Effect of urban traffic-restriction policy on improving air quality based on system dynamics and a non-homogeneous discrete grey model.

With the acceleration of urbanization, traffic congestion and vehicle exhaust pollution are becoming increasingly serious problems. Focusing on the problem of urban pollution from vehicle exhaust, this study used system dynamics to establish an urban congestion mitigation and emission-reduction management model. Specifically, a nonlinear function that integrates system dynamics and a non-homogeneous discrete grey model (SD-NDGM) was used to construct an algorithm, which improved the accuracy of the model. Thereafter, the mid- and long-term effects of the restriction policy were explored. The main findings from dynamic model simulations were as follows: All types of restrictions alleviated traffic congestion to varying degrees, but "odd and even" restrictions had more obvious effects, with an average annual reduction rate of 43.53% in the number of motor vehicle trips. The driving-restriction policy had a time effect, significantly reducing the number of vehicle trips in the short term. However, it could have negative effects in the long term (e.g., agglomeration effect, emission-reduction paradox), and it does not fundamentally solve traffic and environmental problems. Thus, it could only be used as a phased policy, not a long-term measure. The purchase-restriction policy controlled excessive increases in the number of private cars, but it had little effect in terms of solving environmental problems. Compared with a single policy, the combination of public-transport development and driving-restriction policy not only reduced traffic congestion, air pollution, and air quality health indexes by 29.13%, 52.63%, and 54.63%, respectively, but also improved environmental carrying capacity by 294.26%. A combined approach can therefore be said to have certain benefits for society, health, and the environment. Supplementary Information: The online version contains supplementary material available at 10.1007/s10098-022-02319-9.

Impact of the COVID-19 Pandemic on Door-to-Balloon Time for Primary Percutaneous Coronary Intervention　- Results From the Singapore Western STEMI Network.

BACKGROUND: Little is known about the effect of the coronavirus disease 2019 (COVID-19) pandemic and the outbreak response measures on door-to-balloon time (D2B). This study examined both D2B and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).Methods and Results:This was a retrospective study of 303 STEMI patients who presented directly or were transferred to a tertiary hospital in Singapore for PPCI from October 2019 to March 2020. We compared the clinical outcomes of patients admitted before (BOR) and during (DOR) the COVID-19 outbreak response. The study outcomes were in-hospital death, D2B, cardiogenic shock and 30-day readmission. For direct presentations, fewer patients in the DOR group achieved D2B time <90 min compared with the BOR group (71.4% vs. 80.9%, P=0.042). This was more apparent after exclusion of non-system delay cases (DOR 81.6% vs. BOR 95.9%, P=0.006). Prevalence of both out-of-hospital cardiac arrest (9.5% vs. 1.9%, P=0.003) and acute mitral regurgitation (31.6% vs. 17.5%, P=0.006) was higher in the DOR group. Mortality was similar between groups. Multivariable regression showed that longer D2B time was an independent predictor of death (odds ratio 1.005, 95% confidence interval 1.000-1.011, P=0.029). CONCLUSIONS: The COVID-19 pandemic and the outbreak response have had an adverse effect on PPCI service efficiency. The study reinforces the need to focus efforts on shortening D2B time, while maintaining infection control measures.

Assessment of volume status in maintenance hemodialysis patients / 上海交通大学学报（医学版）

Objective · To assess volume status in maintenance hemodialysis (MHD) patients.Methods · Body composition analysis was performed on 128 MHD patients from Renji Hospital,Shanghai Jiao Tong University School of Medicine.The volume status was assessed based on body composition data and predialysis systolic blood pressure (preBPsys),edema grade,brain natriuretic peptide (BNP).Patients were divided into hyperhydrated group (percentage of hydration status,HS％＞ 15％) or normohydrated group (HS％ ≤ 15％).Body composition data were compared,including lean tissue index (LTI) and fat tissue index (FTI).The blood pressure,edema grade,serum calcium,serum phosphate,intact parathyroid hormone (iPTH),hemoglobin,albumin,pre-albumin,hypersensitive C-reactive protein (hs-CRP),serum sodium,and urea clearance Kt/V were compared between two groups.Results · Sixtynine patients were normohydrated and preBPsys reached target;10 patients were overhydrated with higher preBPsys;18 patients had overhydration but preBPsys was in target range.Compared to normohydraed group,patients in hyperhydmted group had more obvious edema,higher BNP level,significantly lower LTI,serum albumin and pre-albumin levels,while serum sodium was significantly higher (P＜0.05).Conclusion· Volume status of hemodialysis patients can be objectively and accurately assessed by body composition analysis using bioimpedance technique with blood pressure,edema grade and biochemical parameters.Hyperhydrated patients may have higher serum sodium level,lower serum albumin,lower hemoglobin,and less lean tissue mass concomitantly.Sodium intake control,nutrition status improvement,and anemia correction may be useful to reduce hyperhydration.

