Ferumoxytol-enhanced MR venography for mapping lower-extremity venous networks and evaluating varicose veins in patients with diabetes.

OBJECTIVES: Comprehensive evaluation of lower-extremity varicose veins (VVs) in patients with diabetes is crucial for treatment strategizing. The study aims to assess the feasibility of using ferumoxytol-enhanced MR venography (FE-MRV) for lower-extremity venous mapping and the detection of VVs in patients with diabetes. MATERIALS AND METHODS: As part of a phase II clinical trial of a generic brand of ferumoxytol, documented patients with diabetes were enrolled and underwent FE-MRV on a 3-Τ MRI system. Two observers assessed FE-MRV images for image quality, signal intensity ratio (SIR), perforator (PV) diameter, and luminal signal uniformity in deep-to-superficial venous networks with the assessment of intra- and inter-rater reliability. FE-MRV was used to detect lower-extremity VVs. RESULTS: Eleven patients underwent FE-MRV without adverse events. The average image quality, as scored by the two observers who assessed 275 venous segments, was 3.4 ± 0.6. Two observers strongly agreed on image quality (κ = 0.90) and SIR measurements (interclass correlation coefficient [ICC]: 0.72) and had good agreement on PV diameter (ICC: 0.64). FE-MRV revealed uniform luminal signals in deep and saphenous venous networks (0.13 ± 0.05 vs 0.08 ± 0.03). Below-knee segments exhibited a significantly higher heterogeneity index than above-knee (p = 0.039) segments. Superficial VVs were observed in 55% (12/22) of legs in 64% (7/11) of patients. Calf muscle VVs were present in 64% (14/22) of legs in 9 patients. CONCLUSION: FE-MRV safely and robustly mapped entire lower-extremity venous networks, enabling the detection and pre-treatment evaluation of both superficial, and deep VVs in patients with diabetes. CLINICAL RELEVANCE STATEMENT: Ferumoxytol-enhanced magnetic resonance venography offers a "one-stop" imaging strategy for the detection and pre-operative evaluation of both superficial and deep VVs in diabetic patients. KEY POINTS: Diabetic patients with VVs are at a higher risk of ulcer-related complications. FE-MRV allowed rapid and comprehensive visualization of the lower-limb venous networks and abdominopelvic veins in diabetic patients. This technique allowed for the detection of superficial and deep VVs in diabetic patients before the development of severe peripheral artery disease.

The freeze-avoiding mountain pine beetle (Dendroctonus ponderosae) survives prolonged exposure to stressful cold by mitigating ionoregulatory collapse.

Insect performance is linked to environmental temperature, and surviving through winter represents a key challenge for temperate, alpine and polar species. To overwinter, insects have adapted a range of strategies to become truly cold hardy. However, although the mechanisms underlying the ability to avoid or tolerate freezing have been well studied, little attention has been given to the challenge of maintaining ion homeostasis at frigid temperatures in these species, despite this limiting cold tolerance for insects susceptible to mild chilling. Here, we investigated how prolonged exposure to temperatures just above the supercooling point affects ion balance in freeze-avoidant mountain pine beetle (Dendroctonus ponderosae) larvae in autumn, mid-winter and spring, and related it to organismal recovery times and survival. Hemolymph ion balance was gradually disrupted during the first day of exposure, characterized by hyperkalemia and hyponatremia, after which a plateau was reached and maintained for the rest of the 7-day experiment. The degree of ionoregulatory collapse correlated strongly with recovery times, which followed a similar asymptotical progression. Mortality increased slightly during extensive cold exposures, where hemolymph K+ concentration was highest, and a sigmoidal relationship was found between survival and hyperkalemia. Thus, the cold tolerance of the freeze-avoiding larvae of D. ponderosae appears limited by the ability to prevent ionoregulatory collapse in a manner similar to that of chill-susceptible insects, albeit at much lower temperatures. Based on these results, we propose that a prerequisite for the evolution of insect freeze avoidance may be a convergent or ancestral ability to maintain ion homeostasis during extreme cold stress.

