Effect of bolus materials on dose deposition in deep tissues during electron beam radiotherapy.

Several materials are utilized in the production of bolus, which is essential for superficial tumor radiotherapy. This research aimed to compare the variations in dose deposition in deep tissues during electron beam radiotherapy when employing different bolus materials. Specifically, the study developed general superficial tumor models (S-T models) and postoperative breast cancer models (P-B models). Each model comprised a bolus made of water, polylactic acid (PLA), polystyrene, silica-gel or glycerol. Geant4 was employed to simulate the transportation of electron beams within the studied models, enabling the acquisition of dose distributions along the central axis of the field. A comparison was conducted to assess the dose distributions in deep tissues. In regions where the percentage depth dose (PDD) decreases rapidly, the relative doses (RDs) in the S-T models with silica-gel bolus exhibited the highest values. Subsequently, RDs for PLA, glycerol and polystyrene boluses followed in descending order. Notably, the RDs for glycerol and polystyrene boluses were consistently below 1. Within the P-B models, RDs for all four bolus materials are consistently below 1. Among them, the smallest RDs are observed with the glycerol bolus, followed by silica-gel, PLA and polystyrene bolus in ascending order. As PDDs are ~1-3% or smaller, the differences in RDs diminish rapidly until are only around 10%. For the S-T and P-B models, polystyrene and glycerol are the most suitable bolus materials, respectively. The choice of appropriate bolus materials, tailored to the specific treatment scenario, holds significant importance in safeguarding deep tissues during radiotherapy.

Quantitative assessment of retinal vasculature changes in systemic lupus erythematosus using wide-field OCTA and the correlation with disease activity.

Purpose: To assess the retinal vasculature changes quantitatively using wide-field optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE), and explore its correlation with systemic clinical features. Design: Prospective, cross-sectional, observational study. Participants and controls: Patients with SLE who presented to the Ophthalmology Department of Peking Union Medical College Hospital from November 2022 to April 2023 were collected. The subjects were divided into retinopathy and without retinopathy groups. Age and gender-matched healthy subjects were selected as controls. Methods: Patients with SLE and control subjects were imaged with 24×20 mm OCTA scans centered on the fovea and 6×6 mm OCTA scans centered on the optic disc. The sub-layers of OCTA images were stratified by the built-in software of the device and then the retinal thickness and vessel density were measured automatically. The characteristics of retinal OCTA parameters of SLE and its correlation with systemic clinical indicators of patients without retinopathy were analyzed. Main outcome measures: OCTA parameters, visual acuity, intraocular pressure, and systemic clinical indicators of patients such as disease activity index, autoimmune antibodies, and inflammatory marker levels were collected. Results: A total of 102 SLE patients were included, 24 of which had retinopathy, and 78 had unaffected retina. Wide-field OCTA could effectively detect retinal vascular obstruction, non-perfusion area, and morphological abnormalities in patients with lupus retinopathy. SLE patients without retinopathy had significantly higher retinal superficial vessel density (SVD) in foveal (P=0.02), para-foveal temporal (P=0.01), nasal (P=0.01), peripheral foveal temporal (P=0.02), and inferior areas (P=0.02), as well as subregion temporal (P=0.01) and inferior areas (P=0.03) when compared with healthy controls (n=65 eyes from 65 participants). The area under curve (AUC) value of subregion inferior SVD combined parafoveal temporal SVD was up to 0.70. There was a significantly positive correlation between SVD and disease activity in SLE without retinopathy group. Patients with severe activity had the most significant increase in SVD. Conclusion: Wide-field OCTA can provide a relatively comprehensive assessment of the retinal vasculature in SLE. In the absence of pathological changes of the retina, the SVD was significantly increased and was positively correlated with the disease activity of SLE.

Computational Nanotoxicology Models for Environmental Risk Assessment of Engineered Nanomaterials.

Although engineered nanomaterials (ENMs) have tremendous potential to generate technological benefits in numerous sectors, uncertainty on the risks of ENMs for human health and the environment may impede the advancement of novel materials. Traditionally, the risks of ENMs can be evaluated by experimental methods such as environmental field monitoring and animal-based toxicity testing. However, it is time-consuming, expensive, and impractical to evaluate the risk of the increasingly large number of ENMs with the experimental methods. On the contrary, with the advancement of artificial intelligence and machine learning, in silico methods have recently received more attention in the risk assessment of ENMs. This review discusses the key progress of computational nanotoxicology models for assessing the risks of ENMs, including material flow analysis models, multimedia environmental models, physiologically based toxicokinetics models, quantitative nanostructure-activity relationships, and meta-analysis. Several challenges are identified and a perspective is provided regarding how the challenges can be addressed.