Effect of fat content on left ventricular hypertrophy in peritoneal dialysis patients / 上海交通大学学报（医学版）

Objective·To explore the association of fat content with left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients.Methods · Eligible PD patients in Renji Hospital,Shanghai Jiao Tong University School of Medicine from November 2016 to June 2017 were recruited.Demographic data of patients were collected and biochemical indicators were measured.Fat content was measured by bioelectrical impedance analysis,and LVH was accessed using echocardiography.The prevalence of LVH in PD patients was compared between groups with different fat contents.Logistic regression was used to analyze the associated risk factors of LVH.Results · A total of 163 PD patients with a mean age of 55.85±13.20 years and a median PD duration of 46.0 (20.0,73.0) months were enrolled.Of them,98 patients (60.1％) were male,34 patients (20.9％) had diabetes mellitus,19 patients (11.7％) combined with cardiovascular disease and 122 patients (74.8％) were hypertensive.There were 51 patients (31.3％) with LVH,including 31 patients (37.8％) in high fat tissue index (FTI) group (n=82) and 20 patients (24.7％) in low FTI group (n=81).Logistic regression analysis indicated that FTI (OR=1.133,95％ CI 1.003-1.280,P=0.044),overhydration (OR=1.651,95％ CI 1.257-2.169,P=0.000) and hemoglobin (OR=0.972,95％ CI 0.948-0.997,P=0.028) were independently associated with LVH in PD patients.Conclusion · LVH is common in PD patients,especially in high fat content patients.Higher fat content,higher overhydration and lower levels of hemoglobin are risk factors for LVH in PD patients.

Adiponectin is related to carotid artery plaque and a predictor of cardiovascular outcome in a cohort of non-diabetic peritoneal dialysis patients.

AIMS: Adiponectin is an adipocytokine with antiatherogenic and anti-inflammatory properties. We investigated associations between circulating adiponectin, inflammation and cardiovascular disease in peritoneal dialysis patients. METHODS: A prospective study was performed in 59 non-diabetic patients. The concentrations of serum adiponectin, biochemical data and ultrasound of carotid artery were measured at enrollment. The patients were followed up to 39 months mainly for cardiovascular events. RESULTS: The serum adiponectin concentration was elevated and inversely related to C-reactive protein and interleukin-6 in the patients. The adiponectin level of patients with carotid plaques was significantly lower than in those without plaques (p < 0.01). Kaplan-Meier analysis showed that the cumulative survival without new cardiovascular events was better in patients with higher adiponectin levels than in those with lower adiponectin levels. CONCLUSION: Serum adiponectin levels are inversely related with markers of systemic inflammation and signs of atherosclerosis which may explain why hyperadiponectinemia in this study was associated with better cardiovascular outcome.

[Relationship of brain natriuretic peptide to renal function and left ventricular hypertrophy in patients with chronic kidney disease].

OBJECTIVE: To clarify the association of brain natriuretic peptide * BNP) with renal function and cardiac dysfunction in non-dialysis-dependent patients with chronic kidney disease (CKD). METHODS: Fluorescence immuno-assay was used to detect the whole blood concentration of BNP in a cohort of 203 CKD patients and 16 hypertensive controls. Color ultrasonography was conducted to determine the left ventricular mass index (LVMI). Estimated glomerular filtration rate (eGFR) was examined. The relationship of BNP to eGFR and LVMI in these patients. RESULTS: There was a trend that the BNP level increased with the decrease of the level of eGFR [9.35 (7.35-15.00) vs 54.40 (15.10-173.00) ng/L, P < 0.01]. Spearman correlation showed that BNP level was correlated negatively with eGFR (r = -0.417, P < 0.01). Multiple regression analysis showed that eGFR was the independent determinant of BNP (beta = -0. 293, P < 0.01), and lgBNP concentration increased by 0.293 ng/L per 1 ml x min(-1) x (1.73 m2)(-1) reduction in lgGFR. The incidence of LV hypertrophy was much higher in the CKD patients than in the controls (53.2% vs 10.0%, P < 0.05). BNP level was greater in the patients with LV hypertrophy [93.05 (37.70-272.00) vs 17.30 (7.20-63.70) ng/L, P < 0.01], and LVMI had an independent effect on BNP concentration ( beta = 0.266, P < 0.01). lgBNP level increased by 0.266 ng/L per 1 g/m2 increase in lgLVMI. CONCLUSION: The declining eGFR level independently elevates the BNP level in non-dialysis-dependent CKD patients. Although renal dysfunction itself may affects the BNP concentration, LV hypertrophy is a powerful independent determinant of BNP.