Association of Low-Density Lipoprotein Cholesterol Levels with More than 20-Year Risk of Cardiovascular and All-Cause Mortality in the General Population.

Background Current cholesterol guidelines have recommended very low low-density lipoprotein cholesterol (LDL-C) treatment targets for people at high risk of cardiovascular disease (CVD). However, recent observational studies indicated that very low LDL-C levels may be associated with increased mortality and other adverse outcomes. The association between LDL-C levels and long-term risk of overall and cardiovascular mortality among the U.S. general population remains to be determined. Methods and Results This prospective cohort study included a nationally representative sample of 14 035 adults aged 18 years or older, who participated in the National Health and Nutrition Examination Survey III 1988-1994. LDL-C levels were divided into 6 categories: <70, 70-99.9, 100-129.9, 130-159.9, 160-189.9 and ≥190 mg/dL. Deaths and underlying causes of deaths were ascertained by linkage to death records through December 31, 2015. Weighted Cox proportional hazards regression models were used to estimate the hazard ratios (HR) of mortality outcomes and its 95% CIs. During 304 025 person-years of follow up (median follow-up 23.2 years), 4458 deaths occurred including 1243 deaths from CVD. At baseline, mean age was 41.5 years and 51.9% were women. Very low and very high levels of LDL-C were associated with increased mortality. After adjustment for age, sex, race and ethnicity, education, socioeconomic status, lifestyle factors, C-reactive protein, body mass index, and other cardiovascular risk factors, individuals with LDL-C<70 mg/dL, compared to those with LDL-C 100-129.9 mg/dL, had HRs of 1.45 (95% CI, 1.10-1.93) for all-cause mortality, 1.60 (95% CI, 1.01-2.54) for CVD mortality, and 4.04 (95% CI, 1.83-8.89) for stroke-specific mortality, but no increased risk of coronary heart disease mortality. Compared with those with LDL-C 100-129.9 mg/dL, individuals with LDL-C≥190 mg/dL had HRs of 1.49 (95% CI, 1.09-2.02) for CVD mortality, and 1.63 (95% CI, 1.12-2.39) for coronary heart disease mortality, but no increased risk of stroke mortality. Conclusions Both very low and very high LDL-C levels were associated with increased risks of CVD mortality. Very low LDL-C levels was also associated with the high risks of all-cause and stroke mortality. Further investigation is needed to elucidate the optimal range of LDL-C levels for CVD health in the general population.

UK dietitians' attitudes and experiences of formula very low- and low-energy diets in clinical practice.

Despite evidence that formula very low-energy diets (VLED) and low-energy diets (LED) are both effective and safe as treatments for obesity and type 2 diabetes, these diets remain underutilized in the United Kingdom. The aim of this study was to explore UK dietitians' attitudes and experiences of using formula VLED and LED. A cross-sectional survey was disseminated between September 2019 and April 2020 through websites, social media platforms and dietetic networks using snowball sampling. In total, 241 dietitians responded to the online survey with 152 participants included in the final analysis (female [94.1%], mean age 40.8 years [SD 9.5]; median 12 years [interquartile range 8, 22] within dietetic practice). One hundred and nine (71.7%) participants reported currently using VLED/LED in clinical practice and 43 (28.3%) did not. Those with lower motivation and confidence in implementing VLED/LED in clinical practice were less likely to use them. Cost and adherence were the two highest reported barriers to use. Dietitians perceived VLED/LED were effective, but concerns remained about long-term effectiveness, particularly for some patient groups. Dietitians also reported that further education, funding and service infrastructure, including access to clinic space and administrative support, were required to help embed VLED/LED into routine clinical practice. With clinical services now regularly offering VLED/LED programmes in the United Kingdom, dietitians are ideally placed to provide long-term support. However, understanding, reporting and addressing the potential barriers (funding/infrastructure and education) appear to be key requirements in increasing the delivery of VLED/LED programmes nationally.

