Impact of timing to initiate adjuvant therapy on survival of elderly glioblastoma patients using the SEER-Medicare and national cancer databases.

The optimal time to initiate adjuvant therapy (AT) in elderly patients with glioblastoma (GBM) remains unclear. We investigated the impact of timing to start AT on overall survival (OS) using two national-scale datasets covering elderly GBM populations in the United States. A total of 3159 and 8161 eligible elderly GBM patients were derived from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked dataset (2004-2013) and the National Cancer Database (NCDB) (2004-2014), respectively. The intervals in days from the diagnosis to the initiation of AT were categorized based on two scenarios: Scenario I (quartiles), ≤ 15, 16-26, 27-37, and ≥ 38 days; Scenario II (median), < 27, and ≥ 27 days. The primary outcome was OS. We performed the Kaplan-Meier and Cox proportional hazards regression methods for survival analysis. A sensitivity analysis was performed using Propensity Score Matching (PSM) method to achieve well-balanced characteristics between early-timing and delayed-timing in Scenario II. Improved OS was observed among patients who underwent resection and initiated AT with either a modest delay (27-37 days) or a longer delay (≥ 38 days) compared to those who received AT immediately (≤ 15 days) from both the SEER-Medicare dataset [adjusted hazard ratio (aHR) 0.74, 95% CI 0.64-0.84, P < 0.001; and aHR 0.81, 95% CI 0.71-0.92, P = 0.002] and the NCDB (aHR 0.83, 95% CI 0.74-0.93, P = 0.001; and aHR 0.87, 95% CI 0.77-0.98, P = 0.017). The survival advantage is observed in delayed-timing group as well in Scenario II. For elderly patients who had biopsy only, improved OS was only detected in a longer delay (Scenario I: ≥ 38 days vs. ≤ 15 days) or the delayed-timing group (Scenario II: ≥ 27 days vs. < 27 days) in the NCDB while no survival difference was seen in SEER-Medicare population. For the best timing to start AT in elderly GBM patients, superior survivals were observed among those who had craniotomy and initiated AT with a modest (27-37 days) or longer delays (≥ 38 days) following diagnosis using both the SEER-Medicare and NCDB datasets (Scenario I). Such survival advantage was confirmed when categorizing delayed-timing vs. early-timing with the cut-off at 27 day in both datasets (Scenario II). The increased likelihood of receiving delayed AT (≥ 27 days) was significantly associated with tumor resection (STR/GTR), years of diagnosis after 2006, African American and Hispanics races, treatments at academic facilities, and being referred. There is no difference in timing of AT on survival among elderly GBM patients who had biopsy in the SEER-Medicare dataset. In conclusion, initiating AT with a modest delay (27-37 days) or a longer delay (≥ 38 days) after craniotomy may be the preferred timing in the elderly GBM population.

Risk assessment in systemic lupus erythematosus-associated pulmonary arterial hypertension: CSTAR-PAH cohort study.

Objective: This study evaluated the prognostic value of the multivariable risk assessment for systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH). Methods: A multicenter prospective cohort of SLE-associated PAH (CSTAR-PAH cohort) diagnosed based on right heart catheterization (RHC) was established. Baseline and follow-up records were collected. Three methods of risk assessment, including (1) the number of low-risk criteria, based on World Health Organization functional class (WHO FC), 6-min walking distance (6MWD), right atrial pressure (RAP), and cardiac index (CI); (2) the three-strata stratification based on the average risk score of four variables (WHO FC, 6MWD, RAP, and CI); and (3) the four-strata stratification based on COMPARE 2.0 model were applied. A risk-assessment method using three noninvasive low-risk criteria was applied at the first follow-up visit. Survival curves between patients with different risk groups were compared by Kaplan-Meier's estimation and log-rank test. Results: Three-hundred and ten patients were enrolled from 14 PAH centers. All methods of stratification at baseline and first follow-up significantly discriminated long-term survival. Survival rates were also significantly different based on the noninvasive risk assessment in first follow-up visit. Survival deteriorated with the escalation of risk from baseline to first follow-up. Patients with baseline serositis had a higher rate of risk improvement in their follow-up. Conclusion: The risk assessment has a significant prognostic value at both the baseline and first follow-up assessment of SLE-associated PAH. A noninvasive risk assessment can also be useful when RHC is not available during follow-up. Baseline serositis may be a predictor of good treatment response in patients with SLE-associated PAH.