Job preferences of Chinese primary health care workers: A discrete choice experiment.

OBJECTIVE: Primary health workers (PHWs) are a critical pillar of health systems but primary health care centers often struggle to attract and retain talented staff. To better understand why this is, we investigated the job preference of PHWs in a Chinese urban setting. METHODS: In a discrete choice experiment, PHWs from 15 primary health care centers in Guangzhou, China, made trade-offs between several hypothetical job scenario combinations of salary, type of health institution, bianzhi (permanent post), work years required for promotion, career development and training opportunities, educational opportunities for children, and community respect. Based on the estimate of the mixed logit model, willingness to pay and policy simulations were applied to estimate the utility of each attribute. RESULTS: Data were collected from 446 PHWs. The PHWs were willing to forgo Chinese Renminbi 2806.1 (US$ 438.5) per month to obtain better education opportunities for their children, making it the most important non-monetary factor. Their preferences were also influenced relatively more by salary, bianzhi, and community respect, than with the other attributes we tested for, work years required for promotion, career development and training opportunities, and type of health institution. CONCLUSION: Salary is a robust predictive factor, while three non-monetary factors (opportunities for children's education, bianzhi, and community respect) are essential in retaining health workers in primary care.

The incidence, risk factors, management and prognosis of postoperative systemic complications after ophthalmic surgery: a retrospective study at a tertiary, academic referral hospital over a decade.

PURPOSE: To explore the incidence, risk factors, management and prognosis of systemic complications after ophthalmic surgeries. METHODS: A retrospective review of hospitalized patients undergoing ophthalmic surgeries between 2012 and 2022 at Peking Union Medical College Hospital was performed to summarize and analyse the postoperative systemic complications. Multivariate logistic and linear regression analyses were conducted to clarify the risk factors of postoperative systemic complications and factors associated with the severity of adverse events. RESULTS: A total of 34,841 patients underwent inpatient ophthalmic surgery, among which 162 systemic complications occurred in 150 patients during postoperative hospitalization. The overall incidence rate was 0.4%, with cardiovascular events (48.1%), digestive events (13.6%) and fever (12.3%) being the leading causes. About 17.3% of the cases had conditions improved after observation, 19.1% after symptomatic treatment, 54.9% had consultation with specific intervention and 8.6% were transferred to the corresponding departments for specialized treatment. For the prognosis, 93.8% had condition improved, 5.6% chose voluntary discharge without improvement, and one patient died of respiratory failure caused by postoperative pulmonary infection. The worse ADL (activities of daily living) grading, indication of primary intraocular lymphoma or intraocular tumour, surgery of simple pars plana vitrectomy (PPV), PPV with silicone oil tamponade, PPV with gas tamponade, general anaesthesia, history of diabetes mellitus (DM), chronic heart failure and digestive system disease were the risk factors positively correlated with postoperative systemic complications (p < .05). The worse ADL grading, history of DM and respiratory system disease were also positively correlated with the severity of the adverse events (p < .05). CONCLUSIONS: The incidence of postoperative systemic complications was low among patients undergoing ophthalmic surgery, most were mild and could be relieved after observation, symptomatic or specialist consultation. Patients with worse ADL and history of DM should be paid extra attention.

[Potential Source Identification and Ecological Risk Assessment of Heavy Metals in Surface Soil of Heze Oil Peony Planting Area Based on PMF-PCA/APCS and PERI].

