-shaped (Jiangsu, Yunnan, and Hubei). Thus, economic development can both promote and inhibit the emission of SO2. Finally, during the study period, the technical effect (approximately -1387.97 × 104-130.24 × 104 t) contributed the most, followed by the economic (approximately 27.81 × 104-1255.59 × 104 t), structural (approximately -56.45 × 104-343.90 × 104 t), and population effects (approximately 4.25 × 104-39.70 × 104 t). Technology was the dominant factor in SO2 emissions reduction, while economic growth played a major role in promoting SO2 emissions. Therefore, to promote SO2 emission reduction, technological innovations and advances should be the primary point of focus.

Does social participation decrease the risk of frailty? Impacts of diversity in frequency and types of social participation on frailty in middle-aged and older populations.

BACKGROUND: Social participation (SP) may be an effective measure for decreasing frailty risks. This study investigated whether frequency and type of SP is associated with decreased frailty risk among Chinese middle-aged and older populations. METHODS: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using the Rockwood's Cumulative Deficit Frailty Index. SP was measured according to frequency (none, occasional, weekly and daily) and type (interacting with friends [IWF]; playing mah-jong, chess, and cards or visiting community clubs [MCCC], going to community-organized dancing, fitness, qigong and so on [DFQ]; participating in community-related organizations [CRO]; voluntary or charitable work [VOC]; using the Internet [INT]). Smooth curves were used to describe the trend for frailty scores across survey waves. The fixed-effect model (N = 9,422) was applied to explore the association between the frequency/type of SP and frailty level. For baseline non-frail respondents (N = 6,073), the time-varying Cox regression model was used to calculate relative risk of frailty in different SP groups. RESULTS: Weekly (ß = - 0.006; 95%CI: [- 0.009, - 0.003]) and daily (ß = - 0.009; 95% CI: [- 0.012, - 0.007]) SP is associated with lower frailty scores using the fixed-effect models. Time-varying Cox regressions present lower risks of frailty in daily SP group (HR = 0.76; 95% CI: [0.69, 0.84]). SP types that can significantly decrease frailty risk include IWF, MCCC and DFQ. Daily IWF and daily DFQ decreases frailty risk in those aged < 65 years, female and urban respondents, but not in those aged ≥ 65 years, male and rural respondents. The impact of daily MCCC is significant in all subgroups, whereas that of lower-frequent MCCC is not significant in those aged ≥ 65 years, male and rural respondents. CONCLUSION: This study demonstrated that enhancing participation in social activities could decrease frailty risk among middle-aged and older populations, especially communicative activities, intellectually demanding/engaging activities and community-organized physical activities. The results suggested very accurate, operable, and valuable intervening measures for promoting healthy ageing.

Identification and assessment method of cable joint health status based on traveling wave reflection.

Due to the difficulty in accurately detecting the health status of cable joints, a new method of identifying and assessing the cable joints' health status based on traveling wave reflection is proposed. By transmitting nanosecond pulse signals at the head end of the cable, the health status characteristics of the cable joints can be obtained, and the noise reduction of the measurement signals is performed by the wavelet function to identify the reflected wave at the joint and the end of the cable. The equivalent circuits and simulation models of contact resistance and leakage resistance are established, and the contact resistance and leakage resistance of the cable joints are calculated according to the amplitude and phase of the reflected signals at the joint and the end of the cable. By comparing with the resistance when the joint is in healthy operation, any measured parameter exceeding the corresponding standard is considered a joint fault. Simulations and test results show that the method can accurately identify the reflected signals of the cable joints in different operating states, and with changes in joint health, clear regular features can be extracted from the reflected signals, and the quality and health of the joints can be determined. The traveling wave method can be used to detect cable joint faults and provide an early warning of defects, which provides a new idea for online monitoring and early warning of cable joints in both theory and engineering practice.

Local and non-local drivers of consumption-based water use in China during 2007-2015: Perspective of metacoupling.

