Simplified S1 Vertebral Bone Quality Score in the Assessment of Patients with Vertebral Fragility Fractures.

OBJECTIVE: To evaluate the effectiveness of the S1 vertebral bone quality (VBQ) score in assessing bone quality among patients with vertebral fragility fractures (VFF). Additionally, whether the combination of S1 VBQ and Hounsfield unit (HU) values improves the predictive accuracy of VFF. METHODS: Using lumbar noncontrast computed tomography and T1-weighted magnetic resonance imaging, we measured L1 HU values, S1 VBQ, and L1-L4 VBQ. To assess their predictive performance for VFF, we constructed receiver operating characteristic curves. We also compared the diagnostic efficacy of HU values with that of S1 VBQ and L1--L4 VBQ values for the joint diagnosis of VFF. The Delong test was used to compare the value of individual or combined predictions of VFF. RESULTS: In comparison to the nonfracture group, all patients exhibited markedly elevated S1 VBQ and L1--L4 VBQ and notably reduced HU values (P < 0.001). Multivariate analysis revealed that elevated S1 VBQ, increased L1--L4 VBQ, and decreased HU values independently correlated with VFF development. The areas under the curve for VFF prediction were 0.806 for S1 VBQ, 0.799 for L1--L4 VBQ, and 0.820 for HU values. According to the Delong test, the combination of HU values with S1 VBQ/L1--L4 VBQ significantly improved the diagnostic accuracy. CONCLUSIONS: The simplified S1 VBQ is a valuable tool for predicting the occurrence of VFF and can be used as an alternative to the L1--L4 VBQ. In addition, the combination of S1 VBQ and HU values can significantly improve the predictive value of VFF.

Cost-of-illness of gastroenteritis caused by rotavirus in Chinese children less than 5 years.

Acute gastroenteritis (AGE) caused by rotavirus (RV) remains a public health issue in China. To accelerate the mass rotavirus vaccination, it is important to inform the policy maker, and the public of the economic burden caused by rotavirus infection. A meta-analysis was conducted applying standardized algorithms. Articles published before January 1, 2023, in English and Chinese were searched through PubMed, CNKI, and WanFang Data. Studies with cost analysis of RV AGE were included. A random-effects model was applied to synthesize the total cost of RV AGE from the societal perspective. A prospective survey aimed to measure the cost of RV AGE was conducted in 2021 and 2022 in Shaoxing city, Zhejiang province, that can represent the developed region. The cost data was applied as deviation indicator, in comparison with the pooled estimate generated from meta-analysis. Totally 286 articles were identified, and eventually 12 studies were included. The pooled total social cost of RV AGE was US$282.1 (95%CI: US$213.4-350.7). The pooled private cost of RV AGE was US$206.4 (95%CI: US$155.2-257.5). RV AGE hospitalized and RV AGE incurred in developed regions caused remarkable higher burden (US$631.2 [95%CI: US$512.6-749.8], and US$333.6 [95%CI: US$234.1-433.2] respectively), compared to RV AGE treated at outpatient, and incurred in less developed regions. Our study demonstrates that RV AGE causes a significant economic burden in China. Given the promising effectiveness and highly cost-effective, introduction of rotavirus vaccines in national immunization programs could substantially reduce the economic burden in China.

Molecular Dynamics Simulations Combined with Markov Model to Explore the Effect of Allosteric Inhibitor Binding on Bromodomain-Containing Protein 4.

Bromodomain-Containing Protein 4 (BRD4) can play an important role in gene transcriptional regulation of tumor development and survival by participating in histone modification epigenetic mechanism. Although it has been reported that novel allosteric inhibitors such as ZL0590 have a high affinity with target protein BRD4 and good efficacy, their inhibitory mechanism has not been studied further. The aim of this study was to reveal the inhibition mechanism of allosteric inhibitor ZL0590 on Free-BRD4 and BRD4 binding MS436 (orthosteric inhibitor) by molecular dynamics simulation combined with a Markov model. Our results showed that BRD4-ZL0590 led to α-helices formation of 100-105 compared with Free-BRD4; the combination of MS436 caused residues 30-40 and 95-105 to form α-helices, while the combination of allosteric inhibitors untangled the α-helices formed by the MS436. The results of Markov flux analysis showed that the binding process of inhibitors mainly involved changes in the degree of α-helices at ZA loop. The binding of ZL0590 reduced the distance between ZA loop and BC loop, blocked the conformation at the active site, and inhibited the binding of MS436. After the allosteric inhibitor binding, the MS436 that could normally penetrate into the interior of the pocket was floating on the edge of the active pocket and did not continue to penetrate into the active pocket as expected. In summary, we provide a theoretical basis for the inhibition mechanism of ZL0590 against BRD4, which can be used as a reference for improving the development of drug targets for cancer therapy.

