Background:Medical artificial intelligence(MAI)is a synthesis of medical science and artificial intelligence development,serving as a crucial field in the current advancement and application of AI.In the process of de...Background:Medical artificial intelligence(MAI)is a synthesis of medical science and artificial intelligence development,serving as a crucial field in the current advancement and application of AI.In the process of developing medical AI,there may arise not only legal risks such as infringement of privacy rights and health rights but also ethical risks stemming from violations of the principles of beneficence and non-maleficence.Methods:To effectively address the damages caused by MAI in the future,it is necessary to establish a hierarchical governance system with MAI.This paper examines the systematic collection of local practices in China and the induction and integration of legal remedies for the damage of MAI.Results:To effectively address the ethical and legal challenges of medical artificial intelligence,a hierarchical regulatory system should be established,which based on the impact of intervention measures on natural rights and differences in intervention timing.This paper finally obtains a legal hierarchical governance system corresponding to the ethical risks and legal risks of MAI in China.Conclusion:The Chinese government has formed a multi-agent governance system based on the impact of risks on rights and the timing of legal intervention,which provides a reference for other countries to follow up on the research on MAI risk management.展开更多
BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and dep...BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.展开更多
BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.A...BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.AIM To determine the incidence of depression and its independent risk factors in patients with esophageal cancer and bone metastasis.METHODS A total of 100 consecutive eligible patients admitted between March 2022 and March 2025 were recruited.Depression was assessed with the Beck Depression Inventory-II;scores>4 defined the depression group(n=42)and scores≤4 the non-depression group(n=58).Demographic,clinical,and laboratory variables were compared between the groups.Multivariate logistic regression was used to identify independent risk factors.RESULTS Depression prevalence was 42.0%(42/100).Univariate analysis demonstrated significant differences in monthly per-capita household income,education level,social support,sleep disorders,and serum high-sensitivity C-reactive protein(all P<0.05);no differences were observed in sex,age,tumor characteristics,or other laboratory indices(all P>0.05).Multivariable analysis revealed the following independent risk factors for depression:Low income[odds ratio(OR)=2.66,95%confidence interval(CI):1.17-6.03],low education(OR=2.46,95%CI:1.08-5.61),low social support(OR=5.10,95%CI:1.81-14.39),sleep disorders(OR=2.79,95%CI:1.23-6.35),and elevated high-sensitivity C-reactive protein(OR=1.31 per unit increase,95%CI:1.18-1.46).CONCLUSION Depression is common among patients with esophageal cancer and bone metastasis.Low socioeconomic status,limited education,insufficient social support,sleep disturbances,and systemic inflammation were independent predictors.Interventions that address these modifiable factors may reduce depression risk in this population.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
Controlling heavy metal pollution in agricultural soil has been a significant challenge.These heavy metals seriously threaten the surrounding ecological environment and human health.The effective assessment and remedi...Controlling heavy metal pollution in agricultural soil has been a significant challenge.These heavy metals seriously threaten the surrounding ecological environment and human health.The effective assessment and remediation of heavy metals in agricultural soils are crucial.These two aspects support each other,forming a close and complete decisionmaking chain.Therefore,this review systematically summarizes the distribution characteristics of soil heavy metal pollution,the correlation between soil and crop heavy metal contents,the presence pattern and migration and transformation mode of heavy metals in the soil-crop system.The advantages and disadvantages of the risk evaluation tools and models of heavy metal pollution in farmland are further outlined,which provides important guidance for an in-depth understanding of the characteristics of heavymetal pollution in farmland soils and the assessment of the environmental risk.Soil remediation strategies involve multiple physical,chemical,biological and even combined technologies,and this paper compares the potential and effect of the above current remediation technologies in heavy metal polluted farmland soils.Finally,the main problems and possible research directions of future heavy metal risk assessment and remediation technologies in agricultural soils are prospected.This review provides new ideas for effective assessment and selection of remediation technologies based on the characterization of soil heavy metals.展开更多
Nitrate contamination of groundwater is a worldwide problem, particularly in agricultural countries. Exposure to high levels of nitrates in groundwater can have adverse effects on the health of residents who use groun...Nitrate contamination of groundwater is a worldwide problem, particularly in agricultural countries. Exposure to high levels of nitrates in groundwater can have adverse effects on the health of residents who use groundwater for drinking. This study aims to assess the health risk associated with the ingestion of nitrates in well water in the town of M’bahiakro. Health risk maps were created on the basis of hazard quotients (HQ) using the US Environmental Protection Agency (USEPA) health risk assessment model. The results indicate that residents of the Koko, Dougouba and Baoulekro neighbourhoods, whatever their age, are potentially exposed to the toxic effects of NO3−during their daily intake of nitrate-contaminated well water, with reference to hazard quotients (HQ) greater than 1. Nitrate concentrations in the groundwater should therefore be controlled in order to prevent their harmful effects on the health of the population and guarantee its use in rice-growing activities in M’Bahiakro.展开更多