The impact of environmental regulations on export trade at provincial level in China: evidence from panel quantile regression.

Based on panel data from 30 provinces in China from 2008 to 2017, this paper constructs a quantile regression econometric model to analyze whether China's environmental regulation has an impact on export trade and to verify whether the Porter hypothesis has been valid in China in recent years. The results show that in the short term, environmental regulations have a restraining effect on export trade, while in the long run, due to the existence of innovation efficiency, environmental regulations will change from having a restraining effect to a promoting effect on export trade. Strict environmental regulations will reduce the production cost of Chinese products, further improve the export competitiveness of Chinese enterprises, and promote export trade. The empirical results verify the conclusion that the Porter hypothesis is confirmed in China. The following three suggestions are proposed for China's exports to promote the win-win of China's green development and export trade: promote the realization of international and domestic double circulation, avoid becoming "pollution shelters" and support technological innovation in environmental protection industries.

Osteonecrosis in systemic lupus erythematosus: Systematic insight from the epidemiology, pathogenesis, diagnosis and management.

Osteonecrosis (ON) is one of the serious and well recognized complicationscausing severe pain and disability in patients with systemic lupus erythematosus (SLE), and its manifestation and pathogenesis are only partially understood. This review provide an update of the recent progress in etiology, pathogenesis, diagnosis, and treatment of systemic lupus erythematosus related osteonecrosis (SLE-ON). Despite the concomitant use of corticosteroids, alcohol and obesity, the dysregulated immune micro-environment and the complex pathogenesis of SLE synergistically play important roles in the development of ON. Osteonecrosis of femoral head (ONFH) is the most often involved joint in SLE. The current classification and staging system of ONFH is based on imaging techniques, particularly relating to MRI and CT, for the identification and quantification of necrotic lesions. For SLE-ONFH patients, both SLE specific clinical symptoms and ONFH imaging findings should be comprehensively evaluated. Even though advances concerning bone grafting and arthroplasty procedures have resulted in improved clinical outcomes, early pharmacological treatment at the pre-collapse stage may prevent joint collapse and reduce the joint arthroplasty rate, and this needs to be accounted. Although some progress has been made, considerably more research is needed before we fully understand SLE-ONFH. Future treatments of SLE-ONFH may involve genetic or cell-based therapies that target potential biomarkers, and this will lead to effective measures for saving thefunction of hip joint and preventing osteonecrosis.

Deep Learning-Based Artificial Intelligence System for Automatic Assessment of Glomerular Pathological Findings in Lupus Nephritis.

Accurate assessment of renal histopathology is crucial for the clinical management of patients with lupus nephritis (LN). However, the current classification system has poor interpathologist agreement. This paper proposes a deep convolutional neural network (CNN)-based system that detects and classifies glomerular pathological findings in LN. A dataset of 349 renal biopsy whole-slide images (WSIs) (163 patients with LN, periodic acid-Schiff stain, 3906 glomeruli) annotated by three expert nephropathologists was used. The CNN models YOLOv4 and VGG16 were employed to localise the glomeruli and classify glomerular lesions (slight/severe impairments or sclerotic lesions). An additional 321 unannotated WSIs from 161 patients were used for performance evaluation at the per-patient kidney level. The proposed model achieved an accuracy of 0.951 and Cohen's kappa of 0.932 (95% CI 0.915-0.949) for the entire test set for classifying the glomerular lesions. For multiclass detection at the glomerular level, the mean average precision of the CNN was 0.807, with 'slight' and 'severe' glomerular lesions being easily identified (F1: 0.924 and 0.952, respectively). At the per-patient kidney level, the model achieved a high agreement with nephropathologist (linear weighted kappa: 0.855, 95% CI: 0.795-0.916, p < 0.001; quadratic weighted kappa: 0.906, 95% CI: 0.873-0.938, p < 0.001). The results suggest that deep learning is a feasible assistive tool for the objective and automatic assessment of pathological LN lesions.

A Comprehensive Assessment of Hip Damage in Ankylosing Spondylitis, Especially Early Features.

