Cardiovascular-specific mortality and risk factors in colorectal Cancer patients: A cohort study based on registry data of over 500,000 individuals in the US.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide, and recent studies have found that CRC patients are at increased risk for cardiovascular disease (CVD). This study aimed to investigate competing causes of death and prognostic factors among a large cohort of CRC patients and to describe cardiovascular-specific mortality in relation to the US standard population. METHODS: This registry-based cohort study identified patients diagnosed with CRC between 1973 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database in the US. Cumulative mortality functions, conditional standardized mortality ratios, and cause-specific hazard ratios were calculated. RESULTS: Of the 563,298 eligible CRC patients included in this study, 407,545 died during the follow-up period. CRC was the leading cause of death, accounting for 49.8% of all possible competing causes of death. CVD was the most common non-cancer cause of death, accounting for 17.8% of total mortality. This study found that CRC patients have a significantly increased risk of cardiovascular-specific mortality compared to the US standard population, with the risk increasing with age and extended survival time. CONCLUSION: This study highlights the need to develop multidisciplinary prevention and management strategies for CRC and CVD to improve CRC patients' survival and quality of life.

Effect of Biofilm Forming on the Migration of Di(2-ethylhexyl)phthalate from PVC Plastics.

Plastic additives, represented by plasticizers, are important components of plastic pollution. Biofilms inevitably form on plastic surfaces when plastic enters the aqueous environment. However, little is known about the effect of biofilms on plastic surfaces on the release of additives therein. In this study, PVC plastics with different levels of di(2-ethylhexyl)phthalate (DEHP) content were investigated to study the effect of biofilm growth on DEHP release. The presence of biofilms promoted the migration of DEHP from PVC plastics to the external environment. Relative to biofilm-free controls, although the presence of surface biofilm resulted in 0.8 to 11.6 times lower DEHP concentrations in water, the concentrations of the degradation product, monoethylhexyl phthalate (MEHP) in water, were 2.3 to 57.3 times higher. When the total release amounts of DEHP in the biofilm and in the water were combined, they were increased by 0.6-73 times after biofilm growth. However, most of the released DEHP was adsorbed in the biofilms and was subsequently degraded. The results of this study suggest that the biofilm as a new interface between plastics and the surrounding environment can affect the transport and transformation of plastic additives in the environment through barrier, adsorption, and degradation. Future research endeavors should aim to explore the transport dynamics and fate of plastic additives under various biofilm compositions as well as evaluate the ecological risks associated with their enrichment by biofilms.

The development of a self-management evaluation scale for elderly adults with hypertension based on the capability, opportunity, and motivation-behaviour (COM-B) model.

BACKGROUND: Using accurate assessment tools to assess patients in clinical practice is important to mining influencing factors and implementing interventions. However, most evaluation tools for the self-management of elderly patients with hypertension lack a theoretical basis and wide applicability, which makes the intervention effect insignificant. METHODS: Based on the Capability, Opportunity, and Motivation-Behaviour (COM-B) model, combined with literature review and qualitative research, a questionnaire item pool was initially formulated; then the initial items were screened and adjusted through expert consultation and pre-testing to form an initial scale. A field survey of 450 elderly hypertensive patients was then performed using the initial scale to test the reliability and validity of the scale. Cronbach's alpha, test-retest reliability and composite reliability were used to test the reliability of the scale, and the validity of the scale was evaluated from two aspects: content validity and construct validity. The evaluation results of the content validity of the scale by experts were used as the content validity index; the results of exploratory factor analysis and confirmatory factor analysis were used as the structural validity index to further verify the model structure of the scale and develop a formal scale. RESULTS: The final self-management scale included 4 dimensions and 33 items. The Scale-Content Validity Index was 0.920. Exploratory factor analysis extracted four factors that explained 71.3% of the total variance. Cronbach's alpha of the formal scale was 0.867, test-retest reliability was 0.894, and composite reliability of the 4 dimensions were within 0.943 ~ 0.973. Confirmatory factor analysis showed the scale had good construct validity. CONCLUSIONS: The Self-management Capability, Support and Motivation-Behaviour scale for elderly hypertensive patients has good reliability and validity, providing a tool for medical staff to evaluate the self-management level of elderly hypertensive patients.

