Explore the Relationship Between Short-Term Ambient Air Pollution Exposure and Daily Outpatient Visits for Metabolic Related Fatty Liver.

Background: Many studies have shown that the pollution of fine particles in the air is related to the incidence of chronic diseases. However, research on air pollution and metabolism-associated fatty liver disease (MAFLD) is limited. Objective: The purpose of this study was to explore the relationship between short-term ambient air pollution and daily outpatient visits for metabolic-related fatty liver. Methods: We used a quasi-Poisson regression generalized additive model to stratify analyses by season, age, and gender. Results: From January 1, 2017, to August 31, 2019, 10,562 confirmed MAFLD outpatient visits were recorded. A 10 µg/m3 increase of fine particular matter (PM10and PM2.5) and NO2 concentrations corresponding with percent change were 0.82 (95% confidence interval [CI], 0.49-1.15), 0.57 (95% CI, 0.18-0.98), and 0.86 (95% CI, 0.59-1.13) elevation in MAFLD outpatient visits. In terms of season, the impact estimates of NO2 and PM2.5% change were 3.55 (95% CI, 1.23-5.87) and 1.12 (95% CI, 0.78-1.46) in the hot season and transition season, respectively. Compared with the warm season, the impact estimates of PM10were more significant in the cool season: 2.88 (95% CI, 0.66-5.10). NO2 has the greatest effect in the transition season, whereas PM10 has the greatest highest effect in the cool and hot seasons. Compared with other pollutants, PM2.5 has the greatest impact in the age stratification, which percent change are 2.69 (95% CI, 0.77-5.61) and 2.88 (95% CI, 0.37-6.40) respectively. The impact values of PM2.5 in male and female percent change were 3.60 (95% CI, 0.63-6.57) and 1.65 (95% CI, 1.05-2.25), respectively. Conclusion: This study shows that the air pollutants are related to the number of outpatient visits for MAFLD. The effects of different air pollutants on MAFLD outpatient visits were different by season, ages, and gender.

Exploring the impact of the COVID-19 epidemic on the medical emergency calls and calls for cardiovascular diseases in Hangzhou, China.

AIMS: We aimed to evaluate the impact of the COVID-19 epidemic on emergency and cardiovascular disease-related calls in Hangzhou, China. METHODS: We conducted a single-center retrospective study, collecting data on emergency calls to the Hangzhou Emergency Center (HEC) during the COVID-19 epidemic (January 20, 2020, to March 15, 2020). Data were compared with the same period in 2019. RESULTS: Compared to 2019, the number of emergency calls has dropped by 21.63%, ambulance calls by 29.02%, rescue calls by 22.57%, and cardiovascular disease-related emergency calls by 32.86%. The numbers of emergency, ambulance, and rescue calls in 2020 were significantly lower than in 2019. CONCLUSIONS: During the COVID-19 epidemic in Hangzhou, the numbers of emergency and cardiovascular disease-related calls have decreased significantly. These results point to a severe social problem that requires the attention of the medical community and the government.

Screening the Influence of Biomarkers for Metabolic Syndrome in Occupational Population Based on the Lasso Algorithm.

Aim: Metabolic syndrome (MS) screening is essential for the early detection of the occupational population. This study aimed to screen out biomarkers related to MS and establish a risk assessment and prediction model for the routine physical examination of an occupational population. Methods: The least absolute shrinkage and selection operator (Lasso) regression algorithm of machine learning was used to screen biomarkers related to MS. Then, the accuracy of the logistic regression model was further verified based on the Lasso regression algorithm. The areas under the receiving operating characteristic curves were used to evaluate the selection accuracy of biomarkers in identifying MS subjects with risk. The screened biomarkers were used to establish a logistic regression model and calculate the odds ratio (OR) of the corresponding biomarkers. A nomogram risk prediction model was established based on the selected biomarkers, and the consistency index (C-index) and calibration curve were derived. Results: A total of 2,844 occupational workers were included, and 10 biomarkers related to MS were screened. The number of non-MS cases was 2,189 and that of MS was 655. The area under the curve (AUC) value for non-Lasso and Lasso logistic regression was 0.652 and 0.907, respectively. The established risk assessment model revealed that the main risk biomarkers were absolute basophil count (OR: 3.38, CI:1.05-6.85), platelet packed volume (OR: 2.63, CI:2.31-3.79), leukocyte count (OR: 2.01, CI:1.79-2.19), red blood cell count (OR: 1.99, CI:1.80-2.71), and alanine aminotransferase level (OR: 1.53, CI:1.12-1.98). Furthermore, favorable results with C-indexes (0.840) and calibration curves closer to ideal curves indicated the accurate predictive ability of this nomogram. Conclusions: The risk assessment model based on the Lasso logistic regression algorithm helped identify MS with high accuracy in physically examining an occupational population.