Uptake, tissue distribution, and biotransformation pattern of triclosan in tilapia exposed to environmentally-relevant concentrations.

Although triclosan has been ubiquitously detected in aquatic environment and is known to have various adverse effects to fish, details on its uptake, bioconcentration, and elimination in fish tissues are still limited. This study investigated the uptake and elimination toxicokinetics, bioconcentration, and biotransformation potential of triclosan in Nile tilapia (Oreochromis niloticus) exposed to environmentally-relevant concentrations under semi-static regimes for 7 days. For toxicokinetics, triclosan reached a plateau concentration within 5-days of exposure, and decreased to stable concentration within 5 days of elimination. Approximately 50 % of triclosan was excreted by fish through feces, and up to 29 % of triclosan was excreted through the biliary excretion. For fish exposed to 200 ng·L-1, 2000 ng·L-1, and 20,000 ng·L-1, the bioconcentration factors (log BCFs) of triclosan in fish tissues obeyed similar order: bile ≈ intestine > gonad ≈ stomach > liver > kidney ≈ gill > skin ≈ plasma > brain > muscle. The log BCFs of triclosan in fish tissues are approximately maintained constants, no matter what triclosan concentrations in exposure water. Seven biotransformation products of triclosan, involved in both phase I and phase II metabolism, were identified in this study, which were produced through hydroxylation, bond cleavages, dichlorination, and sulfation pathways. Metabolite of triclosan-O-sulfate was detected in all tissues of tilapia, and more toxic product of 2,4-dichlorophenol was also found in intestine, gonad, and bile of tilapia. Meanwhile, two metabolites of 2,4-dichlorophenol-O-sulfate and monohydroxy-triclosan-O-sulfate were firstly discovered in the skin, liver, gill, intestine, gonad, and bile of tilapia in this study. These findings highlight the importance of considering triclosan biotransformation products in ecological assessment. They also provide a scientific basis for health risk evaluation of triclosan to humans, who are associated with dietary exposure through ingesting fish.

In vitro metabolism of the emerging contaminant 6PPD-quinone in human and rat liver microsomes: Kinetics, pathways, and mechanism.

N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine-quinone (6PPD-Q) is an ozonation product of the rubber antioxidant N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine (6PPD). 6PPD-Q has recently been detected in various environmental media, which may enter the human body via inhalation and skin contact pathways. However, the human metabolism of 6PPD-Q has remained unknown. This study investigated the in vitro Cytochrome P450-mediated metabolism of 6PPD-Q in human and rat liver microsomes (HLMs and RLMs). 6PPD-Q was significantly metabolized at lower concentrations but slowed at high concentrations. The intrinsic clearance (CLint) of 6PPD-Q was 21.10 and 18.58 µL min-1 mg-1 protein of HLMs and RLMs, respectively, suggesting low metabolic ability compared with other reported pollutants. Seven metabolites and one intermediate were identified, and metabolites were predicted immunotoxic or mutagenic toxicity. Mono- and di-oxygenation reactions were the main phase I in vitro metabolic pathways. Enzyme inhibition experiments and molecular docking techniques were further used to reveal the metabolic mechanism. CYP1A2, 3A4, and 2C19, especially CYP1A2, play critical roles in 6PPD-Q metabolism in HLMs, whereas 6PPD-Q is extensively metabolized in RLMs. Our study is the first to demonstrate the in vitro metabolic profile of 6PPD-Q in HLMs and RLMs. The results will significantly contribute to future human health management targeting the emerging pollutant 6PPD-Q.

Pericarotid adipose tissue computed tomography attenuation distinguishes different stages of carotid atherosclerotic disease: a cross-sectional study.