An NLP approach to identify SDoH-related circumstance and suicide crisis from death investigation narratives.

OBJECTIVES: Suicide presents a major public health challenge worldwide, affecting people across the lifespan. While previous studies revealed strong associations between Social Determinants of Health (SDoH) and suicide deaths, existing evidence is limited by the reliance on structured data. To resolve this, we aim to adapt a suicide-specific SDoH ontology (Suicide-SDoHO) and use natural language processing (NLP) to effectively identify individual-level SDoH-related social risks from death investigation narratives. MATERIALS AND METHODS: We used the latest National Violent Death Report System (NVDRS), which contains 267 804 victim suicide data from 2003 to 2019. After adapting the Suicide-SDoHO, we developed a transformer-based model to identify SDoH-related circumstances and crises in death investigation narratives. We applied our model retrospectively to annotate narratives whose crisis variables were not coded in NVDRS. The crisis rates were calculated as the percentage of the group's total suicide population with the crisis present. RESULTS: The Suicide-SDoHO contains 57 fine-grained circumstances in a hierarchical structure. Our classifier achieves AUCs of 0.966 and 0.942 for classifying circumstances and crises, respectively. Through the crisis trend analysis, we observed that not everyone is equally affected by SDoH-related social risks. For the economic stability crisis, our result showed a significant increase in crisis rate in 2007-2009, parallel with the Great Recession. CONCLUSIONS: This is the first study curating a Suicide-SDoHO using death investigation narratives. We showcased that our model can effectively classify SDoH-related social risks through NLP approaches. We hope our study will facilitate the understanding of suicide crises and inform effective prevention strategies.

Value assessment of NMPA-approved new cancer drugs for solid cancer in China, 2016-2020.

Background: Whether the high cost of cancer drugs is commensurate with their value to patients, which has become the focus of public concern. We aimed to assess the value of new cancer drugs approved for solid cancer in China and to explore the association between price and value of drugs. Methods: We identified all new drugs for solid tumor that approved by the China's National Medical Products Administration (NMPA) between 2016 and 2020. The value of these drugs was assessed according to the American Society of Clinical Oncology Value Framework (ASCO-VF) and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). We calculated Cohen's κ statistic to describe agreement between the two frameworks. Spearman's correlation coefficient was used to evaluate the correlation between price and value of drugs. Results: Between 2016 and 2020, 37 new drugs were approved by the NMPA for solid tumor and we could evaluate the value of 28 drugs (76%). Eight (29%) of drugs were approved for non-small-cell lung cancer and 6 (21%) for breast cancer. ASCO-VF scores had a range of -20 to 110.1, and the median score was 43.3 (inter-quartile range 27.1-58.35). Only seven drugs (25%) met the ASCO-VF cutoff score. By the ESMO-MCBS, 13 drugs showed a meaningful value. Agreement between these two frameworks thresholds was only fair (κ = 0.515, P < 0.05). We found no statistically significant correlation between launch price of drugs and clinical benefit according to both frameworks. Conclusions: Not all NMPA-approved new cancer drugs had meaningful value as measured by ASCO-VF or ESMO-MCBS. There was no significant correlation between drug price and the level of clinical benefit.

Exploring key sectors of CO2 emissions and driving factors to spatiotemporal evolution in China from multiple perspectives.