COVID-19 Vaccination Acceptance Among Healthcare Workers and Non-healthcare Workers in China: A Survey.

Background: The coronavirus pneumonia is still spreading around the world. Much progress has been made in vaccine development, and vaccination will become an inevitable trend in the fight against this pandemic. However, the public acceptance of COVID-19 vaccination still remains uncertain. Methods: An anonymous questionnaire was used in Wen Juan Xing survey platform. All the respondents were divided into healthcare workers and non-healthcare workers. Multinomial logistic regression analyses were performed to identify the key sociodemographic, cognitive, and attitude associations among the samples of healthcare workers and non-healthcare workers. Results: A total of 2,580 respondents completed the questionnaire, including 1,329 healthcare workers and 1,251 non-healthcare workers. This study showed that 76.98% of healthcare workers accepted the COVID-19 vaccine, 18.28% workers were hesitant, and 4.74% workers were resistant. Among the non-healthcare workers, 56.19% workers received the COVID-19 vaccine, 37.57% workers were hesitant, and 6.24% workers were resistant. Among the healthcare workers, compared with vaccine recipients, vaccine-hesitant individuals were more likely to be female (AOR = 1.52, 95% CI: 1.12-2.07); vaccine-resistant individuals were more likely to live in the suburbs (AOR = 2.81, 95% CI: 1.44-3.99) with an income of 10,000 RMB or greater (AOR = 2.00, 95% CI: 1.03-3.90). Among the non-healthcare workers, vaccine-hesitant individuals were more likely to be female (AOR = 1.66, 95% CI: 1.31-2.11); vaccine-resistant individuals were also more likely to be female (AOR = 1.87, 95% CI: 1.16-3.02) and older than 65 years (AOR = 4.96, 95% CI: 1.40-7.62). There are great differences between healthcare workers and non-healthcare workers in their cognition and attitude toward vaccines. Conclusions: Our study shows that healthcare workers are more willing to be vaccinated than non-healthcare workers. Current vaccine safety issues continue to be a major factor affecting public acceptance, and to expand vaccine coverage in response to the COVID-19 pandemic, appropriate vaccination strategies and immunization programs are essential, especially for non-healthcare workers.

The Dilemma of Masks During the COVID-19 Outbreak.

BACKGROUND: Many people have experienced novel coronavirus pneumonia since the beginning of the COVID-19 pandemic in Wuhan, China. The Chinese government has encouraged people to wear face masks in public places; however, due to the large population, there may be a series of problems related to this recommendation, including shortages of masks and lack of an optimal disposal method for used masks. OBJECTIVE: The purpose of this study is to understand the current status of mask shortages and used masks in China. METHODS: A questionnaire survey was designed to assess the current status of mask shortages and used masks. The differences among groups were analyzed with chi-square tests. RESULTS: The constituent ratio of those who reuse masks was 61%. Obtaining masks from the drugstore was reported to be very difficult due to high demand and short supply, and approximately 1/3 of the respondents purchased expensive masks. Most people know how to properly handle used masks, and only 7% of them casually discard masks. However, 50% of respondents have seen others throw away used masks at will. A further subgroup analysis showed that respondents in Central China tended to use masks repeatedly, as did medical personnel. Females, people living in the central region, and medical personnel may find it more difficult to purchase masks in drugstores. Non-medical personnel may be more likely to buy expensive masks. Females, people living in the western region, and medical personnel may be more likely to know how to properly handle used masks and not to discard used masks at will. Medical personnel may be more likely to observe others discarding used masks at will. CONCLUSION: In response to COVID-19, the public should be encouraged to use face masks and are advised not to reuse or throw away masks at will due to safety concerns.

Air quality and the COVID-19 outbreak in China

We appreciate that Urrutia-Pereira M., et al. have reported on "COVID-19 and air pol­lution: A dangerous association."1 Research on the role of air pollution in the spread of SARS-CoV-2 is worth discussing. Air pollution refers to harmful substances that are carried in the air. When the quantity or proportion of the pollutants reaches or exceeds the environmental carrying capacity, they will change the normal state of the environment.2 With rapid economic development around the world, global pollution gradually increases. Ecological governance has become a crucial issue across the globe.3 Pollution control is also a highly debated issue between developing countries and developed countries; China too has an environmental pollution control problem.4 China began to pay attention to the question of pollution control and its preven­tion methods early on. The Chinese government has formulated many policies in this respect. However, these measures did not improve the environment. At the end of 2019, the COVID-19 epidemic broke in Wuhan, China.5 The Chinese government has taken a series of measures to control the outbreak. Wuhan was locked down on January 23, 2020, and people's travel was restricted. We downloaded the daily air pollution parameters of 367 cities around China from the China Meteorological Administration website (http://data.cma.cn/). Records covered the periods between January 23, 2019 and March 23, 2019; November 22, 2019 and January 22, 2020; and January 23, 2020 and March 23, 2020. Pollution severity was divided into quartiles according to the air quality index (AQI). The AQI was calculated using the con­centration of the following six pollutants: PM10, PM2.5, CO, NO2, SO2, and O3. An AQI of 0-100 indicates no pollution, 101-150 indicates mild pollution, 151-200 indicates moderate pollution, and AQI > 200 indicates severe pollution (USEPA 2013, http://www.Gpo.gov/). We found a significant improvement in air quality across China as a result of the reduction

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Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction.