Ankylosing spondylitis (AS) is most common in adolescents and the ultimate result is disability, which places a huge burden on patients and society. Therefore, the key to improve the prognosis of AS is the early diagnosis of hip injury. To examine if AS patients whose hip pain is either absent or minimal might already have observable MRI and X-ray hip changes. Clinical and imaging hip data were systematically analyzed in 200 healthy controls (HC) and 300 AS with varying degrees of hip pain. Forty-four patients with early hip osteoarthritis (OA) served as positive imaging controls. In MRI images, BME lesions in the STIR sequence were much more frequent in AS (62%) compared to HC (2%) (p < 0.0001). Most importantly, 42% of AS with no or minimal hip pain had one or more MRI lesions. This was much more frequent compared to the 2% in HC (p < 0.05). These lesions in AS were observed singly or in combination in the trochanters (8%), femoral heads (12%), and acetabula (13%). Parallel finding that X-ray changes were present in patients with minimal or no hip pain was also observed with X-ray. Based on the normal hip width of HC, joint space narrowing was observed in 94.3% of the entire AS cohort, and importantly 56.7% of AS patients with no or mild hip pain. In these latter patients, functional activities of the hips such as walking were normal. At least 40% of AS patients with minimal or no hip pain might already show MRI and X-ray changes.

Dissipation behavior, residue distribution, and dietary risk assessment of fluopimomide and dimethomorph in taro using HPLC-MS/MS.

Dimethomorph is a morpholine broad-spectrum fungicide and effectively controls taro blight, cucumber downy mildew, rice blast disease, and others. Fluopimomide is a newly developed broad-spectrum fungicide to primarily control oomycetes and rhizoctonia diseases. Taro, one of the earliest cultivated crops, is a staple food in Africa, Oceania, and Asia. Recently, a commercial suspension concentrate formulation containing 15% fluopimomide and 25% dimethomorph has been registered in China, the second largest taro producer in the world. The objective of this study was to develop a high-performance liquid chromatography tandem mass spectrometry method to detect the residues of fluopimomide and dimethomorph concurrently in taro samples. The results showed that the average recoveries of fluopimomide and dimethomorph ranged from 83 to 108%, and relative standard deviations (RSD) ranged from 1 to 11%. The limit of quantitation (LOQ) was 0.01 mg kg-1 for the two compounds. The dissipation results demonstrated that both fluopimomide and dimethomorph in taro degraded rapidly in taro fields, and the residues of the two fungicides were below the LOQ within 14 days post-application. The final residue levels of fluopimomide and dimethomorph in taro were lower than 0.066 mg kg-1 28 days post-application. For dietary risk assessments, the dietary structure of different genders and age of people in China exposure risk assessment and whole diet exposure risk assessment shows that the risk quotient (RQ) values were substantially lower than 100%, suggesting that the long-term risks of fluopimomide/dimethomorph mixed formulation in taro at the recommended dosage were negligible. In summary, our combined results from the dissipation behaviors, terminal residues, and dietary risk assessments provide the critical empirical data for the establishment of the maximum residue levels (MRLs) of the two broad-spectrum fungicides in taro, a traditional food for African, Oceanic, and South Asian cultures.

Performance of the PET vascular activity score (PETVAS) for qualitative and quantitative assessment of inflammatory activity in Takayasu's arteritis patients.

PURPOSE: To assess the performance of PET vascular activity score (PETVAS) in comparison with SUVmax, inflammatory biomarkers and ITAS-2010 score in a cohort of TAK patients. METHODS: Sixty-four PET/CT scans acquired from 54 TAK patients were analyzed. The inflammatory activity was qualitatively determined by physician's global assessment and quantitatively determined by ITAS-2010 score. SUVmax and PETVAS were acquired by consensus review. Levels of the inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and pentraxin-3 (PTX-3) were measured. Performance of the qualitative diagnoses and the quantitative correlation were, respectively, compared by receiver operating characteristic (ROC) curve and Spearman correlation coefficient. RESULTS: The biomarkers (CRP, ESR, PTX-3), PET uptake values (SUVmax, PETVAS), and ITAS-2010 scores were all significantly higher in active patients than in non-active ones. The area under the ROC curve and Youden Index of PETVAS and PTX-3 were higher than those of SUVmax, CRP, ESR, and ITAS-2010. PETVAS and PTX-3 resulted in a higher Spearman correlation coefficient with ITAS-2010 than other criteria, either among all patients or within the active group. Alteration trends of PETVAS and PTX-3 during follow-up showed a tighter correlation with clinical progression/remission assessment than other criteria. CONCLUSIONS: In TAK evaluation, PETVAS is superior for qualitative and quantitative assessment, compared with the regional SUVmax. Compared to CRP and ESR, inflammatory biomarker PTX-3 shows better qualitative performance and a higher correlation with PETVAS and ITAS-2010. These findings indicate that the use of PETVAS and PTX-3, instead of SUVmax and CRP/ESR, has potential advantages in the clinical evaluation of TAK.