To study the volatile organic compounds(VOCs)emission characteristics of industrial enterprises in China,6 typical chemical industries in Yuncheng City were selected as research objects,including the modern coal chemi...To study the volatile organic compounds(VOCs)emission characteristics of industrial enterprises in China,6 typical chemical industries in Yuncheng City were selected as research objects,including the modern coal chemical industry(MCC),pharmaceutical industry(PM),pesticide industry(PE),coking industry(CO)and organic chemical industry(OC).The chemical composition of 91 VOCs was quantitatively analyzed.The results showed that the emission concentration of VOCs in the chemical industry ranged from 1.16 to 155.59 mg/m^(3).Alkanes were the main emission components of MCC(62.0%),PE(55.1%),and OC(58.5%).Alkenes(46.5%)were important components of PM,followed by alkanes(23.8%)and oxygenated volatile organic compounds(OVOCs)(21.2%).Halocarbons(8.6%-71.1%),OVOCs(9.7%-37.6%)and alkanes(11.2%-27.0%)were characteristic components of CO.The largest contributor to OFP was alkenes(0.6%-81.7%),followed by alkanes(9.3%-45.9%),and the lowest onewas alkyne(0%-0.5%).Aromatics(66.9%-85.4%)were the largest contributing components to SOA generation,followed by alkanes(2.6%-28.5%),and the lowest one was alkenes(0%-4.1%).Ethylene and BTEX were the key active species in various chemical industries.The human health risk assessment showed workers long-term exposed to the air in the chemical industrial zone had a high cancer and non-cancer risk during work,and BTEX and dichloromethane were the largest contributors.展开更多
The complexity of coupled risks,which refer to the compounded effects of interacting uncertainties across multiple interdependent objectives,is inherent to cities functioning as dynamic,interdependent systems.A disrup...The complexity of coupled risks,which refer to the compounded effects of interacting uncertainties across multiple interdependent objectives,is inherent to cities functioning as dynamic,interdependent systems.A disruption in one domain ripples across various urban systems,often with unforeseen consequences.Central to this complexity are people,whose behaviors,needs,and vulnerabilities shape risk evolution and response effectiveness.Realizing cities as complex systems centered on human needs and behaviors is essential to understanding the complexities of coupled urban risks.This paper adopts a complex systems perspective to examine the intricacies of coupled urban risks,emphasizing the critical role of human decisions and behavior in shaping these dynamics.We focus on two key dimensions:cascading hazards in urban environments and cascading failures across interdependent exposed systems in cities.Existing risk assessment models often fail to capture the complexity of these processes,particularly when factoring in human decision-making.To tackle these challenges,we advocate for a standardized taxonomy of cascading hazards,urban components,and their interactions.At its core is a people-centric perspective,emphasizing the bidirectional interactions between people and the systems that serve them.Building on this foundation,we argue the need for an integrated,people-centric risk assessment framework that evaluates event impacts in relation to the hierarchical needs of people and incorporates their preparedness and response capacities.By leveraging real-time data,advanced simulations,and innovative validation methods,this framework aims to enhance the accuracy of coupled urban risk modeling.To effectively manage coupled urban risks,cities can draw from proven strategies in real complex systems.However,given the escalating uncertainties and complexities associated with climate change,prioritizing people-centric strategies is crucial.This approach will empower cities to build resilience not only against known hazards but also against evolving and unforeseen challenges in an increasingly uncertain world.展开更多
Phthalate esters(PAEs),recognized as endocrine disruptors,are released into the environment during usage,thereby exerting adverse ecological effects.This study investigates the occurrence,sources,and risk assessment o...Phthalate esters(PAEs),recognized as endocrine disruptors,are released into the environment during usage,thereby exerting adverse ecological effects.This study investigates the occurrence,sources,and risk assessment of PAEs in surface water obtained from 36 sampling points within the Yellow River and Yangtze River basins.The total concentration of PAEs in the Yellow River spans from124.5 to 836.5 ng/L,with Dimethyl phthalate(DMP)(75.4±102.7 ng/L)and Diisobutyl phthalate(DiBP)(263.4±103.1 ng/L)emerging as the predominant types.Concentrations exhibit a pattern of upstream(512.9±202.1 ng/L)>midstream(344.5±135.3 ng/L)>downstream(177.8±46.7 ng/L).In the Yangtze River,the total concentration ranges from 81.9 to 441.6 ng/L,with DMP(46.1±23.4 ng/L),Diethyl phthalate(DEP)(93.3±45.2 ng/L),and DiBP(174.2±67.6 ng/L)as the primary components.Concentration levels follow a midstream(324.8±107.3 ng/L)>upstream(200.8±51.8 ng/L)>downstream(165.8±71.6 ng/L)pattern.Attention should be directed towards the moderate ecological risks of DiBP in the upstream of HH,and both the upstream and midstream of CJ need consideration for the moderate ecological risks associated with Di-n-octyl phthalate(DNOP).Conversely,in other regions,the associated risk with PAEs is either low or negligible.The main source of PAEs in Yellow River is attributed to the release of construction land,while in the Yangtze River Basin,it stems from the accumulation of pollutants in lakes and forests discharged into the river.These findings are instrumental for pinpointing sources of PAEs pollution and formulating control strategies in the Yellow and Yangtze Rivers,providing valuable insights for global PAEs research in other major rivers.展开更多