OBJECTIVE: To explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. METHODS: We retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). General characteristics of the patients were recorded, analyzed, and compared. Moreover, we compared the groups for the time from symptom onset to the first medical contact (SO-to-FMC), time from first medical contact to balloon expansion (FMC-to-B), time from hospital door entry to first balloon expansion (D-to-B), and catheter room activation time. The groups were also compared for postoperative cardiac color Doppler ultrasonographic left ventricular ejection fraction (LVEF),the incidence of major adverse cardiovascular and cerebrovascular events (MACCE),Kaplan-Meier survival curves during the 28 days after the operation. RESULTS: The times of SO-to-FMC, D-to-B, and catheter room activation in the 2020 group were significantly longer than those in the 2019 group (P < 0.05). The cumulative mortality after the surgery in the 2020 group was significantly higher than the 2019 group (P < 0.05). CONCLUSION: The pre-hospital and in-hospital treatment times of STEMI patients during the COVID-19 epidemic were longer than those before the epidemic. Cumulative mortality was showed in Kaplan-Meier survival curves after the surgery in the 2020 group was significantly different higher than the 2019 group during the 28 days.The diagnosis and treatment process of STEMI patients during an epidemic should be optimized to improve their prognosis.

Prophylactic AEDs Treatment for Patients With Supratentorial Meningioma Does Not Reduce the Rate of Perioperative Seizures: A Retrospective Single-Center Cohort Study.

Meningiomas, the most common brain tumor, inevitably require surgical treatment. However, the efficacy of prophylactic antiepileptic drugs (AEDs), in reducing the frequency of new-onset seizures during the perioperative period remains controversial. To further clarify if prophylactic antiepileptic drug treatment for patients with meningioma had value, we reviewed the medical records of 186 supratentorial meningioma patients who were operated at our hospital between 2016 and 2018. SPSS 24.0 software was used for statistical analysis. The results of univariate analysis showed that factors including age, sex, the course of the disease (years), maximum cross-sectional area of the tumor, location of the tumor, multiple or single tumors, adjacent to the cortex, peritumoral brain edema, World Health Organization classification, and peritumoral adhesion were not associated with perioperative seizures (P >0.05). Furthermore, the results of multivariate analysis revealed hydrocephalus (OR 4.87 P = 0.05) and non-skull base location (OR 1.88 P = 0.04) were significant risk factors for perioperative in-hospital seizures. Prophylactic valproic acid treatment did not contribute to the alleviation of perioperative seizures (OR 1.76 P = 0.04). However, Multivariate logistic regression analyses excluding the patients with seizures before operation confirmed prophylactic valproic acid treatment did not reduce the frequency of seizures during the perioperative period (OR 1.84 P = 0.04). Taken together, the data suggest that prophylactic valproic acid treatment for patients with supratentorial meningioma does not reduce the rate of perioperative seizures.

High time for ease the doctor-patient relationship in China.

As doctors, we find it disturbing to read the paper "Burnout in physicians who are exposed to workplace violence" (January 2020).1 Workplace violence experienced by doctors has been documented both in developed and developing countries. Reports show that Chinese medical professionals are being injured, disabled, or even killed by patients or their family members.2,3 The killing of a doctor in Beijing in 2019 attracted national attention. China's top legislative body has approved the first fundamental and comprehensive law to protect health-care professionals. The bill will take effect on June 1, 2020. However, the law alone will not solve the problem. We need to treat it from the root and address the issues that have led to this health-care-related violence. A multi-faceted action must be launched to reduce violence against doctors in China urgently.

The impact of Community intervention on the time from Symptom onset to first medical contact with acute coronary syndrome.