Background: Carotid atherosclerotic plaque inflammation plays a critical role in guiding the prevention of secondary stroke. Increased perivascular adipose tissue attenuation observed on computed tomography angiography (CTA) may indicate local inflammation. Our objective was to investigate whether pericarotid adipose tissue (PCAT), as a local inflammation biomarker, could distinguish between different stages of carotid atherosclerotic disease plaques. Methods: We prospectively enrolled 45 consecutive acute stroke patients with carotid artery stenosis from September 2019 to September 2021. We then matched them to non-stroke patients (n=67) and no carotid atherosclerotic disease controls (n=65) based on gender, age, and cardiovascular risk factors. We compared PCAT attenuation, carotid plaque features on CTA, clinical risk factors, and serum inflammatory factors across the different groups. To detect the association of PCAT attenuation with stage of carotid atherosclerotic disease, we used multivariable logistic regression analysis. Results: Patients with acute stroke had a higher PCAT attenuation (-78.80±11.62 HU) than patients with non-stroke (-89.01±10.81 HU, P<0.001) and no carotid atherosclerotic disease controls (-95.24±10.81 HU, P<0.001). PCAT attenuation was significantly increased in non-stroke patients compared to non-stroke patients over no carotid atherosclerotic disease controls (P=0.004). The association between PCAT attenuation and the stage of carotid atherosclerotic disease was independent of age, gender, cardiovascular risk factors, and CTA plaque characteristics. No interaction was observed between clinical features and CTA plaque characteristics on PCAT attenuation. Conclusions: PCAT attenuation, which is an imaging biomarker of local inflammation, independently distinguishes patients with different stages of carotid atherosclerotic disease. Quantitative evaluation of PCAT attenuation in carotid atherosclerotic disease is expected to guide targeted surgical treatment of carotid plaque.

Adsorption and Sensing Performances of a TiO2 Cluster-Doped Graphene Monolayer toward SOF2 and SO2F2.

Due to the high surface activity of metal atoms, it is difficult for doped metals to maintain long-term stability. Compared with other metal oxides, TiO2 graphene sensors have a higher sensing response and a larger specific surface area. However, there is currently no literature comparing and analyzing the effect of graphene-doped TiO2 on the adsorption performance of SF6 decomposition components. Therefore, this article investigated the adsorption performance of SF6 decomposition products: the distribution of SOF2 and SO2F2 on nTiO2 (n = 1,2,3)-doped graphene. In order to explore the interaction mechanism between gas molecules and these modified systems, their Eads, charge transfer, DOS, and PDOS were systematically studied. The doping of nTiO2 significantly improves the adsorption ability of graphene to gas molecules, discovers and enriches the online monitoring methods of GIS, and improves the engineering application value of GIS.

High systemic inflammation response index level is associated with an increased risk of lower extremity deep venous thrombosis: a large retrospective study.

BACKGROUND: The association between inflammation and venous thromboembolism (VTE) has attracted increasing research interest. Recently, the systemic inflammation response index (SIRI) has been proposed as a novel inflammatory biomarker, but its potential association with lower extremity deep venous thrombosis (LEDVT) has not been investigated. Thus, this study aimed to explore the association between SIRI and LEDVT risk in a large sample over a 10-year period (2012-2022). METHODS: All hospitalized patients who underwent lower extremity compression ultrasonography (CUS) examinations were consecutively identified from our hospital information system database. Multivariate logistic regression analysis was used to investigate the association between SIRI and LEDVT risk. Sensitivity, restricted cubic spline and subgroup analyses were also performed. RESULTS: In total, 12643 patients were included, and 1346 (10.6%) LEDVT events occurred. After full adjustment, a higher SIRI level was significantly associated with an increased risk of LEDVT (odds ratio [OR] = 1.098, 95% confidence interval [CI]: 1.068-1.128, p < 0.001), and patients in quartile 4 had a 2.563-fold higher risk of LEDVT than those in quartile 1 (95% CI: 2.064-3.182, p < 0.001). A nonlinear relationship was observed (P for nonlinearity < 0.001), with an inflection point of 4.17. Below this point, each unit increase in SIRI corresponded to a 35.3% increase in LEDVT risk (95% CI: 1.255-1.458, p < 0.001). No significant difference was found above the inflection point (OR = 1.015, 95% CI: 0.963-1.069, p = 0.582). Sensitivity and subgroup analyses confirmed the robustness of the association. This association also existed in both distal and proximal LEDVT. CONCLUSION: A High SIRI is significantly associated with an increased risk of LEDVT in hospitalized patients. Given that the SIRI is a readily available biomarker in clinical settings, its potential clinical use deserves further exploration.