Identifying CO2 emission from different perspectives is necessary for developing the effective mitigation policies for China. Previous studies mainly focus on exploring important sectors from production and consumption sides, while the perspective of betweenness has been neglected. For narrowing the gap, a new perspective for accounting the critical transmission sectors is discussed. In this study, we calculated and compared the CO2 emissions of production-based, consumption-based, and betweenness-based from 2012 to 2017 based on the multi-regional input-output (MRIO) model. A structural decomposition analysis (SDA) is conducted to uncover the driving forces of CO2 emissions change from three accounting principles. The Findings are as follows: (1) the heavy industry sector (559.26 Mt) in Shandong and Jiangsu (471.97 Mt), Power in Guangdong (83.77 Mt) and Beijing (199.24 Mt), Equipment in Jiangsu (213.88 Mt) are identified as the key transmission sectors; (2) the emission intensity effect and the final demand product structure effect contribute to CO2 emission decrease in China, which are largely offset by the structure effect of final demand source and the final demand scale effect. Based on this, we propose some typical policy implications, such as paying close attention to the production efficiency of the key transmission sectors, optimizing the intermediate product input structure and increasing investment in the technology level, and then reducing the intensity of carbon emission.

Helicobacter pylori Infection Combined with OLGA and OLGIM Staging Systems for Risk Assessment of Gastric Cancer: A Retrospective Study in Eastern China.

Purpose: Helicobacter pylori (H. pylori) infection is a high-risk factor for gastric cancer (GC). The main aim of this study was to evaluate the effect of H. pylori on gastritis staging systems and the value of H. pylori combined with gastritis staging systems in predicting GC risk. Patients and Methods: This study enrolled 609 patients with gastric atrophy (GA) and 527 patients with gastric intestinal metaplasia (GIM), who were graded by the OLGA and OLGIM staging systems, respectively. Each individual underwent serum pepsinogen (PG) test, H. pylori detection and questionnaire investigation. We did a real-world retrospective follow-up survey for them in April 2022. Results: Compared with H. pylori-negative patients, H. pylori-positive patients had higher serum PGs/gastrin-17 (G-17) levels and lower PGR levels, regardless of OLGA/OLGIM stages I-II or III-IV. Furthermore, eight patients with atrophic gastritis who progressed to GC were previously in OLGA stages III-IV and OLGIM stages II-IV. The average duration of this process was 2.19±1.03 years. Logistic regression analysis indicated that PGI and H. pylori infection were independent risk factors of individuals with OLGA stages III-IV. Age and PGR were independent risk factors of patients with OLGIM stages III-IV. PGI and PGR had good clinical diagnostic values for OLGA stages III-IV and OLGIM stages III-IV, respectively. Conclusion: Patients with OLGA/OLGIM stages III-IV should undergo endoscopic surveillance regardless of H. pylori infection. H. pylori-positive patients with OLGIM stage II also have a high risk of GC. H. pylori combined with PGI and PGR is helpful to evaluate the severity of chronic gastritis.

Pollution Risk Assessment and Sources Analysis of Heavy Metal in Soil from Bamboo Shoots.

In order to investigate the pollution situation and sources analysis of heavy metals in bamboo shoot soil in Guangdong Province, a total of 175 soil samples were collected at 46 sites. Atomic fluorescence spectrophotometer and inductively coupled plasma mass spectrometry were used to determine the content of five heavy metals: lead (Pb), cadmium (Cd), arsenic (As), mercury (Hg), and chromium (Cr). In addition, the soil environmental quality was evaluated through different index methods, including single-factor pollution, Nemeiro comprehensive pollution, geoaccumulation, and potential ecological risk. Furthermore, the correlation coefficients were also discussed. The results showed that the soils collected were acidic or slight alkaline. The maximum content of Pb and As from some areas exceeded the standard limit value. The coefficient of variation value from six areas exceeded 100%. The index method mentioned above confirmed that the soil within study areas was divided into three pollution levels: no, slightly, and mild. Additionally, there was a very significant correlation between pH and Pb, Hg; the correlation between heavy metal As and Pb, Cr also reached a very significant level. The principal component analysis results show that PC1 accounts for 39.60% of the total variance, which includes Pb, Cd, and As. PC2 mainly includes Hg and Cr.

Projections in Various Scenarios and the Impact of Economy, Population, and Technology for Regional Emission Peak and Carbon Neutrality in China.