BACKGROUND Antibiotic resistance is a key factor influencing the treatment outcomes of Helicobacter pylori(H.pylori)infection.The antibiotic resistance spectrum of H.pylori varies in different regions.We investigated ...BACKGROUND Antibiotic resistance is a key factor influencing the treatment outcomes of Helicobacter pylori(H.pylori)infection.The antibiotic resistance spectrum of H.pylori varies in different regions.We investigated the current status of antibiotic resistance of H.pylori in Hunan Province and analyzed the factors related to such resistance to provide strategies for the accurate clinical treatment of H.pylori infection.AIM To understand the antibiotic resistance of H.pylori in Hunan Province and provide guidance for the clinical treatment of H.pylori infection.METHODS This study selected patients who underwent gastroscopy in five hospitals in Hunan Province from April 2022 to April 2023.The sensitivity of H.pylori to clarithromycin,levofloxacin,metronidazole,amoxicillin,furazolidone,and tetracycline was detected using the Agar dilution method.RESULTS H.pylori strains from a total of 566 patients were isolated and identified.The resistance rates of H.pylori strains to clarithromycin,levofloxacin,metronidazole,amoxicillin,furazolidone,and tetracycline were 49.2%,37.8%,76.1%,2.3%,1.4%,and 0.7%,respectively.The resistance rates to clarithromycin,levofloxacin,and metronidazole were high in the four regions of Hunan Province,and the overall resistance rates in central Hunan Province were higher than those in other regions.The resistance rates of H.pylori strains to clarithromycin and levofloxacin were significantly different among the different age groups(P<0.05),with the elderly group having a higher resistance rate than the young group.The resistance rate of H.pylori strains to clarithromycin was greater in patients with atrophic gastritis,and the resistance rate to levofloxacin was the lowest in patients with peptic ulcers.CONCLUSION The resistance rate of H.pylori to amoxicillin,clarithromycin,and metronidazole is high in Hunan Province.Age,stomach disease,and H.pylori reinfection may affect the antibiotic resistance of H.pylori.展开更多
BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultras...In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultrasound imaging,as well as the advances in fetal medical and interventional therapies informed by the deeper understanding of pathophysiological mechanisms underlying fetal and maternal disease processes.展开更多
BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatm...BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.展开更多
BACKGROUND Gastric cancer is one of the most common cancers worldwide,especially in East Asia.AIM To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia(LGIN)in the gas...BACKGROUND Gastric cancer is one of the most common cancers worldwide,especially in East Asia.AIM To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia(LGIN)in the gastric mucosa and provide valuable guidance for improving treatment efficacy.METHODS A total of 357 patients diagnosed with LGIN based on initial pathological examination in Anhui Provincial Hospital or three other medical consortium units between January 2022 and June 2024 were included.Among them,296 patients were followed up with endoscopic and biopsy pathology.Logistic regression was utilized to analyze the relevant risk factors for LGIN progression in the gastric mucosa.RESULTS The distribution sites of LGIN among the 357 patients were as follows:Gastric antrum(54.6%),gastric cardia(24.1%),gastric angulus(8.7%),gastric body(4.8%),gastric fundus(4.8%),and multiple sites(3.1%).Additionally,of the 357 patients with LGIN,112(31.4%)developed ulceration and 59(16.5%)experienced gastric polyps.Furthermore,231 of the 357(64.71%)patients with LGIN tested positive for Helicobacter pylori(H.pylori)infection.The H.pylori infection rates of the patients with LGIN with accompanying atrophy,intestinal metaplasia,and gastric ulcer were 51.95%,59.31%,and 28.57%,respectively.Multivariate logistic regression analysis showed that age≥60 years[odds ratio(OR)=3.063,95%confidence interval(CI):1.351-6.945,P=0.007],H.pylori infection(OR=3.560,95%CI:1.158-10.949,P=0.027),multiple locations(OR=10.136,95%CI:2.045-50.237,P=0.005),lesion size≥2 cm(OR=3.921,95%CI:1.664-9.237,P=0.002),and gastric ulcer(OR=2.730,95%CI:1.197-6.223,P=0.017)were predictive factors for LGIN progression.CONCLUSION LGIN progression is closely related to age,H.pylori positivity,multiple locations,lesion size≥2 cm,and gastric ulcer.Thus,actively identifying these risk factors in patients with LGIN may have certain clinical significance in preventing further tumor progression.展开更多
Fifty agricultural soil samples collected from Fuzhou,southeast China,were first investigated for the occurrence,distribution,and potential risks of twelve organophosphate esters(OPEs).The total concentration of OPEs(...Fifty agricultural soil samples collected from Fuzhou,southeast China,were first investigated for the occurrence,distribution,and potential risks of twelve organophosphate esters(OPEs).The total concentration of OPEs(ΣOPEs)in soil ranged from 1.33 to 96.5 ng/g dry weight(dw),with an average value of 17.1 ng/g dw.Especially,halogenated-OPEs were the predominant group with amean level of 9.75 ng/g dw,and tris(1-chloro-2-propyl)phosphate(TCIPP)was the most abundant OPEs,accounting for 51.1%ofΣOPEs.The concentrations of TCIPP andΣOPEs were found to be significantly higher(P<0.05)in soils of urban areas than those in suburban areas.In addition,the use of agricultural plastic films and total organic carbon had a positive effect on the occurrence of OPE in this study.The positive matrix factorization model suggested complex sources of OPEs in agricultural soils from Fuzhou.The ecological risk assessment demonstrated that tricresyl phosphate presented a medium risk to land-based organisms(0.1≤risk quotient<1.0).Nevertheless,the carcinogenic and noncarcinogenic risks for human exposure to OPEs through soil ingestion and dermal absorption were negligible.These findings would facilitate further investigations into the pollution management and risk control of OPEs.展开更多