A High SIRI is significantly associated with an increased risk of LEDVT in hospitalized patients.The association between SIRI and LEDVT risk was nonlinear, with an inflection point of 4.17.A positive association was observed below the inflection point, but no significant difference was found above this point.

Association between systemic immune-inflammation index and risk of lower extremity deep venous thrombosis in hospitalized patients: a 10-year retrospective analysis.

Background: The systemic immune-inflammation index (SII), as a novel inflammatory biomarker, has recently attracted attention in cardiovascular disease research. However, the relationship between SII and risk of lower extremity deep venous thrombosis (LEDVT) remains unclear to date. Thus, this study aimed to explore the association in a large sample over a 10-year period (2012-2022). Methods: All hospitalized patients undergoing lower extremity compression ultrasonography (CUS) examination were consecutively screened by searching our hospital information system database. The receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value for high and low SII group. Multivariate logistic regression analyses were performed to investigate the relationship between SII and LEDVT risk. Propensity score matching (PSM), subgroup and sensitivity analyses were also conducted. Moreover, restricted cubic spline (RCS) regression and two-piecewise linear regression models were used to assess the dose-response relationship between natural log transformed SII [ln(SII)] and risk of LEDVT. Results: A total of 16,725 consecutive hospitalized patients were included, and 1,962 LEDVT events occurred. After adjusting for confounding factors, patients in the high SII group (≥ 574.2 × 109/L) showed a 1.740-fold risk of LEDVT (95% CI: 1.546-1.959, P < 0.001), and elevated ln(SII) was associated with a 36.1% increased risk of LEDVT (95% CI: 1.278-1.449, P < 0.001). PSM, subgroup and sensitivity analyses confirmed the robustness of the association. A non-linear relationship was observed (P non-linear < 0.001), with a threshold value of 5.6 × 109/L for all LEDVT events. Above the threshold, each unit increase in ln(SII) had a 1.369-fold higher risk of LEDVT (95% CI: 1.271-1.475, P < 0.001). The association also existed in both distal and proximal LEDVT. Conclusion: Elevated SII is significantly associated with an increased risk of LEDVT in hospitalized patients. Additionally, the association is non-linear and exhibit a threshold effect.

Anatomic distribution of lower extremity deep venous thrombosis is associated with an increased risk of pulmonary embolism: A 10-year retrospective analysis.

Aims: To investigate the potential relationship between anatomic distribution of lower extremity deep venous thrombosis (LEDVT) and pulmonary embolism (PE). Methods: A retrospective case-control study was performed in patients diagnosed with LEDVT, which were confirmed by bilateral lower extremity compression ultrasonography (CUS) examination. According to the ultrasound reports, thrombus sidedness was categorized as unilateral and bilateral lower extremity, thrombus location was classified into distal and proximal LEDVT. Anatomic distributions of LEDVT were further subdivided depending on the combination of thrombus sidedness and location. Patients with PE were identified using the International Classification of Diseases-10 (ICD-10) codes (I26.0 and I26.9), and divided into PE group and Non-PE group. Univariate and multivariate logistic regression analyses were used to assess the association between anatomic distribution of LEDVT and PE. Sensitivity analyses were also conducted. Results: A total of 2,363 consecutive patients with LEDVT were included, of whom 66.10% and 33.90% were unilateral and bilateral LEDVT, as well as 71.39% and 28.61% were isolated distal and proximal LEDVT, respectively. After the diagnosis of LEDVT, 185 patients (7.83%) developed PE. The proportions of PE ranged between the lowest (4.07%) in unilateral-distal LEDVT and highest (14.55%) in bilateral-proximal LEDVT. Multivariate logistic regression analysis showed that bilateral LEDVT (odds ratios [OR] = 2.455, 95% confidence interval [CI]: 1.803-3.344, P < 0.001) and proximal LEDVT (OR = 1.530, 95% CI: 1.105-2.118, P = 0.010) were risk factors for developing PE. Moreover, unilateral-proximal (OR = 2.129, 95% CI: 1.365-3.320, P = 0.00), bilateral-distal (OR = 3.193, 95% CI: 2.146-4.752, P < 0.001) and bilateral-proximal LEDVT(OR = 3.425, 95% CI: 2.093-5.603, P < 0.001) were significantly associated with an increased risk of PE. Sensitivity analyses also confirmed the robustness of these associations. Conclusion: Patients with unilateral-proximal, bilateral-distal or bilateral-proximal are more likely to suffer from PE than those with unilateral-distal LEDVT.