Increasingly growing consumption-based water use (WU) combined with climate change have exacerbated water stress globally and regionally, yet little is known about how the WU change is affected by metacoupled processes which involve human-nature interactions across space; within and across adjacent and distant places. This study aims to unveil the spatio-temporal pattern of China's WUs during 2007-2015 and its underlying local and non-local drivers. Results show that China's total WU exhibited an upward trend from 386.7 billion m³; in 2007 to 431.2 billion m³ in 2012 but dropped to 412.6 billion m³ by 2015. Widespread and continuous water use efficiency improvement contributed most to offsetting the increase in WU driven by the rising affluence and growing population in the context of rapid urbanization and industrialization. Economic structure drove a relatively large WU reduction (responsible for -23.7% of the WU change during 2007-2015), in line with China's ongoing transform from a capital investment-driven economy to a consumption-driven one and decoupling economic growth from environmental pressure. The population share representing the non-local factor of migration effect was large enough to be seen clearly in the changing WUs across China: the WUs of coastal areas ascended while inland areas descended, which was in accordance with migration patterns. Our findings could make a valuable contribution to decision-making in identifying hotspot areas, charting systematic courses for sustainable water use, and combining demand-oriented and supply-oriented measures.

Effect of manual hyperinflation on recurrent atelectasis in a ventilator-dependent C3 complete spinal cord injury patient: A case report.

CLINICAL CASE: We present here the case of a ventilator-dependent 76-year-old man with C3 complete spinal cord injury (SCI) who presented with recurrent left lung atelectasis managed with manual hyperinflation (MH). Atelectasis was primarily assessed with chest X-ray (CXR). Additional monitoring included blood gas analysis, serum procalcitonin, and the Modified Borg Dyspnea Scale (MBS), as an objective measure of reported dyspnea. We found that MH successfully reversed the radiographic appearance of atelectasis after the first treatment and maintained this effect for the duration of the 2-week intervention period as well as at 2 weeks of follow-up post-intervention. Furthermore, MH decreased the patient's oxygen requirements and was associated with a decrease in serum procalcitonin. Clinically, the patient reported reduced subjective dyspnea post-MH, which was reflected as an improvement on the MBS. We conclude that MH may represent a therapeutic modality for consideration in the routine management of recurrent atelectasis in mechanically ventilated patients.

The assessment of the ASGE-grading system of ERCP: a large-sample retrospective study.

BACKGROUND AND AIMS: The American Society for Gastrointestinal Endoscopy (ASGE) has developed a complexity-grading system for endoscopic retrograde cholangiopancreatography (ERCP) to predict technical success and adverse events. This study aimed to assess the association between the degree of difficulty for ERCP and the rates of success and adverse event, in turn demonstrating the validity and practicality of this system. METHODS: ERCP procedures performed in the First Affiliated Hospital of Nanchang University from January 2011 to December 2020 were retrospectively reviewed. Procedural success and adverse events were recorded based on difficulty level according to the ASGE-grading system. RESULTS: A total of 20,652 ERCP procedures performed during the study period were analyzed, including 1908 procedures considered grade 1(9.2%), 10,170 procedures considered grade 2 (49.2%), 7764 procedures considered grade 3 (37.6%), 810 procedures considered grade 4 (3.9%). The overall success rate increased from 92.8% in 2011-2015 to 94.0% in 2016-2020, while the distribution of procedures and the incidence of complications showed little variation. The success rate revealed a significantly decreasing trend with increasing difficulty (ranging from 55.6 to 98.6%), mainly for biliary diseases. In addition, the difficulty scale was not associated with any differences in the rate of adverse event, except for the pancreatitis for grade 1 procedures, which had a low incidence. CONCLUSIONS: The ASGE-grading system can help predict the success rate of ERCP procedures but showed poor performance in predicting adverse events. Further exploration may be required to improve the grading system by adjusting or including certain clinical parameters, and to validate the system for extrapolation to other endoscopy units.

Integrating crop redistribution and improved management towards meeting China's food demand with lower environmental costs.