Furniture is identified as a vital volatile organic compound(VOC)emission source in the indoor environment.Leather has become the most common raw and auxiliary fabric material for upholstered furniture,particularly wi...Furniture is identified as a vital volatile organic compound(VOC)emission source in the indoor environment.Leather has become the most common raw and auxiliary fabric material for upholstered furniture,particularly with extensive consumption in sofas,due to its abundant resources and efficient functions.Despite being widely traded across the world,little research has been conducted on the VOCs released by leathermaterials and their health risk assessment in the indoor environment.Accordingly,this study investigated the VOC emissions of leather with different grades and the health risk of the inhalation exposure.Based on the ultra-fast gas phase electronic nose(EN)and GC-FID/Qtof,the substantial emissions of aliphatic aldehyde ketones(Aks),particularly hexanal,appear to be the cause of off-flavor in medium and low grade(MG and LG)sofa leathers.The health risk assessment indicated that leather materials barely pose non-carcinogenic and carcinogenic effects to residents.Given the abundance of VOC sources and the accumulation of health risks in the indoor environment,more stringent specifications concerning qualitative and quantitative content should be extended to provide VOC treatment basic for the manufacturing industry and obtain better indoor air quality.展开更多
Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortal...Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortality, high false positive rates can create economic and psychological burdens.展开更多
Understanding the levels,causes,and sources of fluoride in groundwater is critical for public health,effective water resource management,and sustainable utilization.This study employs multivariate statistical methods,...Understanding the levels,causes,and sources of fluoride in groundwater is critical for public health,effective water resource management,and sustainable utilization.This study employs multivariate statistical methods,hazard quotient assessment,and geochemical analyses,such as mineral saturation index,ionic activities,and Gibbs diagrams,to investigate the hydrochemical characteristics,causes,and noncarcinogenic risks of fluoride in Red bed groundwater and geothermal water in the Guang'an area and neighboring regions.Approximately 9%of the Red bed groundwater samples contain fluoride concentrations exceeding 1 mg·L^(-1).The predominant water types identified are Cl-Na and HCO_(3)-Na,primarily influenced by evapotranspiration.Low-fluoride groundwater and high-fluoride geothermal water exhibit distinct hydrochemical types HCO_(3)-Ca and SO_(4)-Ca,respectively,which are mainly related to the weathering of carbonate,sulfate,and fluorite-containing rocks.Correlation analysis reveals that fluoride content in Red bed groundwater is positively associated with Na^(+),Cl^(-),SO_(4)^(2-),and TDS(r^(2)=0.45-0.64,p<0.01),while in geothermal water,it correlates strongly with pH,K^(+),Ca^(2+),and Mg^(2+)(r^(2)=0.52-0.80,p<0.05).Mineral saturation indices and ionic activities indicate that ion exchange processes and the dissolution of minerals such as carbonatite and fluorite are important sources of fluoride in groundwater.The enrichment of fluorine in the Red bed groundwater is linked to evaporation,cation exchange and dissolution of fluorite,caused by the lithologic characteristics of the red bed in this area.However,it exhibits minimal correlation with the geothermal water in the adjacent area.The noncarcinogenic health risk assessment indicates that 7%(n=5)of Red bed groundwater points exceed the fluoride safety limit for adults,while 12%(n=8)exceed the limit for children.These findings underscore the importance of avoiding highly fluoridated red bed groundwater as a direct drinking source and enhancing groundwater monitoring to mitigate health risks associated with elevated fluoride levels.展开更多
·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case gro...·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.展开更多
With the continuous control of anthropogenic emissions,China’s air quality has improved significantly in recent years.Given this background,research on how the short-term exposure risks caused by air pollution in Chi...With the continuous control of anthropogenic emissions,China’s air quality has improved significantly in recent years.Given this background,research on how the short-term exposure risks caused by air pollution in China have changed is insufficient.This study utilized hourly concentration data from ground observation stations and the official air quality guidelines of the Ministry of Ecology and Environment of China and the World Health Organization as standards to systematically investigate the spatiotemporal characteristics and short-term exposure risks of air pollution in China from 2015 to 2022.The results indicate that various atmospheric pollutants except for ozone showed a decreasing trend yearly.Nationwide,both single pollutant air pollution days(SAPDs)and multiple pollutant air pollution days(MAPDs)showed varying degrees of reduction within 15 and 25 days,respectively.SAPD was dominated mainly by excessive PM_(2.5)and PM_(10)pollutants,while MAPD was dominated mainly by excessive pollutant combinations,including PM_(2.5)+PM_(10),CO+PM_(2.5)+PM_(10),and SO_(2)+PM_(2.5)+PM_(10).As the concentration of atmospheric pollutants decreased,the total excess risk(ER)decreased yearly from 2015 to 2022,but there were significant regional differences.Now,the ER is less than 0.25%in southern China,in the range of 0.25%-0.5%in the North China Plain and some cities in the northeast,and higher than 1%in the northwest.Particulate matter is currently the primary pollutant posing short-term exposure risk in China,especially due to the impact of sandstorm weather.This study indicates that China’s atmospheric cleaning action is significantly beneficial for reducing health risks.展开更多
基金funded by China Law Society 2025 Annual Legal Research,Project grant number:CLS(2025)Y04.