Exploratory study on the spatial relationship between emerging infectious diseases and urban characteristics: Cases from Korea.

In the modern global context of interconnected populations, the recent emergence of infectious diseases involves complex interactions. The purpose of this study is to investigate the spatial correlations between urban characteristics, taking into account the socio-ecological aspects, and the emergence of infectious diseases. Using exploratory spatial data analysis and spatial regression between the infectious disease emergence data and 14 urban characteristics, we analyzed 225 spatial units in South Korea, where there was a re-emergence of measles and a 2015 outbreak of Middle East Respiratory Syndrome. As results of exploratory spatial data analysis, the emerging infectious diseases had spatial dependence and showed spatial clusters. Spatial regression models showed that urban characteristic factors had different effects according to the type of infectious disease. Common factors were characteristics related to low socioeconomic status in water or food-borne diseases and manageable infectious diseases. Intermittent infections disease epidemics are related to high-quality residential environments and the response capacity of the local government. New infectious diseases are different than other infectious diseases, which are related to the ecological environment. This study suggests spatial policies for preventing infectious diseases considering the spatial relationships between urban characteristics and infectious diseases as well as the management of public health.

Drug-Tolerant Idling Melanoma Cells Exhibit Theory-Predicted Metabolic Low-Low Phenotype.

Cancer cells adjust their metabolic profiles to evade treatment. Metabolic adaptation is complex and hence better understood by an integrated theoretical-experimental approach. Using a minimal kinetic model, we predicted a previously undescribed Low/Low (L/L) phenotype, characterized by low oxidative phosphorylation (OXPHOS) and low glycolysis. Here, we report that L/L metabolism is observed in BRAF-mutated melanoma cells that enter a drug-tolerant "idling state" upon long-term MAPK inhibition (MAPKi). Consistently, using publicly available RNA-sequencing data of both cell lines and patient samples, we show that melanoma cells decrease their glycolysis and/or OXPHOS activity upon MAPKi and converge toward the L/L phenotype. L/L metabolism is unfavorable for tumor growth, yet supports successful cell division at ~50% rate. Thus, L/L drug-tolerant idling cells are a reservoir for accumulating mutations responsible for relapse, and it should be considered as a target subpopulation for improving MAPKi outcomes in melanoma treatment.

Distribution and emission characteristics of filterable and condensable particulate matter before and after a low-low temperature electrostatic precipitator.

The low-low temperature electrostatic precipitator (LLT-ESP), a combination of a traditional temperature electrostatic precipitator (ESP) and a non-leakage media gas-gas exchange (MGGH), could reduce the inlet flue gas temperature below the dew point and improved the performance of the ESP. Particulate matter (PM) from the stationary sources contains filterable particulate matter (FPM) and condensable particulate matter (CPM). In this study, coal with a high ash content (coal-HA) was burned, and the emission characteristics and removal efficiencies of the particulate matter in an LLT-ESP were investigated. The standards used to test filterable and condensable PM were ISO standard 23210-2009 and U.S. EPA Method 202, respectively. The LLT-ESP was efficient in removing filterable PM, with a total filterable PM removal efficiency as high as 99.6%. The removal efficiency of filterable PM increased with increasing particulate size and decreasing imported flue gas temperature. The LLT-ESP also provided excellent removal of condensable PM with a condensable PM removal efficiency exceeding 77%. Upstream of the LLT-ESP, the concentrations of filterable PM were much higher than those of condensable PM. Downstream of the LLT-ESP, the relationship between the quantities of condensable and filterable PM reversed. To reduce the emissions of PM from coal-fired power plants, more attention should be paid to controlling condensable PM. The temperature of the flue gas upstream of the LLT-ESP played an important role in eliminating condensable PM. At lower imported flue gas temperature operation conditions, the removal efficiency of the LLT-ESP for the condensable PM and the escaping mass concentration of condensable PM increased. Among the organic fraction of the condensable PM, hydrocarbons and esters were dominant. Meanwhile, SO42- was the primary component, followed by Cl- in anions. Na+, Ca2+, and Fe3+ were the main components in metal ions. Particles with diameters ≥ 10 µm, which contained most of the Si and Al, were dominant in the fly ash collected from sections 1 and 2 of the LLT-ESP. The main particles in sections 3 and 4 were PM10, which contained the highest concentrations of Ca and Fe.