The response of soil Olsen-P to the P budgets of three typical cropland soil types under long-term fertilization.

The Olsen phosphorus (Olsen-P) concentration of soil is generally a good indicator for estimating the bioavailability of P and environmental risk in soils. To maintain soil Olsen-P at adequate levels for crop growth and environmental sustainability, the relationship between soil Olsen-P and the P budget (the P input minus the output) as well as the variations of soil Olsen-P and P budget were investigated from three long-term (22 years) experiments in China. Five treatments were selected: (1) unfertilized control (CK); (2) nitrogen and potassium (NK); (3) nitrogen, phosphorous, and potassium (NPK); (4) nitrogen, phosphorous, potassium and straw; (5) nitrogen, phosphorous, potassium and manure. The results showed that without P fertilizers (CK, NK), there was a soil P deficit of 75-640 kg ha-1, and the lowest P deficit (mean of CK and NK) was in Eutric Cambisol. Soil Olsen-P decreased by 0.11-0.39 mg kg-1 year-1 in the order of Luvic Phaeozems > Eutric Cambisol > Calcaric Cambisol. Soil Olsen-P and the P deficit had a significantly (P<0.01) positive linear relationship. For every 100 kg of P ha-1 of deficit, soil Olsen-P decreased by 0.44-9.19 mg kg-1 in the order of Eutric Cambisol > Luvic Phaeozems > Calcaric Cambisol. Under the P fertilizer treatments (NPK, NPKS, and NPKM), soil Olsen-P showed an obvious surplus (except the NPK and NPKS in Luvic Phaeozems) of 122-2190 kg ha-1, and the largest P surplus was found under the NPKM treatment at each site. The relation between soil Olsen-P and the experimental years could be simulated using quadratic equation of one unknown in Calcaric Cambisol for the lower P input after 14 years of fertilization. And soil Olsen-P increased by 1.30-7.69 mg kg-1 year-1 in the order of Luvic Phaeozems > Eutric Cambisol. The relation between soil Olsen-P and the P surplus could be simulated by a simple linear equation except under NPK and NPKS in Luvic Phaeozems. With 100 kg ha-1 P surplus, soil Olsen-P increased by 3.24-7.27 mg kg-1 in the order of Calcaric Cambisol (6.42 mg kg-1) > Eutric Cambisol (3.24 mg kg-1). In addition, the change in soil Olsen-P with a 100 kg P ha-1 surplus (soil Olsen-P efficiency) was affected by the soil organic matter (SOM), pH, and CaCO3 content, etc. In the practice of fertilization, it's not necessary to increase the amount of P fertilizers, farmers should take measure to solve the local problem, for adjust the soil pH of Eutric Cambisol and Calcaric Cambisol, and apply more nitrogen in Luvic Phaeozems. In the area of serious soil P surplus, it is encouraged to stop applying P fertilizers for a few years to take advantage of soil accumulated P and make the high Olsen-P content decrease to a reasonable level.

Characterization and functional assessment of alginate fibers prepared by metal-calcium ion complex coagulation bath.

In order to improve the mechanical properties of alginate fiber and enrich its application properties, the metal-alginate fibers were produced with wet spinning in the coagulation bath of Zn2+, Ba2+, Cu2+, Al3+ ions blended with Ca2+ ions. FT-IR and 13C NMR were used to characterize the binding mode of alginic acid with metal ions and the arrangement of G and M groups in the molecular chain. The flame retardancy, mechanical and antibacterial properties of metal-alginate fiber were improved, while its water absorption was decreased. The results of Thermogravimetric (TG) and Limiting oxygen index (LOI) showed that the flame retardancy of metal-alginate fibers was better than that of calcium alginate fibers. The combination of metal ions and alginic acid has different improvement effect of mechanical strength and antimicrobial activity against Escherichia coli and Staphylococcus aureus. The multi-functional fiber is expected to be used in medical textiles and new textile fibers.

Economical production of isomaltulose from agricultural residues in a system with sucrose isomerase displayed on Bacillus subtilis spores.