文摘Background:Medical artificial intelligence(MAI)is a synthesis of medical science and artificial intelligence development,serving as a crucial field in the current advancement and application of AI.In the process of developing medical AI,there may arise not only legal risks such as infringement of privacy rights and health rights but also ethical risks stemming from violations of the principles of beneficence and non-maleficence.Methods:To effectively address the damages caused by MAI in the future,it is necessary to establish a hierarchical governance system with MAI.This paper examines the systematic collection of local practices in China and the induction and integration of legal remedies for the damage of MAI.Results:To effectively address the ethical and legal challenges of medical artificial intelligence,a hierarchical regulatory system should be established,which based on the impact of intervention measures on natural rights and differences in intervention timing.This paper finally obtains a legal hierarchical governance system corresponding to the ethical risks and legal risks of MAI in China.Conclusion:The Chinese government has formed a multi-agent governance system based on the impact of risks on rights and the timing of legal intervention,which provides a reference for other countries to follow up on the research on MAI risk management.
文摘BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.
文摘BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.AIM To determine the incidence of depression and its independent risk factors in patients with esophageal cancer and bone metastasis.METHODS A total of 100 consecutive eligible patients admitted between March 2022 and March 2025 were recruited.Depression was assessed with the Beck Depression Inventory-II;scores>4 defined the depression group(n=42)and scores≤4 the non-depression group(n=58).Demographic,clinical,and laboratory variables were compared between the groups.Multivariate logistic regression was used to identify independent risk factors.RESULTS Depression prevalence was 42.0%(42/100).Univariate analysis demonstrated significant differences in monthly per-capita household income,education level,social support,sleep disorders,and serum high-sensitivity C-reactive protein(all P<0.05);no differences were observed in sex,age,tumor characteristics,or other laboratory indices(all P>0.05).Multivariable analysis revealed the following independent risk factors for depression:Low income[odds ratio(OR)=2.66,95%confidence interval(CI):1.17-6.03],low education(OR=2.46,95%CI:1.08-5.61),low social support(OR=5.10,95%CI:1.81-14.39),sleep disorders(OR=2.79,95%CI:1.23-6.35),and elevated high-sensitivity C-reactive protein(OR=1.31 per unit increase,95%CI:1.18-1.46).CONCLUSION Depression is common among patients with esophageal cancer and bone metastasis.Low socioeconomic status,limited education,insufficient social support,sleep disturbances,and systemic inflammation were independent predictors.Interventions that address these modifiable factors may reduce depression risk in this population.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
基金supported by the National Natural Science Foundation of China(Nos.52100184,and U22A20617).
文摘Controlling heavy metal pollution in agricultural soil has been a significant challenge.These heavy metals seriously threaten the surrounding ecological environment and human health.The effective assessment and remediation of heavy metals in agricultural soils are crucial.These two aspects support each other,forming a close and complete decisionmaking chain.Therefore,this review systematically summarizes the distribution characteristics of soil heavy metal pollution,the correlation between soil and crop heavy metal contents,the presence pattern and migration and transformation mode of heavy metals in the soil-crop system.The advantages and disadvantages of the risk evaluation tools and models of heavy metal pollution in farmland are further outlined,which provides important guidance for an in-depth understanding of the characteristics of heavymetal pollution in farmland soils and the assessment of the environmental risk.Soil remediation strategies involve multiple physical,chemical,biological and even combined technologies,and this paper compares the potential and effect of the above current remediation technologies in heavy metal polluted farmland soils.Finally,the main problems and possible research directions of future heavy metal risk assessment and remediation technologies in agricultural soils are prospected.This review provides new ideas for effective assessment and selection of remediation technologies based on the characterization of soil heavy metals.
文摘Nitrate contamination of groundwater is a worldwide problem, particularly in agricultural countries. Exposure to high levels of nitrates in groundwater can have adverse effects on the health of residents who use groundwater for drinking. This study aims to assess the health risk associated with the ingestion of nitrates in well water in the town of M’bahiakro. Health risk maps were created on the basis of hazard quotients (HQ) using the US Environmental Protection Agency (USEPA) health risk assessment model. The results indicate that residents of the Koko, Dougouba and Baoulekro neighbourhoods, whatever their age, are potentially exposed to the toxic effects of NO3−during their daily intake of nitrate-contaminated well water, with reference to hazard quotients (HQ) greater than 1. Nitrate concentrations in the groundwater should therefore be controlled in order to prevent their harmful effects on the health of the population and guarantee its use in rice-growing activities in M’Bahiakro.
基金supported by the National Natural Science Foundation of China(No.41905108)the National Research Program for Key Issues in Air Pollution Control(No.DQ GG0532).