Determinants of self-rated health among elderly patients with hypertension: a cross-sectional analysis based on the Chinese longitudinal healthy longevity survey.

BACKGROUND: The total number of elderly patients with hypertension in China has been increasing year by year, it is necessary to adopt simple and valid measures to evaluate the health status of elderly patients with hypertension to reduce the heavy burden faced by this group. METHOD: This study is a cross-sectional analysis. Participants aged at least 65 years were included. Self-Rated Health (SRH) assessment of respondents was classified into two groups: participants who responded as "very good" and "good" were considered as having good SRH, and participants who answered as "average," "poor," and "very poor" were considered as having poor SRH. Chi-square tests were used to determine differences in patient characteristics between the two groups. Binary logistic regression models were used to identify factors associated with SRH. RESULTS: The results of the logistic regression analysis indicated that having a spouse, better economic status, exercise, eating fruits and vegetables, nighttime sleep of 7 to 9 hours, good living environment, interaction with friends, and hypertension with comorbidity such as diabetes mellitus, heart disease, stroke or hyperlipidemia were influencing factors of SRH (P < .05). Another finding was that alcohol use significantly affected SRH (P < .05). Depression, anxiety, and community nursing services did not figure as determinants of health in this group. CONCLUSION: The findings of this study provide evidence for the need to develop effective health promotion programs for the well-being of hypertensive patients.

Cancer Patients with Venous Access Device Status and Influencing Factors of Path Analysis Decision Conflicts.

Objective: The study aims to investigate the status of decision-making and the influencing factors of venous access devices in cancer patients and to explore their action path. Methods: A retrospective analysis was conducted on the clinical data of 360 inpatients in the oncology department from July 2022 to October 2022 in Hebei, Shandong, and Shanxi provinces. The patients were assessed with a general information questionnaire, decision conflict scale, general self-efficacy scale, patient version of doctor-patient decision-making questionnaire, and medical version of social support scale. Further analysis was conducted on the influencing factors of decision conflict on cancer patients' status and access to venous access devices. Results: A total of 345 valid questionnaires were acquired, showing the total score of decision-making conflict regarding venous access devices in cancer patients to be 34.72 ± 12.13. A total of 245 patients exhibited decision-making conflict, with a high level in 119 patients. A negative correlation was found between the total score of decision-making conflict with that of self-efficacy, doctor-patient joint decision-making, and social support (r = 0.766, -0.816, -0.74, P < .001). The joint decision-making between doctor and patient directly negatively affected decision-making conflict (ß = -0.587, P < .001). Self-efficacy was found to exert a direct positive and negative predictive effect on the doctor-patient joint decision-making and decision-making conflict, respectively (ß = 0.415, 0.277, P < .001). Social support can contribute to decision-making conflict in a direct or indirect way through multiple modulations of self-efficacy and joint decision-making between doctors and patients (ß = -0.296, -0.237, -0.185, P < .001). Conclusion: Decisional conflicts are existing among cancer patients in intravenous access device selection, the degree of joint decisional involvement of doctors and patients makes a negative predictive effect on intravenous access device selection, and self-efficacy and social support exert direct or indirect effects. Accordingly, enhancing patients' self-efficacy and improving patients' social support from multiple perspectives could contribute to decision-making of intravenous access devices for cancer patients, which could be achieved by developing decision support programs to elevate decision quality, block related paths early, and reduce the level of patients' decision conflicts.

Nearly a decade-long repeatable seasonal diversity patterns of bacterioplankton communities in the eutrophic Lake Donghu (Wuhan, China).