A safe, efficient, environmentally friendly process for producing isomaltulose is needed. Here, the biocatalyst, sucrose isomerase (SIase) from Erwinia rhapontici NX-5, displayed on the surface of Bacillus subtilis 168 spores (food-grade strain) was applied for isomaltulose production. The anchored SIase showed relatively high bioactivity, suggesting that the surface display system using CotX as the anchoring protein was successful. The stability of the anchored SIase was also significantly better. Thermal stability analysis showed that 80% of relative activity was retained after incubation at 40 °C and 45 °C for 60 min. To develop an economical industrial fermentation medium, untreated beet molasses (30 g/L) and cold-pressed soybean powder (50 g/L) were utilised as the main broth components for SIase pilot-scale production. Under the optimal conditions, the productive spores converted 92% of sucrose after 6 h and the conversion rate was 45% after six cycles. Isomaltulose production with this system using the agricultural residues, untreated beet molasses and soybean powder, as substrates is cost-effective and environmentally friendly and can help to overcome issues due to the genetic background.

Spatial distribution and risk assessment of heavy metals in contaminated paddy fields - A case study in Xiangtan City, southern China.

An extensive investigation on spatial distribution and environmental risk assessment based on total content and fractions of heavy metals, as well as the cancer risk of Cd from seven adjacent contaminated paddy fields at Xiangtan City, southern China, was conducted in this study. A total of 63 soil samples were analyzed for soil physical properties and concentrations of eight heavy metals (Cd, Cr, Co, Cu, Mn, Ni, Pb, Zn). The results showed that concentrations of metals except for Cr, Mn and Ni exceeded the background values to varying degrees, and particularly, content of Cd was as 57.4-612 times higher than background values. Principal components analysis and correlation analysis revealed three groups: industry activities for Cd and Zn; natural sources mainly for Cu, Pb, Ni and Cr, with some slight anthropogenic activities for Cu and Pb accumulation; and manganese ore associated with cobalt for Co and Mn. Combined with different indices, Cd and Zn were the major contributors to the ecological risk, and cancer risk of Cd indicated an unacceptable degree in this area. Altogether, results from this study will facilitate a better understanding of metals distribution characteristics and provide a scientific basis for further comprehensive management for these paddy fields. Combination of functional microbial agent and plants promises to be a feasible and effective remediation method for cadmium pollution in the study area.

Comparison of the flexible parametric survival model and Cox model in estimating Markov transition probabilities using real-world data.

BACKGROUND AND OBJECTIVE: Markov micro-simulation models are being increasingly used in health economic evaluations. An important feature of the Markov micro-simulation model is its ability to consider transition probabilities of heterogeneous subgroups with different risk profiles. A survival analysis is generally performed to accurately estimate the transition probabilities associated with the risk profiles. This study aimed to apply a flexible parametric survival model (FPSM) to estimate individual transition probabilities. MATERIALS AND METHODS: The data were obtained from a cohort study investigating ischemic stroke outcomes in Western China. In total, 585 subjects were included in the analysis. To explore the goodness of fit of the FPSM, we compared the estimated hazard ratios and baseline cumulative hazards, both of which are necessary to the calculate individual transition probabilities, and the Markov micro-simulation models constructed using the FPSM and Cox model to determine the validity of the two Markov micro-simulation models and cost-effectiveness results. RESULTS: The flexible parametric proportional hazards model produced hazard ratio and baseline cumulative hazard estimates that were similar to those obtained using the Cox proportional hazards model. The simulated cumulative incidence of recurrent ischemic stroke and 5-years cost-effectiveness of Incremental cost-effectiveness Ratios (ICERs) were also similar using the two approaches. A discrepancy in the results was evident between the 5-years cost-effectiveness and the 10-years cost-effectiveness of ICERs, which were approximately 0.9 million (China Yuan) and 0.5 million (China Yuan), respectively. CONCLUSIONS: The flexible parametric survival model represents a good approach for estimating individual transition probabilities for a Markov micro-simulation model.

[Health Utility of Patients with Stroke Measured by EQ-5D and SF-6D].