OBJECTIVE: Patient delay in the recognition of and response to the symptoms of acute coronary syndrome (ACS) is a worldwide problem. A community education program about chest pain was implemented in China, and was aimed at providing better community intervention. In this study, the impact of this program on the time of symptom onset to the first medical contact (SO-to-FMC) in ACS patients was investigated, as was the incidence of major adverse cardiac and cerebrovascular events (MACCE) in these patients. METHODS: A total of 10 local communities were included in this study. A 9-month intensive community education program about chest pain was conducted in these communities. The data on the demographics, mode of transportation, procedures, clinical outcomes, and discharge diagnoses of all ACS patients in these communities were collected. RESULTS: The study communities had a combined population of 361,609, and all community population sizes ranged from 12,823 to 66,127. The average SO-to-FMC time of the control period was 510 min, whereas, following community intervention, the average SO-to-FMC time was 256 min (P <  0.001). Furthermore, comparative analyses revealed that, following discharge from the hospital, the 1.5-year MACCE-free survival rate was higher in the community intervention group than in the control group (95.0 % vs. 90.5 %, P =  0.025), and the 1.5-year mortality rate was lower in the community intervention group than in the control group (3.3 % vs. 6.3 %, P =  0.03). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The Hangzhou Chest Pain Science Education Project(HCPSEP) was found to reduce the SO-to-FMC time and improve the outcome of ACS patients. This indicates that a scientific, educational program on chest pain can be effective in improving the knowledge and alertness of the local residents about chest pain. This type of program may be recognized and carried out in other regions.

Corrigendum: Prophylactic AEDs Treatment for Patients With Supratentorial Meningioma Does Not Reduce the Rate of Perioperative Seizures: A Retrospective Single-Center Cohort Study.

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Upregulation of RBFOX1 in the malformed cortex of patients with intractable epilepsy and in cultured rat neurons.

Mutations in RNA­binding Fox 1 (RBFOX1) are known to be associated with neurodevelopmental disorders including epilepsy, mental retardation and autism spectrum disorder. The deletion of the Rbfox1 gene in mice has been shown to result in heightened susceptibility to seizures. However, other studies have revealed mutations or the downregulation of RBFOX1 in specimens obtained from patients with epilepsy or malformations of cortical development (MCD). Generally, the expression of RBFOX1 varies according to tissue type. In this study, we demonstrated the upregulation of RBFOX1 protein in the cortex of patients with MCD and intractable epilepsy. Electrophysiological recordings of cultured rat cortical neurons with increased Rbfox1 expression also revealed a significantly increased amplitude of action potential (AP) and Na+ current density. Some of these neurons (26.32%) even displayed spontaneous, recurrent, epileptiform discharges (SREDs). Additionally, certain Rbfox1 target transcripts associated with epilepsy, including glutamate receptor, ionotropic, N-methyl D-aspartate 1 [Grin1, also known as N-methyl-D-aspartate receptor subunit NR1 (NMDAR1)], synaptosomal-associated protein, 25 kDa (SNAP­25 or Snap25) and sodium channel, voltage gated, type VIII, alpha subunit (Scn8a, also known as Nav1.6) were identified to be upregulated in these cultured cortical neurons with an upregulated Rbfox1 expression. These data suggest that the upregulation of RBFOX1 contributes to neuronal hyperexcitation and seizures. The upregulation of NMDAR1 (Grin1), SNAP­25 (Snap25) and Scn8a may thus be involved in Rbfox1­related neuronal hyperexcitation.

Overexpression of µ-calpain in the anterior temporal neocortex of patients with intractable epilepsy correlates with clinicopathological characteristics.

PURPOSE: This study aims to investigate µ-calpain expression profiles in the anterior temporal neocortex in patients with intractable epilepsy, and to determine whether its pattern of expression is related to pathological changes seen in these patients. METHODS: The study subjects consisted of 30 patients with intractable epilepsy and a control group of 10 patients with brain trauma who underwent resection of the anterior temporal lobe. µ-Calpain expression in surgically resected anterior temporal cortices of patients with intractable epilepsy were analyzed using the RT-PCR, Western blot, immunohistochemistry and immunofluorescence staining. GFAP expression was detected by immunohistochemical staining. The related pro-inflammatory cytokines were quantified by elisa. Clinicopathological characteristics were evaluated by HE staining. RESULTS: Analysis by Western blot and RT-PCR revealed that inactive µ-calpain expression and the calpain-cleaved spectrin fragment in surgically resected anterior temporal cortices of patients with intractable epilepsy were significantly increased compared to the tissues from corresponding regions of the control group. Immunohistological staining demonstrated that µ-calpain was overexpressed in the cell cytoplasm of neurons and glial cells in patients with intractable epilepsy and GFAP was overexpressed in the cell cytoplasm of glial cells in patients with intractable epilepsy. The level of pro-inflammatory cytokines, such as IL-1ß, IL-6 and TGF-ß1 were significantly increased in patients with intractable epilepsy. HE staining indicated µ-calpain overexpression is an independent prognostic factor for pathological changes such as neuronal loss, neuronal degeneration, gliosis and astrocytosis. CONCLUSION: These data suggest that overexpression of µ-calpain is relationship with intractable epilepsy as well as the clinicopathological characteristics in these patients.