Owing to the surge in greenhouse gas emissions, climate change is attracting increasing attention worldwide. As the world's largest carbon emitter, the achievement of emission peak and carbon neutrality by China is seen as a milestone in the global response to the threat. By setting different "emission peak" and "carbon neutrality" paths, this study compares the different pathways taken by China towards regional emission reduction to illustrate China's possible contribution to global emission reduction, and analyzes the role that China's economy, population, and technology need to play in this process through the Stochastic Impacts by Regression on Population, Affluence, and Technology model. In terms of path setting, based on actual carbon emissions in various regions from 2000 to 2019 and grid data on land use from 2000 to 2020, the model simulates three emission peak paths to 2030 and two carbon neutrality paths to 2060, thus setting six possible carbon emission trends from 2000 to 2060 in different regions. It is found that the higher the unity of policy objectives at the emission peak stage, the lower the heterogeneity of the inter-regional carbon emission trends. In the carbon neutrality stage, the carbon emissions in the unconstrained symmetrical extension decline state scenario causes the greatest environmental harm. Certain regions must shoulder heavier responsibilities in the realization of carbon neutrality. The economic development level can lead to a rise in carbon emissions at the emission peak stage and inhibit it at the carbon neutrality stage. Furthermore, the dual effects of population scale and its quality level will increase carbon emissions at the emission peak stage and decrease it at the carbon neutrality stage. There will be a time lag between the output of science and technology innovation and its industrialization, while green innovation is a key factor in carbon neutrality. Based on the results, this study puts forward policy suggestions from a macro perspective to better realize China's carbon emission goals.

Value of Assessment of Different Neoplasias in the Adnexa in the Differential Diagnosis of Malignant Ovarian Tumor and Benign Ovarian Tumor: A Meta-analysis.

To evaluate the accuracy of the assessment of different neoplasias in the adnexa (ADNEX) model in the differential diagnosis of malignant and benign ovarian tumors, the optimal cutoff value and the accuracy in diagnosing ovarian tumors at different stages, PubMed, Web of Science and Cochrane Library databases were retrieved to search literature with per-patient analysis until publication of the last study in November 2021. STATA 14.1, Meta-Disc 1.4 and Revman software 5.3 were used in the performance of meta-analysis. To explore sources of heterogeneity, a subgroup analysis was conducted for the ADNEX model. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood, negative likelihood ratio and area under the summary receiver operating characteristic curve were 0.91 (95% confidence interval [CI]: 0.89-0.93), 0.84 (95% CI: 0.80-0.88), 55.55 (95% CI: 40.47-76.26), 5.71 (95% CI: 4.49-7.26), 0.10 (95% CI: 0.08-0.13) and 0.94 (95% CI: 0.92-0.96) in differentiating benign and malignant ovarian tumors, respectively. The area under the curve in identifying benign, borderline, stage I and stages II-IV were 0.93, 0.73, 0.27 and 0.92. The ADNEX model had high diagnostic performance was influential in the diagnosis of benign and stage II-IV ovarian tumors.

Development and Validation of Nomograms to Predict Operative Link for Gastritis Assessment Any-Stage and Stages III-IV in the Chinese High-Risk Gastric Cancer Population.

Purpose: It is very essential to diagnose gastric atrophy in the area with high prevalence of gastric cancer. Operative link for gastritis assessment (OLGA) was developed to detect the severity of gastric atrophy. The aim of this study was to develop and validate nomograms for predicting OLGA any-stage and stages III-IV in the Chinese high-risk gastric cancer population. Methods: We retrospectively analyzed 7,945 participants obtained by a multicenter cross-sectional study. We randomly selected 55% individuals (4,370 participants, training cohort) to analyze and generate the prediction models and validated the models on the remaining individuals (3,575 participants, validation cohort). A multivariate logistic regression model was used to select variables in the training cohort. The corresponding nomograms were developed to predict OLGA any-stage and stages III-IV, respectively. The area under the receiver operating characteristic curves and the GiViTI calibration belts were used to estimate the discrimination and calibration of the prediction models. Results: There were 1,226 (28.05%) participants in the training sample and 970 (27.13%) in the validation sample who were diagnosed with gastric atrophy. The nomogram predicting OLGA any-stage had an area under the curve (AUC) of 0.610 for the training sample and 0.615 for the validation sample, with favorable calibrations in the overall population. Similarly, the nomogram predicting OLGA stages III-IV had an AUC of 0.702 and 0.714 for the training and validation samples, respectively, with favorable calibrations in the overall population. Conclusions: The prediction model can early identify the occurrence of gastric atrophy and the severity stage of gastric atrophy to some extent.