Efficacy and factors influencing outcomes of customized music therapy combined with a follow-up system in chronic tinnitus patients.

BACKGROUNDS: Tinnitus is a meaningless sound signal perceived by the patients in the absence of auditory stimuli. Due to the complex etiology and unclear mechanism, specific therapies for tinnitus are still in the exploratory stage. In recent years, personalized and customized music therapy has been proposed as an effective method for tinnitus treatment. The aim of this study was to explore the efficacy of customized therapy with a well-designed follow-up system in the treatment of tinnitus through a large sample one arm study and to identify the relevant factors affecting the treatment outcome. METHODS: The study investigated a total of 615 patients with unilateral or bilateral chronic tinnitus who received personalized and customized music therapy for 3 months. A complete follow-up system was designed by the professionals. Questionnaires of Tinnitus Handicap Inventory (THI), Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Scale (VAS) were used to evaluate the therapeutic effects and relevant factors affecting the efficacy of therapy. RESULTS: The results showed a decreasing trend in THI and VAS scores after 3 months of therapy, with statistically significant differences between pre- and post-therapy time points (P < 0.001). All patients were divided into 5 groups according to THI scores, and the mean reduction score in catastrophic, severe, moderate, mild and slight group was 28, 19, 11, 5, 0 respectively. The proportion of tinnitus patients with anxiety was higher than that with depression (70.57% and 40.65%, respectively), and there were statistically significant differences between HADS-A/D scores pre- and post-therapy. Binary logistic regression showed that the baseline of THI, VAS scores, the duration of tinnitus and the state of anxiety prior to therapy were significant influencing factors of therapeutic efficacy. CONCLUSIONS: The magnitude of reduction in THI scores after music therapy depended on the severity of the patients' tinnitus, the higher the initial THI scores, the greater the potential for improvement in tinnitus disorders. Music therapy also reduced the anxiety and depression levels of tinnitus patients. Therefore, personalized and customized music therapy with a comprehensive follow-up system may be an effective treatment option for chronic tinnitus patients.

Deep Learning Algorithm Enables Cerebral Venous Thrombosis Detection With Routine Brain Magnetic Resonance Imaging.

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease. Routine brain magnetic resonance imaging is commonly used to diagnose CVT. This study aimed to develop and evaluate a novel deep learning (DL) algorithm for detecting CVT using routine brain magnetic resonance imaging. METHODS: Routine brain magnetic resonance imaging, including T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images of patients suspected of CVT from April 2014 through December 2019 who were enrolled from a CVT registry, were collected. The images were divided into 2 data sets: a development set and a test set. Different DL algorithms were constructed in the development set using 5-fold cross-validation. Four radiologists with various levels of expertise independently read the images and performed diagnosis within the test set. The diagnostic performance on per-patient and per-segment diagnosis levels of the DL algorithms and radiologist's assessment were evaluated and compared. RESULTS: A total of 392 patients, including 294 patients with CVT (37±14 years, 151 women) and 98 patients without CVT (42±15 years, 65 women), were enrolled. Of these, 100 patients (50 CVT and 50 non-CVT) were randomly assigned to the test set, and the other 292 patients comprised the development set. In the test set, the optimal DL algorithm (multisequence multitask deep learning algorithm) achieved an area under the curve of 0.96, with a sensitivity of 96% (48/50) and a specificity of 88% (44/50) on per-patient diagnosis level, as well as a sensitivity of 88% (129/146) and a specificity of 80% (521/654) on per-segment diagnosis level. Compared with 4 radiologists, multisequence multitask deep learning algorithm showed higher sensitivity both on per-patient (all P<0.05) and per-segment diagnosis levels (all P<0.001). CONCLUSIONS: The CVT-detected DL algorithm herein improved diagnostic performance of routine brain magnetic resonance imaging, with high sensitivity and specificity, which provides a promising approach for detecting CVT.