China feeds 19.1% of the world's population with 8.6% of the arable land. Here we propose an integrated approach combining crop redistribution and improved management to meet China's food demand in 2030. We simulated the food demand, estimated the national crop production through the productivity of the top 10% of producers in each county, and optimized the spatial distribution of 11 groups of crop types among counties using the data of the top producers. Integrating crop redistribution and improved management increased crop production and can meet the food demand in 2030, while the agricultural inputs (N and P fertilizers and irrigation water) and environmental impacts (reactive N loss and greenhouse gas emissions) were reduced. Although there are significant socio-economic and cultural barriers to implementing such redistribution, these results suggest that integrated measures can achieve food security and decrease negative environmental impacts. County-specific policies and advisory support will be needed to achieve the promises of combining optimization strategies.

Global Burden of Disease Study 2019 suggests that metabolic risk factors are the leading drivers of the burden of ischemic heart disease.

Metabolic dysfunction is becoming a predominant risk for the development of many comorbidities. Ischemic heart disease (IHD) still imposes the highest disease burden among all cardiovascular diseases worldwide. However, the contributions of metabolic risk factors to IHD over time have not been fully characterized. Here, we analyzed the global disease burden of IHD and 15 associated general risk factors from 1990 to 2019 by applying the methodology framework of the Global Burden of Disease Study. We found that the global death cases due to IHD increased steadily during that time frame, while the mortality rate gradually declined. Notably, metabolic risk factors have become the leading driver of IHD, which also largely contributed to the majority of IHD-related deaths shifting from developed countries to developing countries. These findings suggest an urgent need to implement effective measures to control metabolic risk factors to prevent further increases in IHD-related deaths.

Nitrogen emission and deposition budget in an agricultural catchment in subtropical central China.

The study of emissions and depositions of atmospheric reactive nitrogen species (Nrs) in a region is important to uncover the sources and sinks of atmospheric Nrs in the region. In this study, atmospheric total Nrs depositions including both wet-only and dry deposition were monitored simultaneously across major land-use types in a 105 km2 catchment called Jinjing River Catchment (JRC) in subtropical central China from 2015 to 2016. Based on activity data and emission factors for the main Nrs emission sources, ammonia (NH3) and nitrogen oxides (NOx) emission inventories for the catchment were also compiled. The estimated total Nrs deposition in JRC was 35.9 kg N ha-1 yr-1, with approximately 49.7 % attributed to reduced compounds (NHx), and 40.5 % attributed to oxidized (NOy). The total Nrs emission rate in JRC was 80.4 kg N ha-1 yr-1, with 61.5 and 18.9 kg N ha-1 yr-1 from NH3 and NOx emissions, respectively. Livestock excretion and fertilization were the two main contributing emission sources for NH3, while vehicle sources contributed the bulk of NOx emissions. The net atmospheric budgets of Nrs in paddy field, forest, and tea field were +3.7, -36.1, and +23.8 kg N ha-1 yr-1, respectively. At the catchment scale, the net atmospheric budget of Nrs was +47.7 kg N ha-1 yr-1, with +43.7 kg N ha-1 yr-1 of NHx and +4.0 kg N ha-1 yr-1 of NOy, indicating that the subtropical catchment was net sources of atmospheric Nrs. Considering that excessive atmospheric Nr emissions and deposition may cause adverse effects on the environment, effects should be conducted to mitigate the Nrs emissions from agriculture and transportation, and increasing the area of forest is good for reducing the net positive budget of atmospheric Nrs in the subtropical catchments in China.

The trend of direct medical costs and associated factors in patients with chronic hepatitis B in Guangzhou, China: an eight-year retrospective cohort study.