Dynamic characteristics and drivers of the regional household energy-carbon-water nexus in China.

Being a node of the energy-water consumer and carbon dioxide (CO2) emitter, the household is one key sector to pilot integrated energy-carbon-water (ECW) management. This study developed an integrated framework to explore China's provincial household ECW nexus as well as their drivers from the years 2000 through 2016. The absolute amount and growth rate of household energy use (HEU), household CO2 emissions (HCE), and household water use (HWU) were abstracted to reveal the dynamic characteristics of the household ECW nexus. Efficiency advance, income growth, urbanization, family size, and household number were defined to explain the changes in the household ECW nexus. This study revealed that there is a huge regional heterogeneity in China's household ECW nexus. Developed regions such as Zhejiang, Jiangsu, Guangdong, and Shanghai are the most important household ECW nexus nodes with larger amounts and growth rates of household ECW. Income growth overwhelmingly increases ECW, while efficiency advance effectively curbs its growth. Comparatively, household number, family size, and urbanization have small effects. Therefore, implementing differentiated management and focusing on the synergy of socioeconomic factors are the keys to achieving integrated household ECW management. And the analytical framework can be used to analyze ECW nexus from a sector, city, or country perspective.

The hidden mediating role of innovation efficiency in coordinating development of economy and ecological environment: evidence from 283 Chinese cities.

The advancement of technological innovations may facilitate the coordinated development of the economy and ecological environment (EGE); however, few studies have noted the role of innovation efficiency (INEF) as a bridge between economic development and EGE. To fill in this gap, this paper adopts DMSP/OLS nighttime light data to measure the level of economic development and the improved data envelopment analysis model to measure INEF, establishing an index system to quantify EGE. Then we propose the panel threshold-mediating (PTM) model that combines the panel threshold model and the mediating effect model. On these bases, considering INEF as a mediator, we use this novel PTM model to empirically test the nonlinear relationship between economic development and EGE in 283 Chinese cities from 2003 to 2018. The results indicate that (1) while economic development can improve EGE, its positive impact on EGE differs with different INEF thresholds. A higher INEF threshold indicates a stronger positive effect of economic development on EGE. (2) For the entire sample, the mediating effect of INEF between economic development and EGE is not significant. However, after applying the PTM model, we found that the mediating effect of INEF was concealed by the sample population. (3) When INEF is lower than 0.2381, its complete mediating effect is verified. When INEF is higher than 0.2381, its mediating effect is not significant. On the contrary, economic development directly improves EGE. (4) Industrial agglomeration, the scale of government expenditure, residents' education level, degree of opening up, and transport infrastructure are all conducive to EGE. These findings can help cities at different INEF levels to achieve coordinated development of economy and EGE.

Has ridesourcing reduced haze? An analysis using the Didi app.

Environmental degradation, often evidenced by haze, has not only increased the cost of China's economic development, but its unfair distribution among regional development, social hierarchy, and generations has also reduced quality of life. Hence, this study uses cross-sectional data from Didi, a Chinese ridesourcing service company, from 2017 to study the impact mechanism of shared mobility on haze. First, it applies the generalized spatial two-stage least squares model after controlling for urban economic, geographic, transportation, meteorological, and policy variables. We then use urbanization depth (urban agglomeration) and breadth (urban sprawl) variables, which represent the intensity and scope of human activities, respectively, as mediators to test the transmission mechanism from shared mobility to haze. Finally, differences based on urban heterogeneity were tested in the end. The study finds that the scale of ridesourcing and haze show a significant U-shaped relationship: the initial development of ridesourcing has a significant effect on reducing haze, but will then intensify haze as it develops to scales such as those of Beijing and Shenzhen. Moreover, the depth of urbanization is the main transmission mechanism of haze. This conclusion is verified in Tier 3 cities and above; however, the transmission mechanism in Tier 4 and Tier 5 cities is not obvious, indicating that the scale of ridesourcing should be compatible with the scale of urban development. Therefore, the design of emission reduction policies should be considered from the perspective of urban agglomeration.

Psychological Status and Correlated Factors of Primary Medical Staff During the COVID-19 Outbreak in Hefei City, China.