Uncovering which environmental factors govern community diversity patterns and how ecological processes drive community turnover are key questions related to understand the community assembly. However, the ecological mechanisms regulating long-term variations of bacterioplankton communities in lake ecosystems remain poorly understood. Here we present nearly a decade-long study of bacterioplankton communities from the eutrophic Lake Donghu (Wuhan, China) using 16S rRNA gene amplicon sequencing with MiSeq platform. We found strong repeatable seasonal diversity patterns in terms of both common (detected in more than 50% samples) and dominant (relative abundance >1%) bacterial taxa turnover. Moreover, community composition tracked the seasonal temperature gradient, indicating that temperature is a key environmental factor controlling observed diversity patterns. Total phosphorus also contributed significantly to the seasonal shifts in bacterioplankton composition. However, any spatial pattern of bacterioplankton communities across the main lake areas within season was overwhelmed by their temporal variabilities. Phylogenetic analysis further indicated that 75%-82% of community turnover was governed by homogeneous selection due to consistent environmental conditions within seasons, suggesting that the microbial communities in Lake Donghu are mainly controlled by niche-based processes. Therefore, dominant niches available within seasons might be occupied by similar combinations of bacterial taxa with modest dispersal rates throughout different lake areas.

Occurrence and Characteristics of Microplastic Pollution in Xiangxi Bay of Three Gorges Reservoir, China.

Microplastic pollution in inland waters is receiving growing attentions. Reservoirs are suspected to be particularly vulnerable to microplastic pollution. However, very limited information is currently available on pollution characteristics of microplastics in reservoir ecosystems. This work studied the distribution and characteristics of microplastics in the backwater area of Xiangxi River, a typical tributary of the Three Gorges Reservoir. Microplastics were detected in both surface water and sediment with concentrations ranging from 0.55 × 105 to 342 × 105 items km-2 and 80 to 864 items m-2, respectively. Polyethylene, polypropylene, and polystyrene were identified in surface water, whereas polyethylene, polypropylene, and polyethylene terephthalate, and pigments were observed in sediment. In addition, microplastics were also detected in the digestion tracts of 25.7% of fish samples, and polyethylene and nylon were identified. Redundancy analysis indicates a weak correlation between microplastics and water quality variables but a negative correlation with water level of the reservoir and Secchi depth. Results from this study confirm the presence of high abundance microplastics in reservoir impacted tributaries, and suggest that water level regulated hydrodynamic condition and input of nonpoint sources are important regulators for microplastic accumulation and distribution in the backwater area of reservoir tributaries.

Sorption and degradation of triclosan in sediments and its effect on microbes.

Sorption and degradation behavior of triclosan (TCS) and its effect on microbes were studied in three sediments spiked at different concentration levels (1, 10, and 100 µg g(-1)). TCS showed a strong affiliation to all the sediments with linear adsorption coefficients (Kd) that varied from 220 to 1092 L g(-1), and the adsorption capacity is related to the total organic carbon (TOC) contents of the sediments. The half-lives of TCS varied from 55 to 239 days, and were longer in sediment with higher Kd. TCS showed minor effect on the activities of fluorescein diacetate hydrolase, dehydrogenase, alkaline phosphatase, and urease in the 1 µg g(-1) treatment, but at higher levels, a short-term effect was observed followed by a rapid recovery except the urease activity in sediment with the lowest adsorption capacity. PCA plots of phospholipid fatty acid showed that the phenotypic community in sediments with low TOC were more sensitive to TCS. A positive relation between bacterial biomass and total microbial biomass suggests that changes of bacteria biomass were responsible for changes of total microbial biomass in treatments. Denaturing gradient gel electrophoresis analysis of the 16S rDNA showed that the bacterial community structure deviated further away from the control at higher TCS concentration levels, with similarity coefficients in Un-weighted Pair Group Mathematics Average clustering between control and 100 µg g(-1) treatment varied from 0.38 to 0.73. Both degradation rate and toxic effects of TCS decreased in sediment with higher sorption capacity, which can be attributed to a reduced bioavailablity.

Nitrogen and phosphorus limitations promoted bacterial nitrate metabolism and propagation of antibiotic resistome in the phycosphere of Auxenochlorella pyrenoidosa.