文摘To study the volatile organic compounds(VOCs)emission characteristics of industrial enterprises in China,6 typical chemical industries in Yuncheng City were selected as research objects,including the modern coal chemical industry(MCC),pharmaceutical industry(PM),pesticide industry(PE),coking industry(CO)and organic chemical industry(OC).The chemical composition of 91 VOCs was quantitatively analyzed.The results showed that the emission concentration of VOCs in the chemical industry ranged from 1.16 to 155.59 mg/m^(3).Alkanes were the main emission components of MCC(62.0%),PE(55.1%),and OC(58.5%).Alkenes(46.5%)were important components of PM,followed by alkanes(23.8%)and oxygenated volatile organic compounds(OVOCs)(21.2%).Halocarbons(8.6%-71.1%),OVOCs(9.7%-37.6%)and alkanes(11.2%-27.0%)were characteristic components of CO.The largest contributor to OFP was alkenes(0.6%-81.7%),followed by alkanes(9.3%-45.9%),and the lowest onewas alkyne(0%-0.5%).Aromatics(66.9%-85.4%)were the largest contributing components to SOA generation,followed by alkanes(2.6%-28.5%),and the lowest one was alkenes(0%-4.1%).Ethylene and BTEX were the key active species in various chemical industries.The human health risk assessment showed workers long-term exposed to the air in the chemical industrial zone had a high cancer and non-cancer risk during work,and BTEX and dichloromethane were the largest contributors.
基金jointly supported by the National Natural Science Foundation of China(71821001,72371109,72071088,72074089,and 51938004)Strategic Study Project of Chinese Academy of Engineering(2022-JB-02)Project of Interdisciplinary Research Support Program in Huazhong University of Science and Technology(2023-32)。
文摘The complexity of coupled risks,which refer to the compounded effects of interacting uncertainties across multiple interdependent objectives,is inherent to cities functioning as dynamic,interdependent systems.A disruption in one domain ripples across various urban systems,often with unforeseen consequences.Central to this complexity are people,whose behaviors,needs,and vulnerabilities shape risk evolution and response effectiveness.Realizing cities as complex systems centered on human needs and behaviors is essential to understanding the complexities of coupled urban risks.This paper adopts a complex systems perspective to examine the intricacies of coupled urban risks,emphasizing the critical role of human decisions and behavior in shaping these dynamics.We focus on two key dimensions:cascading hazards in urban environments and cascading failures across interdependent exposed systems in cities.Existing risk assessment models often fail to capture the complexity of these processes,particularly when factoring in human decision-making.To tackle these challenges,we advocate for a standardized taxonomy of cascading hazards,urban components,and their interactions.At its core is a people-centric perspective,emphasizing the bidirectional interactions between people and the systems that serve them.Building on this foundation,we argue the need for an integrated,people-centric risk assessment framework that evaluates event impacts in relation to the hierarchical needs of people and incorporates their preparedness and response capacities.By leveraging real-time data,advanced simulations,and innovative validation methods,this framework aims to enhance the accuracy of coupled urban risk modeling.To effectively manage coupled urban risks,cities can draw from proven strategies in real complex systems.However,given the escalating uncertainties and complexities associated with climate change,prioritizing people-centric strategies is crucial.This approach will empower cities to build resilience not only against known hazards but also against evolving and unforeseen challenges in an increasingly uncertain world.
基金supported by the Ministry of Science and Technology of China(Nos.2021YFC3200904 and 2022YFC3203705)the National Natural Science Foundation of China(Nos.52270012 and 52070184).
文摘Phthalate esters(PAEs),recognized as endocrine disruptors,are released into the environment during usage,thereby exerting adverse ecological effects.This study investigates the occurrence,sources,and risk assessment of PAEs in surface water obtained from 36 sampling points within the Yellow River and Yangtze River basins.The total concentration of PAEs in the Yellow River spans from124.5 to 836.5 ng/L,with Dimethyl phthalate(DMP)(75.4±102.7 ng/L)and Diisobutyl phthalate(DiBP)(263.4±103.1 ng/L)emerging as the predominant types.Concentrations exhibit a pattern of upstream(512.9±202.1 ng/L)>midstream(344.5±135.3 ng/L)>downstream(177.8±46.7 ng/L).In the Yangtze River,the total concentration ranges from 81.9 to 441.6 ng/L,with DMP(46.1±23.4 ng/L),Diethyl phthalate(DEP)(93.3±45.2 ng/L),and DiBP(174.2±67.6 ng/L)as the primary components.Concentration levels follow a midstream(324.8±107.3 ng/L)>upstream(200.8±51.8 ng/L)>downstream(165.8±71.6 ng/L)pattern.Attention should be directed towards the moderate ecological risks of DiBP in the upstream of HH,and both the upstream and midstream of CJ need consideration for the moderate ecological risks associated with Di-n-octyl phthalate(DNOP).Conversely,in other regions,the associated risk with PAEs is either low or negligible.The main source of PAEs in Yellow River is attributed to the release of construction land,while in the Yangtze River Basin,it stems from the accumulation of pollutants in lakes and forests discharged into the river.These findings are instrumental for pinpointing sources of PAEs pollution and formulating control strategies in the Yellow and Yangtze Rivers,providing valuable insights for global PAEs research in other major rivers.
基金Supported by the National Natural Science Foundation of China,No.82270594the Independent Exploration and Innovation Project of Central South University,No.2024ZZTS0966.