OBJECTIVE: To investigate the mental illness and correlated factors of primary medical staff during the COVID-19 outbreak in Hefei city, China. METHODS: A total of 180 primary medical staff were randomly selected from seven community hospitals in Hefei Economic and Technological Development Zone as a study group. One hundred and eighty-two health people were recruited as the control group. The self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS) and Psychological questionnaire of public health emergencies were distributed to them for evaluation. RESULTS: The score of SAS, SDS in study group was higher than that in control group [(35.57±10.39) vs (31.31±7.98); (44.16±8.46) vs (41.47±9.47)] (t=4.371, P< 0.001; t=2.849, P=0.005). The fear subscale and total score in the psychological questionnaire of sudden public health events were negatively correlated with age (r=-0.216, P=0.004; r=-0.154, P=0.039). Marriage was negatively correlated with depression subscales in psychological questionnaires of SAS, SDS and sudden public health events (r=-0.184, P=0.013; r=-0.298, P<0.001; r=-0.161, P=0.031; r=-0.147, P=0.049). Education level was positively correlated with the total score of a psychological questionnaire for sudden public health events (r=0.151, P=0.043); Logistic regression analysis showed that marital status was a protective factor of psychological abnormality. CONCLUSION: It is necessary to pay attention to the psychological status of primary medical staff, especially the young unmarried medical staff.

Healthcare Resource Utilization and Costs in Celiac Disease: A US Claims Analysis.

INTRODUCTION: Celiac disease (CeD) is a lifelong immune-mediated enteropathy in which dietary gluten triggers an inflammatory reaction in the small intestine. This retrospective cohort study examines healthcare resource utilization (HRU) and costs between patients with CeD and matched controls. METHODS: Patients with CeD (cases) with an endoscopic biopsy and ≥2 medical encounters with a CeD diagnosis between January 1, 2010, and October 1, 2015, were identified in the MarketScan databases. The date of the first claim with a CeD diagnosis on or after the endoscopic biopsy was the index date. Cases were matched 1:1 to patients without CeD (controls) on demographic characteristics and Deyo-Charlson Comorbidity Index score. Clinical characteristics, all-cause, and CeD-related HRU and costs (adjusted to 2017 US dollars) were compared between cases and controls during the 12 months before (baseline) and 24 months after (follow-up) the index date. RESULTS: A total of 11,008 cases (mean age 40.6 years, 71.3% women) were matched to 11,008 controls. During the follow-up, a higher proportion of cases had all-cause and CeD-related HRU including inpatient admissions, emergency department visits, gastroenterologist visits, dietician visits, endoscopic biopsies, and gastroenterology imaging (all P ≤ 0.002). Incremental all-cause and CeD-related costs were in the first ($7,921 and $2,894) and second ($3,777 and $935) year of follow-up, driven by outpatient services costs. DISCUSSION: In this US national claims database analysis, there was evidence of an increase in both all-cause and CeD-related HRU and related costs in patients with CeD compared with matched patients without CeD, suggesting a significant economic burden associated with CeD.

Pollution, sources and environmental risk assessment of heavy metals in the surface AMD water, sediments and surface soils around unexploited Rona Cu deposit, Tibet, China.

The pollution by heavy metals (HMs) of mining is a widespread problem in the world. However, the pollution by HMs around unexploited deposits (virgin fields) has been studied rarely, especially in Tibet, China. Water, sediments and surface soils were collected to investigate the concentrations of HMs around unexploited Rona Cu deposit in Tibet, China. Furthermore, geochemical fractions of these elements were also analyzed. Pollution and environmental risk introduced by HMs accumulation were assessed using pollution indices, geo-accumulation (Igeo), potential ecological risk index and risk assessment code (RAC). Results indicated that the pH values of Rona tributary river ranged from 2.70 to 3.08, and the average concentrations of Cu and Zn were 2114.00 ± 65.89 and 1402.14 ± 27.36 µg L-1, respectively, exceeding their standard limits. The concentrations (mg kg-1) of Cu, Zn and As ranged in 19.01-1763.10, 62.00-543.06 and 11.12-61.78 for sediments, respectively, and 154.60-1489.35, 55.38-344.74 and 10.05-404.03 for surface soils, respectively, exceeding their standard limits. According to RAC, almost all Cu, Zn and As near low risk status. However, Cd ranged from medium to very high risk in sediments, and low to high risk in surface soils. Statistical analysis suggested that Cu, Pb, Zn, As and Cd in sediments and surface soils may mainly derive from Rona deposit, whereas Cr and Hg may primarily originate from lithogenic sources. The results indicated that very high concentrations of HMs could be occurred in surface water, sediments and surface soils around unexploited deposits. Especially at high-altitude Tibet, the high environmental risk of HMs deserves more attention.