Occurrence and risks of 23 tire additives and their transformation products in an urban water system.

Tire wear particles (TWPs) enter road surface with the friction between tires and road surfaces. Under the volatilization, leaching, and transformation action on TWPs by sunlight and rain, tire additives are released into urban water systems, such as surface rainfall runoff, wastewater treatment plants (WWTPs), receiving surface waters, and drinking water treatment plant (DWTP). In this study, we investigated the occurrence of 23 tire additives and their transformation products in the urban water system of the Pearl River Delta region, South China. Nineteen target compounds were detected in the surface runoff, with 1,3-Diphenylguanidine (DPG) showing highest maximum concentration of 58780 ng/L. Benzothiazole and its transformation products are detected at the frequency of 100 % with the total concentrations of 480-42160 ng/L. The antioxidant derivative N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine-quinone (6PPD-Q) was also detected up to 1562 ng/L, which was considerably higher than that of the parent compound 6PPD (the maximum concentration of 7.52 ng/L). Eleven and 8 compounds were detected in WWTPs influents and effluents, respectively, with removal rates of - 62-100 %. Seventeen compounds were detected in the receiving Zhujiang and Dongjiang rivers, while 9 compounds were detected in drinking water sources and DWTP samples. Road runoff, with total concentrations of target compounds up to 79200 ng/L, is suggested as the main non-point source for receiving rivers, while WWTPs effluents are the point sources due to incomplete removal of target compounds after accepting the initial runoff. 6PPD-Q and other 10 compounds displayed median to high ecological risks in surface waters, and the human daily intake of tire additives was estimated to be 2.63 × 10-8-3.16 × 10-5 mg/(kg d) via drinking water. This is the first report of the 6PPD-Q and 1,3-Diphenylurea levels in surface waters in China.

Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients.

Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It is associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department of cardiology, geriatric, and intensive care unit of hospital. With the increase in the aged population, further increases in delirium seem likely. However, it remains poorly recognized in the clinical practice. This article comprehensively discusses the latest research perspectives on the epidemiological data, risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium, including specific measures to manage delirium in clinical real-world situations. This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.

Schottky diodes based on blue phosphorene nanoribbon homojunctions.

Diodes have been widely studied as one of the most commonly used electronic components in circuits, and it is important to find diodes with an excellent rectification performance. Herein, we investigate the electronic and transport properties of Schottky contact diodes based on zigzag hydrogenated blue phosphorene nanoribbons, by employing density functional theory combined with the non-equilibrium Green's function. It is found that the adsorption of transition metal atoms Sc/Cr/Ti and Ni on the top site of blue phosphorene nanoribbons leads to metallic and semiconducting properties, respectively. Devices consisting of the planar contact of the metallic and semiconducting nanoribbons show rectifying behavior due to the Schottky barriers of the homojunctions. The current is preferential to flow from the semiconducting side to the metallic side. The rectification ratio of the Sc-Ni device and the Cr-Ni device can reach up to 108, which is much higher than that of traditional p-n junctions of about 105-107. The high rectification ratio at low bias regions, together with the low threshold voltages and negligible reverse currents, make blue phosphorene nanoribbon homojunctions ideal rectifier diodes.

The Widowhood Effect on Mortality in Older Patients with Hip Fracture.

Objective: Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture. Methods: Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted. Results: Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054-1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038-1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607-2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female. Conclusion: Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.

Enhanced prediction of internal concentrations of phenolic endocrine disrupting chemicals and their metabolites in fish by a physiologically based toxicokinetic incorporating metabolism (PBTK-MT) model.