文摘BACKGROUND Antibiotic resistance is a key factor influencing the treatment outcomes of Helicobacter pylori(H.pylori)infection.The antibiotic resistance spectrum of H.pylori varies in different regions.We investigated the current status of antibiotic resistance of H.pylori in Hunan Province and analyzed the factors related to such resistance to provide strategies for the accurate clinical treatment of H.pylori infection.AIM To understand the antibiotic resistance of H.pylori in Hunan Province and provide guidance for the clinical treatment of H.pylori infection.METHODS This study selected patients who underwent gastroscopy in five hospitals in Hunan Province from April 2022 to April 2023.The sensitivity of H.pylori to clarithromycin,levofloxacin,metronidazole,amoxicillin,furazolidone,and tetracycline was detected using the Agar dilution method.RESULTS H.pylori strains from a total of 566 patients were isolated and identified.The resistance rates of H.pylori strains to clarithromycin,levofloxacin,metronidazole,amoxicillin,furazolidone,and tetracycline were 49.2%,37.8%,76.1%,2.3%,1.4%,and 0.7%,respectively.The resistance rates to clarithromycin,levofloxacin,and metronidazole were high in the four regions of Hunan Province,and the overall resistance rates in central Hunan Province were higher than those in other regions.The resistance rates of H.pylori strains to clarithromycin and levofloxacin were significantly different among the different age groups(P<0.05),with the elderly group having a higher resistance rate than the young group.The resistance rate of H.pylori strains to clarithromycin was greater in patients with atrophic gastritis,and the resistance rate to levofloxacin was the lowest in patients with peptic ulcers.CONCLUSION The resistance rate of H.pylori to amoxicillin,clarithromycin,and metronidazole is high in Hunan Province.Age,stomach disease,and H.pylori reinfection may affect the antibiotic resistance of H.pylori.
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
文摘In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultrasound imaging,as well as the advances in fetal medical and interventional therapies informed by the deeper understanding of pathophysiological mechanisms underlying fetal and maternal disease processes.
文摘BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.
基金the Research Project of the Chinese Digestive Early Cancer Physicians’Joint Growth Program,No.GTCZ-2021-AH-34-0012.
文摘BACKGROUND Gastric cancer is one of the most common cancers worldwide,especially in East Asia.AIM To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia(LGIN)in the gastric mucosa and provide valuable guidance for improving treatment efficacy.METHODS A total of 357 patients diagnosed with LGIN based on initial pathological examination in Anhui Provincial Hospital or three other medical consortium units between January 2022 and June 2024 were included.Among them,296 patients were followed up with endoscopic and biopsy pathology.Logistic regression was utilized to analyze the relevant risk factors for LGIN progression in the gastric mucosa.RESULTS The distribution sites of LGIN among the 357 patients were as follows:Gastric antrum(54.6%),gastric cardia(24.1%),gastric angulus(8.7%),gastric body(4.8%),gastric fundus(4.8%),and multiple sites(3.1%).Additionally,of the 357 patients with LGIN,112(31.4%)developed ulceration and 59(16.5%)experienced gastric polyps.Furthermore,231 of the 357(64.71%)patients with LGIN tested positive for Helicobacter pylori(H.pylori)infection.The H.pylori infection rates of the patients with LGIN with accompanying atrophy,intestinal metaplasia,and gastric ulcer were 51.95%,59.31%,and 28.57%,respectively.Multivariate logistic regression analysis showed that age≥60 years[odds ratio(OR)=3.063,95%confidence interval(CI):1.351-6.945,P=0.007],H.pylori infection(OR=3.560,95%CI:1.158-10.949,P=0.027),multiple locations(OR=10.136,95%CI:2.045-50.237,P=0.005),lesion size≥2 cm(OR=3.921,95%CI:1.664-9.237,P=0.002),and gastric ulcer(OR=2.730,95%CI:1.197-6.223,P=0.017)were predictive factors for LGIN progression.CONCLUSION LGIN progression is closely related to age,H.pylori positivity,multiple locations,lesion size≥2 cm,and gastric ulcer.Thus,actively identifying these risk factors in patients with LGIN may have certain clinical significance in preventing further tumor progression.
基金supported by the Open Fund of the Laboratory for Earth Surface Processes,Ministry of Education,Peking University,Beijing,China,and the Cultivation Fund Program for Excellent Dissertation in Fujian Normal University,China(No.LWPYS202315)the Research Start-up Fund of Fujian Normal University,China(No.Y0720304X13).
文摘Fifty agricultural soil samples collected from Fuzhou,southeast China,were first investigated for the occurrence,distribution,and potential risks of twelve organophosphate esters(OPEs).The total concentration of OPEs(ΣOPEs)in soil ranged from 1.33 to 96.5 ng/g dry weight(dw),with an average value of 17.1 ng/g dw.Especially,halogenated-OPEs were the predominant group with amean level of 9.75 ng/g dw,and tris(1-chloro-2-propyl)phosphate(TCIPP)was the most abundant OPEs,accounting for 51.1%ofΣOPEs.The concentrations of TCIPP andΣOPEs were found to be significantly higher(P<0.05)in soils of urban areas than those in suburban areas.In addition,the use of agricultural plastic films and total organic carbon had a positive effect on the occurrence of OPE in this study.The positive matrix factorization model suggested complex sources of OPEs in agricultural soils from Fuzhou.The ecological risk assessment demonstrated that tricresyl phosphate presented a medium risk to land-based organisms(0.1≤risk quotient<1.0).Nevertheless,the carcinogenic and noncarcinogenic risks for human exposure to OPEs through soil ingestion and dermal absorption were negligible.These findings would facilitate further investigations into the pollution management and risk control of OPEs.