BACKGROUND: Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the medical costs associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the problem, we investigated the trend of direct medical costs and associated factors in patients with chronic HBV infection. METHODS: A retrospective cohort study of 65,175 outpatients and 12,649 inpatients was conducted using a hospital information system database for the period from 2008 to 2015. Generalized estimating equations (GEE) were applied to explore associations between annual direct medical costs and corresponding factors, meanwhile quantile regression models were used to evaluate the effect of treatment modes on different quantiles of annual direct medical costs stratified by medical insurances. RESULTS: The direct medical costs increased with time, but the proportion of antiviral costs decreased with CHB progression. Antiviral costs accounted 54.61% of total direct medical costs for outpatients, but only 6.17% for inpatients. Non-antiviral medicine costs (46.06%) and lab tests costs (23.63%) accounted for the majority of the cost for inpatients. The direct medical costs were positively associated with CHB progression and hospitalization days in inpatients. The direct medical costs were the highest in outpatients with medical insurance and in inpatients with free medical service, and treatment modes had different effects on the direct medical costs in patients with and without medical insurance. CONCLUSIONS: CHB patients had a heavy economic burden in Guangzhou, China, which increased over time, which were influenced by payment mode and treatment mode.

Spatial differentiation and driving mechanism of rural water security in typical "engineering water depletion" of karst mountainous area-A lesson of Guizhou, China.

Southwest China gets abundant rainfall, but in its rural areas, there is a severe shortage of water resources for irrigation and drinking. A case study was conducted in the Guizhou Province, which has the most concentrated karst distribution worldwide. The rural water security index was constructed, and Geodetector and ArcGIS were employed to systematically analyze the status quo, spatial differentiation, and driving mechanism of water security in rural areas of Guizhou in 2016. The results showed that (1) there was obvious spatial variation in the rural water security index in the study area, with only 3.85% of areas being maximally safe, and 20.51%, 35.89%, 15.38%, and 24.36% being sub-optimally safe, moderately safe, unsafe, and extremely unsafe, respectively. The spatial distribution of the rural water security index, it generally coincides with a gradual decay from the economically developed areas to the periphery. The water security of the geographical environment is inferior to those of domestic water and water for agricultural production. (2) For Guizhou Province, economic and social factors, such as the disposable income of rural residents and the incidence of impoverishment, were critical factors influencing rural water security. The critical influencing factors vary greatly among prefectures; however, there are some common factors that affect rural water security, such as the incidence of impoverishment, the penetration rate of rural piped water, the percentage of primary industry, and the percentage of karst area. The maximum value of the interactive driver of the percentage of groundwater and the disposable income of rural residents was 0.812, indicating that the interaction between the high percentage of groundwater caused by karst development and the low disposable income of rural residents was the primary reason for the low rural water security. (3) Rural water security was largely influenced by poor socioeconomic development, resulting in a low level of security and the availability of public water facilities and domestic water in rural areas. Significant improvements in rural water security depend on ameliorating the water security of agricultural production and domestic water, rather than improving the geo-environmental conditions of water resources at extremely high costs.

Acute hepatotoxicity and nephrotoxicity risk assessment of the Tibetan medicine 25 flavors of the turquoise pill based on 1H-NMR metabonomics.

ETHNOPHARMACOLOGICAL RELEVANCE: 25 flavors of the turquoise pill, a traditional Tibetan medicine for the treatment of various types of hepatitis, has not been investigated on its safety, especially the component mineral turquoise, which is believed to be essential but worried for its potential toxicity. AIM OF THE STUDY: To explore the potential acute toxicity and function of 25 flavors of the turquoise pill and turquoise, the possible mechanism of the effects of turquoise and 25 flavors of the turquoise pill were systematically studied based on 1H NMR metabolomics. MATERIALS AND METHODS: The rats were administered with turquoise and 25 flavors of the turquoise pill by gavage for 7 days, and samples of serum, liver, and kidney were collected. The potential toxicity and function of turquoise and 25 flavors of the turquoise pill on the liver and kidney of SD rats were evaluated by 1H NMR metabonomics, histopathology, and biochemical indexes. RESULTS: The results demonstrated that 25 flavors of the turquoise pill could scavenge free oxygen radicals, strengthen aerobic respiration and inhibit glycolysis in the liver. It did not cause oxidative stress in the kidney with no obvious damage. By modulation of branched-chain amino acids (BCAAs), 25 flavors of the turquoise pill can improve the utilization of glucose and promote aerobic respiration of the kidney. CONCLUSION: Considering the high dosage and short duration used in this study relative to their typical clinical usage, administration of 25 flavors of the turquoise pill and its component mineral turquoise are safe to livers and kidneys.