To study the sources and potential risks of heavy metals in soils of characteristic agricultural product producing areas is of great significance for the scientific management and safe utilization of soil and crop resources. The contents of heavy metals As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn in the 254 surface soil samples collected from the Heze oil peony planting area were determined. The content characteristics and correlation of heavy metals were analyzed using multivariate statistical methods. The sources of heavy metals in topsoil were analyzed using Igeo, PMF, and PCA/APCS. The ecological risks of the eight heavy metals were assessed through the potential ecological risk index (PERI). The results showed that the average contents of seven heavy metals in the soil were basically consistent with the background values of soil elements in Heze City, except that the average value of Cd was 1.44 times higher than the background value in Heze City. Correlation analysis and cluster analysis revealed that Pb, Hg, and Cd elements in the soil were greatly affected by human activities in the later period. The sources of eight heavy metals in the study area were natural sources, agricultural fertilizer sources, industrial coal sources, and domestic transportation sources, with the contribution rates of 81.31%, 15.45%, 2.74%, and 0.50%, respectively; 84.25% of the sites in the study area were at slight ecological risk, whereas the moderate risk and strong risk sites accounted for 14.96% and 0.79%, respectively. Among them, Cd and Hg were the dominant elements of ecological risk in the study area.

Economic evaluations of electronic health interventions for people with age-related cognitive impairment and their caregivers: A systematic review.

OBJECTS: Dementia has physical, social and economic impacts, causing considerable distress for people with age-related cognitive impairment (PWACI) and their caregivers. Electronic health (e-health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e-health interventions will facilitate the decision making and implementation of integrating e-health into routine health services. The present review aimed to appraise economic evidence related to e-health interventions for PWACI and their caregivers. METHODS: We systematically searched multiple cross-disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive-analytical narrative method was used to analyze the review findings. RESULTS: Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi-experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost-effectiveness analysis, five cost-consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e-health multicomponent interventions can reduce the cost of health service utilization in short term (10-104 weeks). CONCLUSIONS: Few studies calculated the incremental cost-effectiveness ratio to evaluate the cost-effectiveness of e-health interventions. Preliminary evidence indicates that e-health interventions can reduce the cost of health service utilization in the short term, but the cost-effectiveness of e-health interventions hasn't been identified. More robust evidence is needed to clarify the value of e-health interventions for PWACI and their caregivers.

Estimation of reduced greenhouse gas emission from municipal solid waste incineration with electricity recovery in prefecture- and county-level cities of China.

Municipal solid waste (MSW) without proper managements could be a significant source of greenhouse gas (GHG) emissions. MSW incineration with electricity recovery (MSW-IER) is recognized as a sustainable way to utilize waste, but its effectiveness on reducing GHG emissions at the city scale in China remain unclear due to limited data of MSW compositions. The aim of the study is to investigate reduction potential of GHG from MSW-IER in China. Based on the MSW compositions covering 106 Chinese prefecture-level cities during the period of 1985 to 2016, random forest models were built to predict MSW compositions in Chinese cities. MSW compositions in 297 cities of China from 2002 to 2017 were predicted using the model trained by a combination of socio-economic, climate and spatiotemporal factors. Spatiotemporal and climatic factors (such as economic development level, precipitation) accounted for 6.5 %-20.7 % and 20.1 %-37.6 % to total contributions on MSW composition, respectively. The GHG emissions from MSW-IER in each Chinese city were further calculated based on the predicted MSW compositions. The plastic is the main GHG emission source, accounting for over 91 % of the total emission during 2002-2017. Compared to baseline (landfill) emission, the GHG emission reduction from MSW-IER was 12.5 × 107 kg CO2-eq in 2002 and 415 × 107 kg CO2-eq in 2017, with an average annual growth rate of 26.3 %. The results provide basic data for estimating GHG emission in MSW management in China.

Analysis of Spatiotemporal Changes of Ecological Environment Quality and Its Coupling Coordination with Urbanization in the Yangtze River Delta Urban Agglomeration, China.