OBJECTIVE: To compare EQ-5D and SF-6D for measuring health utility of stroke patients in health economic evaluation studies. METHODS: A prospective cohort study was conducted on 596 stroke patients in the West China Hospital of Sichuan University from 2010 to 2016. Data were collected at baseline through face to face interviews and at the follow-up stages through telephone interviews with a three-month interval. EQ-5D and SF-6D were used for measuring health utility scores of the participants. The consistency of the two instruments was assessed using Bland-Altman plot and Intraclass correlation coefficient (ICC) . Logistic regression models were established to identify predictors of health utility. RESULTS: The participants had a mean utility score of 0.78 (95% confidence interval:0.76, 0.80) in EQ-5D,compared with 0.74 (95% confidence interval: 0.73, 0.76) in SF-6D,and a median (interquartile range) of 0.86 (0.68, 1.00) in EQ-5D and 0.73 (0.62, 0.86) in SF-6D. The 95% limits of agreement between the two instruments ranged from -0.28 to 0.35,with an ICC of 0.67 (95% confidence interval: 0.62,0.71). EQ-5D had a higher ceiling effect. The health utility score of stroke patients changed there rapidly in acute phase (less than 3 months) but barely changed there after.Severity of stroke was a major predictor of health utility scores. CONCLUSION: The two instruments generate inconsistent results in health utility. SF-6D is better for measuring health utility in patients with stroke in China.

Cost-effectiveness of Different Intra-articular Drug Injections on Wrist and/or Elbow Compromise in Patients With Established Rheumatoid Arthritis: Short-term Results of an Open Observational Evaluation.

BACKGROUND: Intra-articular (IA) injections are an integral part of the management of rheumatoid arthritis (RA). However, there are few reports regarding the association between drug effectiveness and cost. OBJECTIVES: The aim of this study was to assess the cost-effectiveness of various combinations of IA injections of betamethasone, hyaluronic acid (HA) or etanercept for oligoarthritis in RA. METHODS: Seventy RA patients were assigned to 4 groups according to the IA injection drug(s): betamethasone alone, betamethasone + etanercept, betamethasone + HA, or etanercept alone. Data for the following were collected before and after IA injection: erythrocyte sedimentation rate, C-reactive protein (CRP), disease activity score in 28 joints calculated with CRP, and patient global visual analog scale. In addition, power Doppler ultrasonography and gray-scale ultrasonography scores were obtained for synovitis, and passive range of motion of joints was measured. RESULTS: Sixty-eight RA patients completed the trial. Compared with patients given etanercept alone, the visual analog scale, power Doppler ultrasonography, and gray-scale ultrasonography scores of each of the other groups were significantly better at each time point. At 1 month, the passive range of motion of joints in patients given betamethasone + HA was significantly better than that of each of the other groups. Synovial hyperplasia improved significantly in all groups, but less so in those given etanercept alone. All other clinical parameters of the 4 groups were similar. The costs per joint for the betamethasone-alone, betamethasone + etanercept, betamethasone + HA, and etanercept-alone groups were, respectively, $7.55, $181.77, $42.68, and $174.22. CONCLUSIONS: Intra-articular injection of betamethasone alone was the most cost-effective treatment for oligoarthritis of RA. Betamethasone combined with HA injection resulted in the best improvement in joint function.

Chinese SLE Treatment and Research Group (CSTAR) registry:VIII. Influence of socioeconomic and geographical variables on disease phenotype and activity in Chinese patients with SLE.

AIM: The aim of this study was to estimate the influence of socioeconomic and geographical variables on disease phenotype and activity of systemic lupus erythematosus (SLE) in a Chinese population. METHODS: Data on 904 therapy-naïve SLE patients from the Chinese SLE Treatment and Research Group (CSTAR), which is a nation-wide database of SLE patients, were used to evaluate the influence of socioeconomic status (SES) and geographical regions on disease phenotypes. The influence of regional climate and economic variables (i.e., data from the database of the Chinese Statistical Yearly Annals) on disease activity and nephropathy was further analyzed in a multivariate analysis to identify some of the environmental factors contributing to SLE. RESULTS: Phenotype differences in SLE were found between patients with different SES. In the multivariate regression analysis that considered regional economic and climate factors, after adjusting for age, gender and disease duration, lower educational levels (ß: -0.122, P = 0.001), lower availability of medical technical personnel (MTP) per 1000 people (ß: -0.192, P < 0.001), higher annual duration of sunshine (ß: 0.178, P = 0.010) and residence in southern China (ß: 0.165, P = 0.001) were significantly associated with higher disease activity scores. Living in southern China (odds ratio [OR]: 1.907, P = 0.002) seemed to be a significant risk factor for nephropathy. A high number of MTP per 1000 people (OR: 0.951, P = 0.014) and relatively high temperatures were determined to be protective factors for nephropathy (OR: 0.946, P = 0.011). CONCLUSIONS: The phenotype pattern and disease activity varied between SLE patients by SES and other regional variables, such as educational level, availability of medical technical personnel, annual sunshine duration and regional temperature.