Despite that nitrogen (N) and phosphorus (P) play critical roles in the lifecycle of microalgae, how N and P further affect the distribution of bacteria and antibiotic resistance genes (ARGs) in the phycosphere is still poorly understood. In this study, the effects of N and P on the distribution of ARGs in the phycosphere of Auxenochlorella pyrenoidosa were investigated. Results showed that the growth and chlorophyll synthesis of microalgae were inhibited when N or P was limited, regardless of the N/P ratios, but the extracellular polymeric substances content and nitrate assimilation efficiency were enhanced in contrast. Metagenomic sequencing revealed that N or P limitation resulted in the recruitment of specific bacteria that highly contribute to the nitrate metabolism in the phycosphere. Besides, N or P limitation promoted the propagation of phycosphere ARGs, primarily through horizontal gene transfer mediated by mobile genetic elements. The enrichment of specific bacteria induced by changes in the algal physiology also contributed to the ARGs proliferation under nutrient limitation. Our results demonstrated that the reduction of algal cells caused by nutrient limitation could promote the propagation of ARGs, which provides new insights into the occurrence and spread of ARGs in the phycosphere.

Antibiotics in the rice-crayfish rotation pattern: Occurrence, prioritization, and resistance risk.

Antibiotics are extensively utilized in aquaculture to mitigate diseases and augment the productivity of aquatic commodities. However, to date, there have been no reports on the presence and associated risks of antibiotics in the emergent rice-crayfish rotation (RCR) system. This study investigated the occurrence, temporal dynamics, prioritization, sources, and potential for resistance development of 15 antibiotics within the RCR ecosystem. The findings revealed that during the crayfish breeding and rice planting periods, florfenicol (FFC) predominated in the RCR's surface water, with peak and average concentrations of 1219.70 ng/L and 57.43 ng/L, and 1280.70 ng/L and 52.60 ng/L, respectively. Meanwhile, enrofloxacin (ENX) was the primary antibiotic detected in RCR soil and its maximum and average concentrations were 624.73 ng/L and 69.02 ng/L in the crayfish breeding period, and 871.27 ng/L and 45.89 ng/L in the rice planting period. Throughout the adjustment period, antibiotic concentrations remained relatively stable in both phases. Notably, antibiotic levels in surface water and soil escalated during the crayfish breeding period and subsided during the rice planting period, with these fluctuations predominantly influenced by FFC and ENX. Source analysis indicated that the antibiotics in RCR predominantly originated from aquaculture activities, supplemented by water exchange processes. Utilizing the entropy utility function and a resistance development model, FFC, clarithromycin (CLR), and roxithromycin (ROX) in surface water, along with ENX, CLR, and ROX in soil, were identified as priority antibiotics. FFC, ENX, and ROX exhibited a medium risk for resistance development. Consequently, this study underscores the necessity to intensify antibiotic usage control during the crayfish breeding period in the RCR system to mitigate environmental risks.

Occurrence, distribution, and ecological risks of antibiotics in Honghu Lake and surrounding aquaculture ponds, China.

Antibiotics are largely applied in aquaculture to increase production and control diseases, while how the antibiotics used in pond farming influence the distribution of antibiotics in receiving water seasonally is still not well understood. In this study, the variations of 15 frequently used antibiotics in Honghu Lake and surrounding ponds were investigated seasonally to figure out the impact of pond farming on antibiotics distributions in Honghu Lake. Results showed that the antibiotic concentrations in fish ponds ranged from 11.76 to 389.8 ng/L, while in crab and crayfish ponds were lower than 30.49 ng/L. The predominant antibiotic in fish ponds was florfenicol, followed by sulfonamides and quinolones, with generally low concentrations. Sulfonamides and florfenicol were the main antibiotics in Honghu Lake, affected by the surrounding aquaculture water partially. The antibiotics residue in aquaculture ponds showed obvious seasonal characteristics, with the lowest in spring. From summer, the concentrations of antibiotics in aquaculture ponds gradually increased and reached a peak in autumn, and the seasonal variation of antibiotics in the receiving lake was also related to the antibiotics in the aquaculture ponds. Risk assessment analysis showed that antibiotics such as enrofloxacin and florfenicol in fish ponds posed a medium and low risk to algae, and Honghu Lake acted as a natural reservoir of antibiotics and poses increased risks to algae. In general, our study demonstrated that aquaculture represented by pond farming brought significant risks of antibiotic pollution to natural water bodies. Therefore, reasonable control of the fish antibiotics usage in autumn and winter, as well as the rational use of antibiotics in aquaculture and the use of antibiotics before pond cleaning, is required to reduce the migration of antibiotics from aquaculture surface water to the receiving lake.