It is inevitable that urban agglomeration will have a coercive impact on the regional Ecological Environment Quality (EEQ) as a consequence of high-speed urbanization. Balancing the EEQ and urbanization development has become a problem worthy of attention. In order to objectively evaluate the EEQ of the Yangtze River Delta Urban Agglomeration (YRDUA) and explore the impact of the urbanization process on it, this paper is based on the Modified Remote Sensing Ecological Index (MRSEI) and the Comprehensive Night Light Index (CNLI), respectively, and conducts a quantitative assessment of the YRDUA in China from 2000 to 2020. The results show that: (1) From 2000 to 2020, the MRSEI of the YRDUA first decreased and then increased, and the ecological environment quality degraded first and then improved; however, there were significant differences between regions. The ecological environment quality in the south is obviously better than that in the north, and the ecological environment quality in the north changes more drastically, and the low value area of MRSEI will gradually move downstream as time changes; (2) During the study period, the YRDUA formed a hierarchical and progressive urbanization pattern. The inland urbanization process expanded from east to west along the Yangtze River, and the urbanization process of coastal cities expanded from Shanghai as the center to the north and south with high-intensity urbanization cities concentrated in Shanghai and its surrounding cities and low-intensity urbanization cities distributed in the western part of the urban agglomeration; (3) The Coupling Coordination Degree (CCD) between urbanization and EEQ in the YRDUA has continuously improved with an increase of 28.57% in the past 21 years, and the number of cities with high level coupling continues to rise, while the number of medium level coupling cities and low level coupling cities has declined. As a large-scale and long-term analysis of changes in the EEQ and the urbanization process, this study can provide theoretical support for policymakers to formulate mesoscale development planning, EEQ monitoring, and environmental protection policies.

The original and two new derivative versions of the COMPERA 2.0 risk assessment model: useful tools for guiding balloon pulmonary angioplasty.

BACKGROUND: The COMPERA 2.0 4-stratum (4-S) risk score has been demonstrated superior over the 3-stratum (3-S) one in patients with pulmonary arterial hypertension and medically managed patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to determine the prognostic value of the original 4-S and 3-S COMPERA 2.0 risk score and two new derivative versions in CTEPH patients who underwent balloon pulmonary angioplasty (BPA). METHODS: We retrospectively enrolled 175 BPA-treated patients with CTEPH. We assessed the risk stratification before and after each BPA session of CTEPH patients by the original 4-S and 3-S COMPERA 2.0 risk score (by rounding decimal to the nearest integer) and two new proposed derivative versions: the modified version (by rounding decimal to the next integer) and a hybrid version that fuses the original and modified versions. The primary endpoint was clinical worsening events. The secondary outcomes were achieving low-risk profile and mean pulmonary arterial pressure (mPAP) < 30 mmHg at follow-up. We used the Kaplan-Meier curve analysis to assess the survival differences between stratified patients. The comparative model's performance was evaluated in terms of discrimination by Harrell's C-index. RESULTS: All versions of COMPERA 2.0 4-S model outperformed the 3-S one in discriminating the differences in echocardiographic and hemodynamic parameters and clinical worsening-free survival rates. The original and hybrid 4-S model could independently predict the primary and secondary endpoints, and the hybrid version seemed to perform better. The first BPA session could significantly improve risk profiles, and these changes were associated with the likelihood of experiencing clinical worsening events, achieving a low-risk profile and mPAP < 30 mmHg at follow-up. The number of BPA sessions required to achieve low risk/mPAP < 30 mmHg increased as the baseline risk score escalated. CONCLUSIONS: The COMPERA 2.0 4-S model outperformed the 3-S one in BPA-treated patients with CTEPH. The 4-S model, especially its hybrid version, could be used to predict clinical outcome before the initiation of BPA and monitor treatment response.

Can China's industrial policies enhance the green competitiveness of the manufacturing industry?

This study innovatively uses local government regulations related to manufacturing to quantitatively identify industrial policies. The degree of influence and functional mechanism of China's industrial policies on the green competitiveness of the manufacturing industry are empirically examined using the provincial and regional panel data. Additionally, the synergistic complementary effect between industrial policy power and market forces and the fiscal decentralization's role in influencing industrial policies are investigated. The results reveal that the promulgation and implementation of industrial policies have significantly promoted the green competitiveness of the manufacturing industry. Regarding functional mechanisms, environmental governance has played a positive role in promoting the green competitiveness of the manufacturing industry supported by industrial policies, resource allocation, and innovation incentives. Meanwhile, industrial policies on green competitiveness in manufacturing depend on marketization and fiscal decentralization in local governments. The above findings demonstrate that the local governments in China, a developing economy, can play the role of development-oriented governments. Based on conforming to market deepening and system optimization, they can formulate and implement industrial policies in a rational manner and achieve green development and upgrade the manufacturing industry.

Development of genic SSR marker resources from RNA-seq data in Camellia japonica and their application in the genus Camellia.