基金supported by the National Key Research and Development Program of China (No.2019YFC1904501).
文摘Furniture is identified as a vital volatile organic compound(VOC)emission source in the indoor environment.Leather has become the most common raw and auxiliary fabric material for upholstered furniture,particularly with extensive consumption in sofas,due to its abundant resources and efficient functions.Despite being widely traded across the world,little research has been conducted on the VOCs released by leathermaterials and their health risk assessment in the indoor environment.Accordingly,this study investigated the VOC emissions of leather with different grades and the health risk of the inhalation exposure.Based on the ultra-fast gas phase electronic nose(EN)and GC-FID/Qtof,the substantial emissions of aliphatic aldehyde ketones(Aks),particularly hexanal,appear to be the cause of off-flavor in medium and low grade(MG and LG)sofa leathers.The health risk assessment indicated that leather materials barely pose non-carcinogenic and carcinogenic effects to residents.Given the abundance of VOC sources and the accumulation of health risks in the indoor environment,more stringent specifications concerning qualitative and quantitative content should be extended to provide VOC treatment basic for the manufacturing industry and obtain better indoor air quality.
基金supported by the National Natural Science Foundation of China(grant numbers 82204127 and 72204172)。
文摘Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortality, high false positive rates can create economic and psychological burdens.
基金supported by the China Geological Survey Project(Nos.DD20220864 and DD20243077).
文摘Understanding the levels,causes,and sources of fluoride in groundwater is critical for public health,effective water resource management,and sustainable utilization.This study employs multivariate statistical methods,hazard quotient assessment,and geochemical analyses,such as mineral saturation index,ionic activities,and Gibbs diagrams,to investigate the hydrochemical characteristics,causes,and noncarcinogenic risks of fluoride in Red bed groundwater and geothermal water in the Guang'an area and neighboring regions.Approximately 9%of the Red bed groundwater samples contain fluoride concentrations exceeding 1 mg·L^(-1).The predominant water types identified are Cl-Na and HCO_(3)-Na,primarily influenced by evapotranspiration.Low-fluoride groundwater and high-fluoride geothermal water exhibit distinct hydrochemical types HCO_(3)-Ca and SO_(4)-Ca,respectively,which are mainly related to the weathering of carbonate,sulfate,and fluorite-containing rocks.Correlation analysis reveals that fluoride content in Red bed groundwater is positively associated with Na^(+),Cl^(-),SO_(4)^(2-),and TDS(r^(2)=0.45-0.64,p<0.01),while in geothermal water,it correlates strongly with pH,K^(+),Ca^(2+),and Mg^(2+)(r^(2)=0.52-0.80,p<0.05).Mineral saturation indices and ionic activities indicate that ion exchange processes and the dissolution of minerals such as carbonatite and fluorite are important sources of fluoride in groundwater.The enrichment of fluorine in the Red bed groundwater is linked to evaporation,cation exchange and dissolution of fluorite,caused by the lithologic characteristics of the red bed in this area.However,it exhibits minimal correlation with the geothermal water in the adjacent area.The noncarcinogenic health risk assessment indicates that 7%(n=5)of Red bed groundwater points exceed the fluoride safety limit for adults,while 12%(n=8)exceed the limit for children.These findings underscore the importance of avoiding highly fluoridated red bed groundwater as a direct drinking source and enhancing groundwater monitoring to mitigate health risks associated with elevated fluoride levels.
文摘·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.
基金supported by the National Natural Science Foundation of China(No.42205178)China Postdoctoral Science Foundation(No.2022M720459).
文摘With the continuous control of anthropogenic emissions,China’s air quality has improved significantly in recent years.Given this background,research on how the short-term exposure risks caused by air pollution in China have changed is insufficient.This study utilized hourly concentration data from ground observation stations and the official air quality guidelines of the Ministry of Ecology and Environment of China and the World Health Organization as standards to systematically investigate the spatiotemporal characteristics and short-term exposure risks of air pollution in China from 2015 to 2022.The results indicate that various atmospheric pollutants except for ozone showed a decreasing trend yearly.Nationwide,both single pollutant air pollution days(SAPDs)and multiple pollutant air pollution days(MAPDs)showed varying degrees of reduction within 15 and 25 days,respectively.SAPD was dominated mainly by excessive PM_(2.5)and PM_(10)pollutants,while MAPD was dominated mainly by excessive pollutant combinations,including PM_(2.5)+PM_(10),CO+PM_(2.5)+PM_(10),and SO_(2)+PM_(2.5)+PM_(10).As the concentration of atmospheric pollutants decreased,the total excess risk(ER)decreased yearly from 2015 to 2022,but there were significant regional differences.Now,the ER is less than 0.25%in southern China,in the range of 0.25%-0.5%in the North China Plain and some cities in the northeast,and higher than 1%in the northwest.Particulate matter is currently the primary pollutant posing short-term exposure risk in China,especially due to the impact of sandstorm weather.This study indicates that China’s atmospheric cleaning action is significantly beneficial for reducing health risks.