Phthalates in plastic stationery in China and their exposure risks to school-aged children.

Phthalates have been strictly banned in children's products in many countries. However, as a product with a high frequency of daily contact with children, stationery is not strictly regulated for phthalates in many countries and the occurrences and risks of phthalates in stationery are rarely reported. In this study, the contents of sixteen types of common phthalates in stationery were determined and the exposure risk of these phthalates to children was also estimated. The total contents of phthalates in all stationery ranged from 5.56 to 3.46 × 105 µg/g, with a median value of 1.48 × 104 µg/g. Polyvinyl chloride (PVC) desk mats (DMs) contained the highest contents of phthalates among all types of stationery. Percutaneous absorption and hand-to-mouth ingestion levels of phthalates for school-age children from the DMs were 2.03 × 10-5 - 10.14 µg/kg-Bw/day and 2.14 × 10-5 - 10.67 µg/kg-Bw/day, respectively. Di-2-ethylhexyl phthalate (DEHP) had the highest proportion, detection rate, and exposure level among all measured phthalates. Our study revealed that phthalates in PVC stationery, especially classroom DMs, at both contents and exposure risks, were higher than those in many other children's plastic products. It was necessary to strengthen the management of plastic stationery from the perspective of materials and phthalates addition.

Spatial analysis of the influence on "microplastic communities" in the water at a medium scale.

The issue of microplastics in freshwater has been growing in concern. Besides their abundance, the characteristics of microplastics are also important issues. The concept of "microplastic communities" has been utilized to assess differences in microplastic characteristics. In this study, we utilized the "microplastic community" approach to evaluate the impact of land use on microplastic characteristics in water at a provincial scale in China. The abundance of microplastics in water bodies in Hubei Province varied between 0.33 items/L and 5.40 items/L, with an average of 1.74 items/L. Microplastics were significantly more abundant in rivers than in lakes and reservoirs, and their abundance was negatively correlated with the distance from the nearest residential district of sampling sites. Similarities of microplastic communities were significantly different in mountainous and plain areas. Anthropogenic surfaces increased microplastic abundance and tended to decrease the size of microplastics, whereas natural vegetation had the opposite effect. The effect of land use on microplastic community similarity was greater than that of geographic distance. However, spatial scale limits the effect of various factors on microplastic community similarity. This study revealed the comprehensive influence of land use on microplastic characteristics in water and emphasized the importance of spatial scale in the study of microplastic characteristics.

The effects of land use on water quality of alpine rivers: A case study in Qilian Mountain, China.

Land use influences the variation of river water quality. This effect varies depending on the region of the river and the spatial scale at which land use is calculated. This study investigated the influence of land use on river water quality in Qilian Mountain, an important alpine river region in northwestern China, on different spatial scales in the headwaters and mainstem areas. Redundancy analysis and multiple linear regression were used to identify the optimal scales of land use for influencing and predicting water quality. Nitrogen and organic carbon parameters were more influenced by land use than phosphorus. The impact of land use on river water quality varied according to regional and seasonal differences. Water quality in headwater streams was better influenced and predicted by land use types on the natural surface at the smaller buffer zone scale, while water quality in mainstream rivers was better influenced and predicted by land use types associated with human activities at the larger catchment or sub-catchment scale. The impact of natural land use types on water quality differed with regional and seasonal variations, while the impact of land types associated with human activities on water quality parameters mainly resulted in elevated concentrations. The results of this study suggested that different land types and spatial scales needed to be considered to assess water quality influences in different areas of alpine rivers in the context of future global change.

A breast cancer classification and immune landscape analysis based on cancer stem-cell-related risk panel.