Camellia is a genus of flowering plants in the family Theaceae, and several species in this genus have economic importance. Although a great deal of molecular makers has been developed for molecular assisted breeding in genus Camellia in the past decade, the number of simple sequence repeats (SSRs) publicly available for plants in this genus is insufficient. In this study, a total of 28,854 potential SSRs were identified with a frequency of 4.63 kb. A total of 172 primer pairs were synthesized and preliminarily screened in 10 C. japonica accessions, and of these primer pairs, 111 were found to be polymorphic. Fifty-one polymorphic SSR markers were randomly selected to perform further analysis of the genetic relationships of 89 accessions across the genus Camellia. Cluster analysis revealed major clusters corresponding to those based on taxonomic classification and geographic origin. Furthermore, all the genotypes of C. japonica separated and consistently grouped well in the genetic structure analysis. The results of the present study provide high-quality SSR resources for molecular genetic breeding studies in camellia plants.

Analysis of hospitalization costs related to fall injuries in elderly patients.

BACKGROUND: With the aging world population, the incidence of falls has intensified and fall-related hospitalization costs are increasing. Falls are one type of event studied in the health economics of patient safety, and many developed countries have conducted such research on fall-related hospitalization costs. However, China, a developing country, still lacks large-scale studies in this area. AIM: To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based, cost-related groupings. METHODS: A retrospective study was conducted. Patient information and cost data for elderly inpatients (age ≥ 60 years, n = 3362) who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China. Quantile regression (QR) analysis was used to identify the factors related to fall-related hospitalization costs. A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes. RESULTS: The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB, and the reimbursement rate of medical benefit funds was 51.0% (92039709.52 RMB/180479203.03 RMB). The medical material costs were the highest component of the total hospitalization cost, followed (in order) by drug costs, test costs, treatment costs, integrated medical service costs and blood transfusion costs The QR results showed that patient age, gender, length of hospital stay, payment method, wound position, wound type, operation times and operation type significantly influenced the inpatient cost (P < 0.05). The cost grouping model was established based on the QR results, and age, length of stay, operation type, wound position and wound type were the most important influencing factors in the model. Furthermore, the cost of each combination varied significantly. CONCLUSION: Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

A flexible and salt-rejecting electrospun film-based solar evaporator for economic, stable and efficient solar desalination and wastewater treatment.

Recently, interfacial solar evaporation has been developed for water treatment. However, the high cost and low stability of solar evaporators significantly hinder their practical applications. In this study, layered graphene and polymethylmethacrylate were used to fabricate a composited film (GF) by electrospinning, which acted as a solar absorber. Together with a water transporter (polyurethane sponge) and a thermal insulator (polystyrene foam), the GF-based evaporator was constructed for solar distillation. Taking advantage of the porous three-dimensional structure of GF, the light path could be extended, rendering an efficient broadband solar absorption (92%). More importantly, although the content of layered graphene in the GF-based evaporator (1.75 g m-2) was only 5.8-17.5% of that in the current reported graphene-based evaporators (10-30 g m-2), a comparable water evaporation efficiency was acquired, which was induced by the much higher utilization efficiency of photothermal nanomaterials in the GF-based evaporator than that in the reported devices, ensuring its economic feasibility. Meanwhile, more than 99.9% heavy metal ions and 99.8% organic dye could be removed by the GF-based evaporator. Combining the merits of long-term and stable evaporation, salt rejection, and resistance to harsh environment, the GF-based evaporator was promising for freshwater recycling from both seawater and wastewater.

Identifying Potentially Climatic Suitability Areas for Arma custos (Hemiptera: Pentatomidae) in China under Climate Change.

Spodoptera frugiperda is a notorious pest that feeds on more than 80 crops, and has spread over 100 countries. Many biological agents have been employed to regulate it, such as Arma custos. A. custos is a polyphagous predatory heteropteran, which can effectively suppress several agricultural and forest pests. Thus, in order to understand where A. custos can survive and where can be released, MaxEnt was used to predict the potentially suitable areas for A. custos in China under climate change conditions. The results show that the annual mean temperature (bio1) and annual precipitation (bio12) are the major factors influencing the distribution of A. custos. The optimal range of the two are 7.5 to 15 °C, 750 to 1200 mm, respectively. The current climate is highly suitable for A. custos in Hebei, Henan, Shandong, Anhui, Hubei, Jiangsu, and Zhejiang Provinces. Considering the currently suitable distribution area of S. frugiperda, artificially reared A. custos is suitable for release in Fujian, Zhejiang, Jiangxi, Hunan, and southeastern Sichuan Provinces. Under the future climatic scenarios, the suitable area will decrease and shift towards the north. Overall, this result can provide a reference framework for future application of A. custos for biological control.