Deceleration of China's human water use and its key drivers.

Increased human water use combined with climate change have aggravated water scarcity from the regional to global scales. However, the lack of spatially detailed datasets limits our understanding of the historical water use trend and its key drivers. Here, we present a survey-based reconstruction of China's sectoral water use in 341 prefectures during 1965 to 2013. The data indicate that water use has doubled during the entire study period, yet with a widespread slowdown of the growth rates from 10.66 km3⋅y-2 before 1975 to 6.23 km3⋅y-2 in 1975 to 1992, and further down to 3.59 km3⋅y-2 afterward. These decelerations were attributed to reduced water use intensities of irrigation and industry, which partly offset the increase driven by pronounced socioeconomic development (i.e., economic growth, population growth, and structural transitions) by 55% in 1975 to 1992 and 83% after 1992. Adoptions for highly efficient irrigation and industrial water recycling technologies explained most of the observed reduction of water use intensities across China. These findings challenge conventional views about an acceleration in water use in China and highlight the opposing roles of different drivers for water use projections.

Epidemiological Features of NAFLD From 1999 to 2018 in China.

With dramatic changes in lifestyles over the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the most prevalent liver disorder in China but has not received sufficient attention. NAFLD-related advanced liver disease and its mortality along with its overall disease burden are expected to increase substantially. There is thus an imperative need to clarify the epidemiological features of NAFLD to guide a holistic approach to management. We summarize eight epidemiological features of NAFLD in China over the past two decades using systematic review and meta-analysis methodology. Our data reveal a rapid growth in the NAFLD population, especially among younger individuals. Importantly, there is a strong ethnic difference in body mass index (BMI) and genetic risk of NAFLD compared with the US population. The etiology of advanced liver disease and its complications (e.g., hepatocellular carcinoma) has been altered because of a Westernized lifestyle and the implementation of effective vaccination strategies against viral hepatitis. Regional epidemiological patterns of NAFLD indicate that economics, environment, and lifestyle are critical factors in disease progression. The analysis also indicates that a large number of patients remain undiagnosed and untreated because of the inadequacy of diagnostic tools and the absence of effective pharmacologic therapies. Given the burden of NAFLD, future policy and research efforts need to address knowledge gaps to mitigate the risk burden.

Antiviral drug utilization and annual expenditures for patients with chronic HBV infection in Guangzhou, China, in 2008-2015.

BACKGROUND: The aims of this study were to describe antiviral drug (AD) utilization and costs in patients with chronic HBV infection. METHODS: We conducted a retrospective study of patients in the hospital and calculated annual proportions of AD utilization and costs among patients. A two-part model was used to estimate adjusted odds ratio (OR) for antiviral therapy and cost ratios for antiviral costs associated with demographics. RESULTS: Of a total of 14,920 records, 143,658 records were involved in the analysis. The annual proportions of AD utilization were 56.99% (45.65%) for inpatients (outpatients) during 2008-2015 and increased annually. Entecavir (ETV), in particular, increased from 11.08% to 70.26% (11.05% to 49.35%) for inpatients (outpatients). The patients with medical insurance were more likely to use AD than patients without insurance, and the adjusted OR was 1.11 (95% CI: 1.03, 1.19) for inpatients and 1.66 (1.59, 1.73) for outpatients. With the disease progressing, the proportion of antiviral costs in total direct medical costs decreased from 13.91% to 4.07% (71.29% to 49.29%) for inpatients (outpatients). CONCLUSIONS: The use of AD for chronic HBV infection was less than expected based on established guidelines, and only half of patients received antiviral treatment. However, the AD utilization, especially ETV, increased annually. Reimbursement policy was the most important factor affecting antiviral treatment. Antiviral therapy was an important part of the direct medical costs, especially in the early stage of disease.