Characteristics of particulate matter from four coal-fired power plants with low-low temperature electrostatic precipitator in China.

The performance of traditional electrostatic precipitators (ESPs) is strongly affected by the flue gas temperature. Operating under much lower temperatures (e.g., ~90 °C), the low-low temperature electrostatic precipitators (LLT-ESPs) are considered as an effective technology to improve the particulate matter (PM) removal efficiency in coal-fired power plants (CFPPs). Wet flue gas desulfurization (WFGD) can also be affected by the decrease in the operating temperature of the ESP. This study evaluates the influence of various ESP operating temperatures on ESP performance, PM2.5 (particles with an aerodynamic diameter of ≤2.5 µm), and total dust emission characteristics at the ESP and WFGD outlets in CFPPs equipped with LLT-ESPs. PM2.5 and total dust concentrations at the ESP and WFGD outlets in CFPPs installed with LLT-ESPs are much lower than those with traditional ESPs. The PM concentrations at both the ESP and WFGD outlets show a decreasing trend with a decrease in the operating temperature. However, the concentration of total water-soluble ions (mainly SO42-, Cl-, and NH4+) in the total dust at the outlet of ESPs increases from 0.3 to 0.8 mg/m3 as the temperature decreases from > 90 °C to 80-90 °C, which is contrary to that at the WFGD outlet (decreases from 4.7 to 0.8 mg/m3). The PM2.5 and total dust concentrations increase by 10.2-80.2% and 13.7-77.0%, respectively, through the WFGD unit due to the entrainment of a gypsum slurry. A relatively lower operating temperature of LLT-ESPs in power plants is also beneficial to decrease the incremental effect of PM emissions in the process of WFGD. The recommended operating temperature for LLT-ESPs is ~90 °C, and limited improvement on PM reduction can be achieved with a further temperature decrease from 90 to 80 °C.

Removal effect of the low-low temperature electrostatic precipitator on polycyclic aromatic hydrocarbons.

The low-low temperature electrostatic precipitator (LLT-ESP) is one of the most used devices for pollutant control in ultra-low emission coal-fired power plants. This study investigated the influence of the LLT-ESP on polycyclic aromatic hydrocarbons (PAHs) distributions in flue gas from an ultra-low emission coal-fired power plant. The total gas-phase PAH concentration was reduced from 27.52 µg/m3 to 3.38 µg/m3. The total particulate-phase PAH concentration decreased from 14.36 µg/m3 to 0.34 µg/m3. The removal efficiency of the LLT-ESP for gas-phase and particulate phase carcinogenic higher molecular weight (HMW) PAHs was 85% and 99%, respectively. The total concentration of 16 selected PAHs in feed coal was 98.16 µg/g. The fly ash particle size successively decreased from Electric Field 1 (F1) to Electric Field 4 (F4). The total PAH concentration decreased from F1 to F2 but increased again from F3 to F4. The flue gas cooling process significantly contributed to the elimination of both gas- and particulate-phase PAHs in the flue gas. Presumably, most of the condensed PAHs were adhered to or absorbed in the fly ash and were scavenged in Field 1. Both gas- and particulate-phase 5- and 6-ring PAHs in the flue gas were completely removed in Field 1. The discharge process in the electric fields may promote the formation of several 4- or 5-ring PAHs. In this study, benzo[k]fluoranthene (BKF) and benzo[a]pyrene (BaP) were regenerated in the particles rather than in the flue gas during the discharge process in the electric fields.