This study sought to identify molecular subtypes of breast cancer (BC) and develop a breast cancer stem cells (BCSCs)-related gene risk score for predicting prognosis and assessing the potential for immunotherapy. Unsupervised clustering based on prognostic BCSC genes was used to determine BC molecular subtypes. Core genes of BC subtypes identified by non-negative matrix factorization algorithm (NMF) were screened using weighted gene co-expression network analysis (WGCNA). A risk model based on prognostic BCSC genes was constructed using machine learning as well as LASSO regression and multivariate Cox regression. The tumor microenvironment and immune infiltration were analyzed using ESTIMATE and CIBERSORT, respectively. A CD79A+CD24-PANCK+-BCSC subpopulation was identified and its spatial relationship with microenvironmental immune response state was evaluated by multiplexed quantitative immunofluorescence (QIF) and TissueFAXS Cytometry. We identified two distinct molecular subtypes, with Cluster 1 displaying better prognosis and enhanced immune response. The constructed risk model involving ten BCSC genes could effectively stratify patients into subgroups with different survival, immune cell abundance, and response to immunotherapy. In subsequent QIF validation involving 267 patients, we demonstrated the existence of CD79A+CD24-PANCK+-BCSC in BC tissues and revealed that this BCSC subtype located close to exhausted CD8+FOXP3+ T cells. Furthermore, both the densities of CD79A+CD24-PANCK+-BCSCs and CD8+FOXP3+T cells were positively correlated with poor survival. These findings highlight the importance of BCSCs in prognosis and reshaping the immune microenvironment, which may provide an option to improve outcomes for patients.

Horizontal transport of macro- and microplastics on soil surface by rainfall induced surface runoff as affected by vegetations.

Surface runoff is considered as an important pathway that transport of plastic waste from terrestrial environment into the aquatic environment but the process is still poorly understood. In this work, runoff plot experiment was carried out to study the horizontal transport of macro- and microplastics between 50 mm and 0.25 mm in size on the soil surface by rain induced runoff. The influences of vegetation cover, characteristics of plastics, and rainfall scenarios were investigated. Results showed that the presence of vegetation significantly enhance the retention of plastics by about 20% under the experimental conditions. Lower density and smaller (<1 mm) plastics were found to have higher mobility. The herb plant (Photinia×fraseri Dress) showed a better interception efficiency on plastics than the shrub plant (Ophiopogon japonicus (Linn. f.) Ker-Gawl.) at the same planting density, while increasing plant density contributed litter to the interception of microplastics. Increase rainfall amount from 20 mm to 60 mm enhanced the transport of plastics while repeating 20 mm rainfall every 3 days did not affect the transport of plastics significantly. The same processes may involve in the transport of plastics and soil particles by rainfall induced surface runoff. Strategies controlling soil erosion could also be used to prevent plastics in soil from entering the aquatic environment. However, effects and risks of plastics retained in the soil are still unclear, which need to be investigated in future.

Urban natural wetland as a sink for microplastics: A case from Lalu Wetland in Tibet, China.

Microplastics have been reported in a wide range of aquatic habitats. The wetlands are considered to be important roles in microplastic migration in water bodies. Nevertheless, knowledge about the occurrence and fate of microplastics in urban natural wetland is still limited for us to better understand how they become a sink of microplastics. In this study, the distribution and characteristics of microplastics in surface water, surface sediments, and sediment cores of the Lalu Wetland watershed, China's highest urban wetland, were investigated in August 2020 and January 2021. The abundances of microplastics in the surface water were 0.06-3.05 MPs/L. Microplastic abundance in the surface sediment and sediment core was 0.01-1.10 MPs/g and 0-16.23 MPs/g, respectively. The abundance of microplastics in the water was significantly lower in the wetland than that in the channel in the watershed. Comparing the wetland inlet and outlet water, the microplastic interception rates were 53% in January and 95% in August. The characteristics and seasonal variation of microplastics in the Lalu Wetland implied that urban natural wetlands were good at intercepting microplastics, and vegetation growth might play an important role on the interception of microplastics by the wetland. The increasing of microplastics from bottom to top in the sediment cores of Lalu Wetland also indicated that the ecological risks of microplastics accumulation in sediments of urban natural wetland required further attention.