A Cost Analysis of Pathology Evaluation of Carotid Plaque after Endarterectomy.

BACKGROUND: Overtreatment and overuse of resources are leading causes of rising health care costs. Identification and elimination process of low value services is important in reducing such costs. At many institutions it is routine to send excised plaque after carotid endarterectomy (CEA) for pathology evaluation. With more than 140,000 CEAs performed annually in the United States, this represents an opportunity for potential cost savings. We set out to examine the cost and clinical use of pathology evaluation of plaque after CEA. METHODS: We performed a retrospective review of patients undergoing CEA at a single institution from 2016 to 2019. Patients were excluded if they had a prolonged postoperative length of stay or if they had a preoperative stroke. Demographics, perioperative outcomes, and billing costs were recorded. RESULTS: We identified 82 total CEAs, of which 42 were excluded according to the aforementioned exclusion criteria. We reviewed 40 CEAs. Mean age of this cohort was 67.2 (±8.3) years. Most (72.5%) were asymptomatic at the time of admission, whereas 27.5% presented with a transient ischemic attack. Mean postoperative length of stay was 1.8 days. The primary insurers were 39.5% private, 39.5% Medicare, and 21.1% Medicaid. Mean total charges for the hospitalization were $83,367 (±$42,874). Of this total, professional fees were $3,512 (±$980) and facility fees were $80,395 (±$42,886). Mean pathology charges were $285 (±$88). The pathology professional fee was $61 (±$27), which represented 1.82% (±0.88) of the professional costs. Reimbursement for the facility pathology charge was $229 (±$57) and for the professional pathology charge was $25 (±$14). All plaque samples were submitted for gross examination and hematoxylin and eosin staining. The correlation rate for the clinical and pathologic diagnosis was 100%. The pathology reports simply read "atherosclerotic plaque" and "calcific plaque" in 32.5% and 45% of samples. For the remaining plaques, 12.5% and 10% of reports also noted fibrosis and degenerative changes, respectively. There were no clinical implications or decisions made based on the pathology reports. Cost of pathology evaluation was on average $285, with an average reimbursement of $235. With 140,000 CEAs done annually, this represents a potential $32.9-$39.9 million saved to the health care system. CONCLUSIONS: Pathology evaluation of carotid plaque incurs significant costs to the health care system with no clear value for the postoperative care of the patient. Hospital policy regarding mandatory pathologic examination and surgeon preferences regarding plaque analysis should be more closely examined.

Health risk assessment associated with heavy metal accumulation in wheat after long-term phosphorus fertilizer application.

Phosphorus (P) fertilizer is widely used to increase wheat yield. However, it remains unclear whether prolonged intake of wheat grain that received long-term P application may promote human health risks by influencing heavy metal(loid)s (HMs) accumulation. A 10-year field experiment was conducted to evaluate the effects of continuous P application (0, 25, 50, 100, 200, and 400 kg P ha-1) on human health risks of HMs, including zinc (Zn), copper (Cu), cadmium (Cd), lead (Pb), arsenic (As), nickel (Ni), and chromium (Cr), by ingesting wheat grain. The results showed that P application facilitated Zn, Pb, Cd, and As accumulation in the topsoil. The Zn, Cu, Pb, and Ni concentrations in grain were decreased, while Cd and As were increased by P application. All HMs concentrations of both soil and grain were in the ranges of corresponding safety thresholds at different P levels. The accumulation abilities of Zn, Cu, Pb, and Ni from soil and straw to grain were suppressed by P addition while of As was enhanced. There was no significant difference in the hazard index (HI) of the investigated HMs in all treatments except 25 kg ha-1. The threshold cancer risk (TCR) associated with As and Cd was enhanced, while that of Pb was alleviated as P application increased. Behaviors of Cr from soil to wheat and to humans were not affected by P application. Phosphorus application at a rate of 50 kg ha-1 decreased total non-cancer and cancer risks by 15% and 21%, respectively, for both children and adults, compared to the highest value. In conclusion, long-term optimal application of 50 kg P ha-1 to wheat did not result in additional adverse effects on the total non-carcinogenic or carcinogenic risk caused by the studied HMs to humans through the ingestion of wheat grain.