Bisphenol A (BPA), 4-nonylphenol (4-NP), and triclosan (TCS) are phenolic endocrine disrupting chemicals (EDCs), which are widely detected in aquatic environments and further bioaccumulated and metabolized in fish. Physiologically based toxicokinetic (PBTK) models have been used to describe the absorption, distribution, metabolism, and excretion (ADME) of parent compounds in fish, whereas the metabolites are less explored. In this study, a PBTK incorporating metabolism (PBTK-MT) model for BPA, 4-NP, and TCS was established to enhance the performance of the traditional PBTK model. The PBTK-MT model comprised 16 compartments, showing great accuracy in predicting the internal concentrations of three compounds and their glucuronidated and sulfated conjugates in fish. The impact of typical hepatic metabolism on the PBTK-MT model was successfully resolved by optimizing the mechanism for deriving the partition coefficients between the blood and liver. The PBTK-MT model exhibited a potential data gap-filling capacity for unknown parameters through a backward extrapolation approach of parameters. Model sensitivity analysis suggested that only five parameters were sensitive in at least two PBTK-MT models, while most parameters were insensitive. The PBTK-MT model will contribute to a well understanding of the environmental behavior and risks of pollutants in aquatic biota.

Effects of Comorbidities on Pain and Function After Total Hip Arthroplasty.

Background: The growing number of patients undergoing total hip arthroplasty (THA) and postoperative outcomes receive increasing attention from doctors and patients. This study aimed to elucidate the effects of comorbidities on postoperative function, pain, complications, readmission rate, and mortality. Methods: We included consecutive patients who underwent primary unilateral THA between 2017 and 2019. The Charlson comorbidity index (CCI) and the WOMAC and SF-36 (physical function, body pain) scales were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. The complications, 30-day readmission, and mortality rates assessed the impact of comorbidities and their changes over time on the WOMAC and SF-36 scores during follow-up. We used mixed model linear regression to examine the association of worsening comorbidity post-THA with change in WOMAC and SF-36 scores in the subsequent follow-up periods, controlling for age, length of follow-up, and repeated observations. Results: This study included 468 patients, divided into four groups based on comorbidity burden (CCI-0, 1, 2, and ≥3). The physiological function recovery and pain scores in the CCI ≥ 3 group were inferior to the other groups and took longer than the other groups (6 vs. 3 months) to reach their best level. The four groups preoperative waiting times were 2.41 ± 0.74, 2.97 ± 0.65, 3.80 ± 0.53, and 5.01 ± 0.71 days, respectively. The complications, 30-day readmission, and 1-year mortality rates for the overall and the CCI ≥ 3 group were 1.92% and 4.69%, 0.85% and 2.01%, and 0.43% and 1.34%, respectively, with no mortality in the other groups. Conclusion: Patients with higher CCI were more susceptible to physical function and pain outcome deterioration, experienced longer waiting time before surgery, took longer to recover, and had higher rates of complications, 30-day readmission, and mortality after THA. Older age in the group led to a greater impact.

Association Between Monocyte Count and Preoperative Deep Venous Thrombosis in Older Patients with hip Fracture: A Retrospective Study.

PURPOSE: To analyze the relationship between monocyte count and preoperative deep venous thrombosis (DVT) in older patients with hip fracture. METHODS: Consecutive older patients with hip fracture undergoing surgery were included from January 2014 to December 2021. Monocyte count was measured on admission, and Doppler ultrasonography was performed for DVT screening prior to surgery. Univariate and multivariate logistic regression analyses were used to assess the association between monocyte count and DVT. RESULTS: A total of 674 patients were finally included, and 128 patients (19.0%) were diagnosed with preoperative DVT. Patients with DVT exhibited a higher monocyte count than patients without DVT [0.55 (0.43-0.72) × 109/L versus 0.49 (0.38-0.63) × 109/L, P = 0.007]. Multivariate logistic regression analysis showed that a high monocyte count (> 0.6 × 109/L) was independently associated with a higher risk of DVT (OR = 1.705, 95% CI: 1.121-2.593, P = 0.013), and for every 0.1 × 109/L increase in monocyte count, the risk of DVT increased by 8.5% (OR = 1.085, 95% CI: 1.003-1.174, P = 0.041). Other risk factors associated with DVT included intertrochanteric fracture (OR = 1.596, 95% CI: 1.022-2.492, P = 0.040), and elevated fibrinogen level (OR = 1.236, 95% CI: 1.029-1.484, P = 0.023). CONCLUSION: A high monocyte count is associated with an increased risk of DVT in older patients with hip fracture. Future studies should evaluate the potential role of monocyte in the prevention and treatment of thrombosis.