Two-step economical welan gum production by Sphingomonas sp. HT-1 from sugar industrial by-products.

A two-step fermentation strategy using glucose mother liquor (GML) for cell growth and xylose mother liquor (XML) for welan gum synthesis was used to alleviate uneconomic welan gum fermentation. This study revealed: (1) optimal initial GML concentration was 11.7g/L (10g/L sugars contained); (2) optimal XML feeding strategy was pseudo-exponential fed-batch and feeding time was 12thh-54thh, amounting to 25.7g/L XML (20g/L sugars contained); and (3) in a 7.5-L bioreactor, welan gum concentration was 22.68±0.50g/L and its yield reached 0.756g/g sugars with trace residual sugars. Compared with the cost of batch fermentation using glucose as sole carbon source, the final carbon source costs decreased by 61.40% and the welan gum yield increased by 50%. GML and XML can be used as inexpensive carbon sources for welan gum production with higher yield, giving them industrial application potential to produce value-added chemicals.

Classification criteria of early rheumatoid arthritis and validation of its performance in a multi-centre cohort.

OBJECTIVES: To develop classification criteria for early rheumatoid arthritis (ERA) based on a large cohort of early inflammatory arthritis patients and to evaluate the performance of these criteria. METHODS: The study population comprised a cohort of early inflammatory arthritis patients with symptom duration less than one year. Classification criteria of ERA were developed by incorporating the most sensitive or specific variables. Performance of the ERA criteria, 1987 ACR and 2010 ACR/EULAR criteria were evaluated. RESULTS: A total of 803 patients were enrolled in this study. By the end of the one year follow-up, 514 patients were diagnosed with RA, 251 with other rheumatic diseases, and 38 patients with undifferentiated arthritis. The ERA criteria are as follows: 1) morning stiffness ≥30 minutes; 2) arthritis of 3 or more joint areas; 3) arthritis of hand joints; 4) positive RF; 5) positive anti-CCP antibody. Rheumatoid arthritis is defined by the presence of 3 or more of the criteria. The sensitivity (84.4%) of the ERA classification criteria was much higher than the 1987 ACR criteria (58.0%). In a validation cohort of early inflammatory arthritis patients, the area under the ROC curves (AUC) showed a better performance for the ERA criteria (0.906, 95%CI 0.866 to 0.945) than the 1987 ACR criteria (0.786, 95%CI 0.725 to 0.848) and the 2010 ACR/EULAR criteria (0.745, 95%CI 0.677 to 0.814). CONCLUSIONS: A set of ERA classification criteria has been developed with good performance for early RA. It is applicable in clinical practice and research.

Societal costs of rheumatoid arthritis in China: a hospital-based cross-sectional study.

OBJECTIVE: To estimate the annual direct and indirect costs of rheumatoid arthritis (RA) in China and identify the predictors for cost of illness. METHODS: A cross-sectional study of cost of illness from the societal perspective was conducted on 829 patients with RA in 21 tertiary care hospitals in China between July 2009 and December 2010. Data on demographics, clinical variables, and components of costs were collected by physician interview. Costs were represented in 2009 US dollars using purchasing power parity estimates. Univariate and multivariate linear regression analyses were performed to identify the predictors for cost of illness. RESULTS: The mean ± SD total cost of RA in China was $3,826 ± $5,659 per patient-year, given a gross domestic product per capita of $6,798 in China in 2009. Direct costs and indirect costs comprised 90.0% and 10.0% of the total costs, respectively. Drug expense represented approximately half of the total costs, dominated by biologic agents (48.2%) and disease-modifying antirheumatic drugs (23.5%). Additionally, the cost of extracted herbal drugs and traditional Chinese medicine comprised ∼17.6% of the drug expense. Higher education level, noninsured status, longer disease duration, more extraarticular manifestations, and higher Health Assessment Questionnaire score independently predicted higher total costs. CONCLUSION: Our results provide the first study of costs of RA in China. This study not only demonstrates the economic burden of RA, but also identifies the predictors that could be interventional factors to reduce the societal costs of RA in China.