Health risk assessment of heavy metals (Zn, Cu, Cd, Pb, As and Cr) in wheat grain receiving repeated Zn fertilizers.

Soil application of Zn fertilizer is an effective approach to improve yield and Zn accumulation in wheat grain. However, it remains unclear whether repeated Zn application can result in high accumulation of heavy metals (HMs) in soils and grains and thus represents a potential risk for human consumption. This study aimed to evaluate the health risk assessment of HMs in a wheat production system which had continuously received 8 years of Zn application at varying rates (0, 2.3, 5.7, 11.4, 22.7, 34.1 kg Zn ha-1). The results showed that Zn application significantly increased the soil total Zn concentration without affecting concentrations of As, Pb, Cd, Cu and Cr. Across Zn rates, Zn application increased grain concentrations of Zn, Pb and Cd by 75%, 51% and 14%, respectively, and reduced grain As concentration by 14%. The human health risk assessment revealed that the threshold hazard quotients for the individual HM were below 1, independent of Zn rates. The hazard index (HI) values at Zn rates of 11.4, 22.7 and 34.1 kg Zn ha-1 were significantly greater than that at null Zn treatment. Furthermore, exposures to As, Cu and Zn accounted for 97% of HI at all Zn rates. Analysis of the threshold cancer risk with Pb and As showed that ingestion of wheat grain even from highest Zn application rate wouldn't bring the lifetime carcinogenic risk. In contrast, long-term Zn application significantly reduced the carcinogenic risk of As by 9.7-26.5%. In conclusion, repeated soil applications of Zn at optimal rate (5.7 kg Zn ha-1) didn't cause health risk for Zn, Cu, Cd, Pb, Cr, and As, while improving productivity and grain Zn concentration of wheat to meet human recruitment. Our study highlights the importance of appropriate Zn fertilizer management in improving grain quality while reducing HMs risks from human consumption.

Management of imported malaria cases and healthcare institutions in central China, 2012-2017: application of decision tree analysis.

BACKGROUND: Imported malaria has been an important challenge for China. Fatality rates from malaria increased in China, particularly in Henan Province, primarily due to malpractice and misdiagnoses in healthcare institutions, and the level of imported malaria. This study aims to investigate the relationship between the state of diagnosis and subsequent complications among imported malaria cases at healthcare institutions, based on malaria surveillance data in Henan Province from 2012 to 2017. METHODS: A retrospective descriptive analysis was performed using data from the Centre for Disease Control and Prevention, Zhengzhou City, the capital of Henan Province. A decision tree method was exploited to provide valuable insight into the correlation between imported malaria cases and healthcare institutions. RESULTS: From 2012 to 2017, there were 371 imported malaria cases, mostly in males aged between 20 and 50 years, including 319 Plasmodium falciparum cases. First visits of 32.3%, 19.9% and 15.9% malaria cases for treatment were to provincial, municipal and county healthcare institutions, respectively. The time interval between onset and initial diagnosis of 284 cases (76.5%) and the time interval between initial diagnosis and final diagnosis of 197 cases (53.1%) was no more than 72 h. An apparent trend was found that there were notably fewer patients misdiagnosed at first visit to healthcare institutions of a higher administrative level; 12.5% of cases were misdiagnosed in provincial healthcare institutions compared to 98.2% in private clinics, leading to fewer complications at healthcare institutions of higher administrative level due to correct initial diagnosis. In the tree model, the rank of healthcare facilities for initial diagnosis, and number of days between onset and initial diagnosis, made a major contribution to the classification of initial diagnosis, which subsequently became the most significant factor influencing complications developed in the second tree model. The classification accuracy were 82.2 and 74.1%, respectively for the tree models of initial diagnosis and complications developed. CONCLUSION: Inadequate seeking medical care by imported malaria patients, and insufficient capacity to diagnose malaria by healthcare institutions of lower administrative level were identified as major factors influencing complications of imported malaria cases in Henan Province. The lack of connection between uncommon imported malaria cases and superior medical resources was found to be the crucial challenge. A web-based system combined with WeChat to target imported malaria cases was proposed to cope with the challenge.