Influence of microplastics on triclosan bioaccumulation and metabolomics variation in Tilapia fish tissues.

Microplastics (MPs) and chemical pollutants usually coexist in aquatic environments. The bioaccumulation and metabolism of pollutants in aquatic organisms can be influenced by MPs. In this study, the bioaccumulation of triclosan (TCS) in tilapia tissues was determined, and metabolomics in the liver, gills, and gut were investigated after 10-day exposure to micro-sized polystyrene (PS) and TCS in water. The results showed that TCS bioaccumulated in various tissues, with the highest average concentration of 2728 ± 577 ng g-1 in the gut. The log bioaccumulation factors (BAFs) for TCS in these tissues were in the range of 0.99-3.56. Compared to the TCS treatment alone, MPs showed enhancement on the bioaccumulation of TCS in tilapia skin, liver, gut, gills, and stomach tissues in the TCS plus MP exposure. Especially in the skin and liver, the TCS concentrations were up to 2.06 and 1.38 times higher in the co-exposure of TCS and MPs, respectively. Based on the metabolomic analysis, MPs mainly disturbed the lipid and energy metabolism in tilapia fish. The altered metabolites between treatment with TCS alone and TCS + MPs were consistent, indicating that TCS has stronger disturbance in lipid and energy metabolism than MPs. This implies that the metabolism influence by the mixture of MPs and compounds is complicated in fish tissues.

[Effect of preoperative waiting time on prognosis of elderly patients with hip fracture].

OBJECTIVE: To investigate the relationship between preoperative waiting time and prognosis of elderly patients with hip fracture. METHODS: From January 2014 to December 2018, 333 elderly hip fracture patients undergoing surgery were retrospectively analyzed, including 104 males and 229 females, aged from 60 to 99 years with an average of (77.93±8.49) years, and 183 patients were femoral neck fracture, 150 patients were femoral intertrochanteric fracture. Among them, 269 patients (80.78%) had a clustered preoperative waiting time of 2 to 8 days, and then divided into within 4-day group(91 cases) and over 4-day group(242 cases) according to their preoperative waiting time. The survival situation was followed by telephone, and follow-up time started from fracture admission to the death event, or to the research deadline (December 31, 2019). The Kaplan-Meier method was used for survival analysis, and Cox risk proportion model was used to analyze the independent risk factors of hip fracture in elderly patients. RESULTS: All patients were followed up for 12 to 75 months(means 35 months), 59 patients died and the mortality rate was 17.72%(59/333). Compared with within 4-day group, the mortality rate was higher in over 4-day group[20.66%(50/242) vs. 9.89%(9/91), χ2=5.263, P=0.022]. Multiariable Cox regression analysis showed that preoperative waiting time, age, male and Charlson comorbidity index were independent risk factors for the prognosis of hip fracture in elderly patients (all P<0.05), and every 1-day delay was associated with 5% increase of the risk of death[HR=1.05, 95%CI(1.00-1.10), P=0.045]. Subsequent analyse was stratified according to the Charlson comorbidity index (CCI), and found that over 4-day group had a higher mortality rate in patients with CCI<2, with statistically significant difference(P<0.05). CONCLUSION: For elderly patients with hip fracture, most of hospitals could not complete the hip fracture surgery within 48 hours, we also need to shorten the waiting time before surgery, and thereby improve their prognosis.