Neurostructural correlates of optimism: Gray matter density in the putamen predicts dispositional optimism in late adolescence.

Dispositional optimism reflects one's generalized positive expectancies for future outcomes and plays a crucial role in personal developmental outcomes and health (e.g., counteracting related mental disorders such as depression and anxiety). Increasing evidence has suggested that extraversion is an important personality factor contributing to dispositional optimism. However, less is known about the association between dispositional optimism and brain structure and the role of extraversion in this association. Here, we examined these issues in 231 healthy high school students aged 16 to 20 years (110 males, mean age = 18.48 years, SD = 0.54) by estimating regional gray matter density (rGMD) using a voxel-based morphometry method via structural magnetic resonance imaging. Whole-brain regression analyses revealed a significant positive correlation between dispositional optimism and the rGMD of the bilateral putamen after adjusting for age, sex, family socioeconomic status (SES), general intelligence, and total gray matter volume (TGMV). Moreover, prediction analyses using fourfold balanced cross-validation combined with linear regression confirmed a significant connection between dispositional optimism and putamen density after adjusting for age, sex, and family SES. More importantly, subsequent mediation analysis showed that extraversion may account for the association between putamen density and dispositional optimism after adjusting for age, sex, family SES, general intelligence, TGMV, and the other four Big Five personality traits. Taken together, the current study provides new evidence regarding the neurostructural basis underlying dispositional optimism in adolescents and underscores the importance of extraversion as an essential personality factor for dispositional optimism acquisition.

Comparison of Time to Next Treatment, Health Care Resource Utilization, and Costs in Patients with Chronic Lymphocytic Leukemia Initiated on Front-line Ibrutinib or Chemoimmunotherapy.

BACKGROUND: Studies assessing ibrutinib's economic burden versus chemoimmunotherapy (CIT) focused on pharmacy costs but not medical costs. This study compared time to next treatment (TTNT), health care resource utilization (HRU), and total direct costs among patients with chronic lymphocytic leukemia (CLL) initiating front-line ibrutinib single agent (Ibr) or CIT. MATERIALS AND METHODS: Optum Clinformatics Extended DataMart De-Identified Databases were used to identify adults with ≥ 2 claims with a CLL diagnosis initiating front-line Ibr or CIT from February 12, 2014 to June 30, 2017. Inverse probability of treatment weighting was used to control for potential differences in baseline characteristics between the Ibr and CIT cohorts. Two periods were considered: entire front-line therapy (until initiation of second-line therapy) and first 6 months of front-line therapy. Comparisons with a subgroup of CIT patients initiating bendamustine/rituximab (BR) were also conducted. RESULTS: TTNT was significantly longer for Ibr (N = 322) relative to CIT (N = 839; hazard ratio, 0.54; P = .0163; Kaplan-Meier rates [24 months]: Ibr = 88.6%, CIT = 75.9%) and the subset of CIT patients treated with BR (N = 455; hazard ratio, 0.54; P = .0208; Kaplan-Meier rates [24 months]: Ibr = 89.0%, BR = 79.0%). During the entire front-line therapy, Ibr patients had significantly fewer monthly days with outpatient visits (rate ratio = 0.75; P = .0200). Ibrutinib's higher pharmacy costs (mean monthly cost difference [MMCD] = $6,849; P < .0001) were offset by lower medical costs (MMCD = -$10,615; P < .0001), yielding net savings (MMCD = -$3,766; P < .0001) versus CIT. Ibr was associated with net savings (MMCD = -$5,569; P < .0001) versus BR. Cost savings and reductions in HRU were more pronounced during the first 6 months of front-line therapy. CONCLUSION: During front-line CLL treatment, Ibr was associated with longer TTNT, fewer monthly days with outpatient visits, and net monthly total cost reduction versus CIT and BR.