Informal landfill contributes to the pollution of microplastics in the surrounding environment.

A large amount of plastic waste is generated yearly worldwide, and landfills are commonly used for the disposal of plastic waste. However, burying in landfill does not get rid of the plastic waste but leave the problem to the future. Previous works have showed that microplastics are presented in the landfill refuse and leachate, which might be potential sources of microplastics. In this work, characteristics of microplastic pollution in an informal landfill in South China were studied. Landfill refuse, underlying soil, leachate, and groundwater samples were collected from different sites within and around the landfill. Results show that microplastics in the landfill refuse and underlying soil varied from 590 to 103,080 items/kg and from 570 to 14,200 items/kg, respectively. Most of the microplastics are fibrous, small sized, and transparent. Polyethylene (PE), polypropylene (PP), and polyethylene terephthalate (PET) are major polymer types. Scanning electron microscope (SEM) images and Fourier Transform Infrared (FTIR) spectra of the microplastic samples indicate varying degree of weathering. Microplastic abundances in the landfill leachate and groundwater ranged from 3 to 25 items/L and from 11 to 17 items/L, respectively. Microplastics detected in the landfill leachate and groundwater are even smaller compared with those in the refuse and underlying soil and their polymer types are more diverse. This work demonstrated that microplastics presented in an informal landfill without sufficient protection can leak out to the surrounding environment. The microplastic pollution originated from informal landfills should receive more attentions.

Risk factors of postoperative delirium after cardiac surgery: a meta-analysis.

BACKGROUND: Postoperative delirium is a frequent event after cardiac surgery. This meta-analysis aimed to identify relevant risk factors. METHOD: In this meta-analysis, all original researches regarding patients undergoing mixed types of cardiac surgery (excluding transcatheter procedures) and postoperative delirium were evaluated for inclusion. On July 28th 2020, we searched PubMed, Embase, Web of Science and Scopus. Data about name of first author, year of publication, inclusion and exclusion criteria, research design, setting, method of delirium assessment, incidence of delirium, odds ratio (OR) and corresponding 95% confidence interval (CI) of risk factors, and other information relevant was collected. OR and 95% CI were used as metrics for summarized results. Random effects model was applied. RESULTS: Fourteen reports were included with a total sample size of 13,286. The incidence of delirium ranged from 4.1 to 54.9%. Eight risk factors were identified including aging, diabetes, preoperative depression, mild cognitive impairment, carotid artery stenosis, NYHA functional class III or IV, time of mechanical ventilation and length of intensive care unit stay. CONCLUSION: In this study several risk factors associated with postoperative delirium after cardiac surgery were identified. Utilizing the information may allow us to identifying patients at high risk of developing postoperative delirium prior to delirium onset.

Transport and fate of microplastics in constructed wetlands: A microcosm study.

Constructed wetlands (CWs) are commonly used for the treatment of wastewater. However, the removal of microplastics in CWs are poorly understood. In this work, the fate and behavior of microplastics of different shapes (film, fragment, and fiber) and sizes (0.5-1 mm and 2-4 mm) were studied. Results showed that the microplastic removal rate was 81.63% in surface flow constructed wetlands (SF-CWs) and 100% in horizontal subsurface flow constructed wetlands (HSF-CWs). Fragments and fibers with 2-4 mm sizes flowed out preferentially from SF-CWs. Retained microplastics accumulated dominantly near the inlet area. Biofilm attachment and physical filtration played an important role in the retention of microplastics. The microplastics' morphological features and the apertures of the substrate related to the transport of microplastics in the substrate. We observed the formation of holes, cracks, and weeny fibers on the surface of the microplastics extracted from the microcosms with a scanning electron microscope (SEM), but we detected no oxidation based on the Fourier transform infrared spectra. Our results suggest that CWs, especially HSF-CWs, are efficient for the removal of microplastic pollution. However, microplastics are persistent in CWs. The potential impacts of microplastics on the function of CWs should be further assessed.