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
Antibiotics are widespread in aquatic environments due to their extensive use in human healthcare and ani-mal husbandry.However,research on the occurrence and bioaccumulation of antibiotics in aquatic organisms within...Antibiotics are widespread in aquatic environments due to their extensive use in human healthcare and ani-mal husbandry.However,research on the occurrence and bioaccumulation of antibiotics in aquatic organisms within shallow wetland lakes remains limited.This study investigated the occurrence and bioaccumulation of ten commonly used antibiotics in the Baiyang Lake,northern China’s largest shallow wetland lake.The results indicated that sulfonamides and fluoroquinolones were the predominant antibiotics in surface water,whereas fluoroquinolones and macrolides were more prevalent in sediment.Fluoroquinolones demonstrated significant potential for bioaccumulation in targeted aquatic organisms,including both animals and plants(Carassius au-ratus and Phragmites australis).The bioaccumulation of antibiotics in Carassius auratus was correlated with their solubility,whereas in Phragmites australis,this was associated with their octanol-water partition coefficients and molecular weights.Ecological risk assessment indicated that most antibiotics posed minimal to low risk levels.However,four antibiotics were exceptions:clarithromycin(12.5%)and sulfamethoxazole(6.25%)presented a high risk in surface water samples,while norfloxacin(25.0%)and ciprofloxacin(25.0%)posed a high risk in sediment samples.Norfloxacin,ciprofloxacin,and roxithromycin were identified as key indicator antibiotics for enhancing the local monitoring and control of antibiotic contamination based on four criteria:(1)high con-centrations,(2)frequent detection,(3)capacity for bioaccumulation,and(4)ecological risk levels.This study contributes to a deeper understanding of the status of antibiotic contamination,bioaccumulation characteristics,and ecological risk in Baiyang Lake,thereby supporting efforts to monitor and regulate antibiotic pollution.展开更多
Objective:To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine(IIV3)under the context of Zhejiang province.Methods:A state transition simulation model was constructed to estimate the he...Objective:To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine(IIV3)under the context of Zhejiang province.Methods:A state transition simulation model was constructed to estimate the health and economic outcomes of IIV3 vaccination program compared to no vaccination for hypothetical cohorts of Zhejiang province stratified by age and risk status.Model input parameters were chosen based on published literatures and expert advices.The analysis used societal perspectives and a one-year time horizon,and permanent outcomes were also included.The primary outcome was the incremental cost-effectiveness ratio(ICER),with expression of US dollars per quality adjusted life years(QALYs)gained.Results:In subgroups not at high risk for influenza-related complications(non-high risk subgroup),ICER ranged from $6268/QALY(for adults aged 50-64 years)to $11260/QALY(for children aged from 6 months to 4 years).In subgroups at high risk for influenza-related complications(high risk subgroup),ICER ranged from cost-saving(adults aged≥65 years)to $5260/QALY(for children aged from 6 months to 4 years).ICER were most sensitive to changes in probability of influenza illness,cost of hospitalization,and probability of death for adults aged 18-49 years with non-high risk status.Conclusions:ICERs of annual influenza vaccination varied by age and risk status but were less than the Gross Domestic Product(GDP)per capita of Zhejiang province($17745 in 2023),which remained cost-effective for all-age and different risk status groups from a societal perspective.展开更多
Debris flow events are frequent in Tajikistan,yet comprehensive investigations at the regional scale are limited.This study integrates remote sensing,Geographic Information System,and machine learning techniques to ev...Debris flow events are frequent in Tajikistan,yet comprehensive investigations at the regional scale are limited.This study integrates remote sensing,Geographic Information System,and machine learning techniques to evaluate debris flow susceptibility and associated hazards across Tajikistan.A dataset comprising 405 documented debris flow points and 14 influencing factors,encompassing geological,climatic-hydrological,and anthropogenic variables,was established.Three machine learning algorithms—Random Forest,Support Vector Machine(SVM),and Multi-layer Perceptron—were applied to generate susceptibility maps and delineate debris flow risk zones.The results indicate that the areas of higher and high susceptibility accounted for 20.43%and 4.41%of the national area,respectively,and were predominantly concentrated along the Zeravshan and Vakhsh river basins.Among the evaluated models,SVM model demonstrated the highest predictive performance.Beyond conventional topographic and environmental controls,drought conditions were identified as a critical factor influencing debris flow occurrence within the arid and semi-arid mountainous regions of Tajikistan.These findings provide a scientific basis for regional debris flow risk management and disaster mitigation planning,and offer practical guidance for selecting conditioning factors in machine-learning-based susceptibility assessments in other dry mountainous environments.展开更多
Excessive levels of Fluoride(F−)and Cadmium(Cd)in drinking groundwater may pose health risks.This study assessed the health risks associated with F−and Cd contamination in rural drinking groundwater sources in Wutai C...Excessive levels of Fluoride(F−)and Cadmium(Cd)in drinking groundwater may pose health risks.This study assessed the health risks associated with F−and Cd contamination in rural drinking groundwater sources in Wutai County,Shanxi Province,China,to support population health protection,water resource management,and environmental decision-making.Groundwater samples were collected and analyzed,and a Human Health Risk Model(HHRA)was applied to evaluate groundwater quality.The results showed that both contents of F−and Cd in groundwater exceeded the Class III limits of China's national groundwater quality standard(GB/T 14848—2024).Fluoride levels met the Class V threshold,with enrichment area mainly located in the east part of the study area.Cadmium levels reached Class IV,with elevated concentrations primarily observed in the western and northwestern regions.Correlation analysis revealed that F−showed weak or no correlation with other measured substances,indicating independent sources.Health risk assessment results indicated that F−poses potential health risks to rural residents,while cadmium,due to its relatively low concentrations,does not currently present a significant health risk.Among different demographic groups,the health risk levels of F−exposure followed the order:Infants>children>adult females>adult males.The findings highlight that fluoride is the primary contributor to health risks associated with groundwater consumption in the study area.Strengthened monitoring and prevention of F−contamination are urgently needed.This research provides a scientific basis for the prevention and control of fluoride pollution in groundwater and offers practical guidance for safeguarding drinking water safety in rural China.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
Virtual power plant(VPP)integrates a variety of distributed renewable energy and energy storage to participate in electricity market transactions,promote the consumption of renewable energy,and improve economic effici...Virtual power plant(VPP)integrates a variety of distributed renewable energy and energy storage to participate in electricity market transactions,promote the consumption of renewable energy,and improve economic efficiency.In this paper,aiming at the uncertainty of distributed wind power and photovoltaic output,considering the coupling relationship between power,carbon trading,and green cardmarket,the optimal operationmodel and bidding scheme of VPP in spot market,carbon trading market,and green card market are established.On this basis,through the Shapley value and independent risk contribution theory in cooperative game theory,the quantitative analysis of the total income and risk contribution of various distributed resources in the virtual power plant is realized.Moreover,the scheduling strategies of virtual power plants under different risk preferences are systematically compared,and the feasibility and accuracy of the combination of Shapley value and independent risk contribution theory in ensuring fair income distribution and reasonable risk assessment are emphasized.A comprehensive solution for virtual power plants in the multi-market environment is constructed,which integrates operation strategy,income distribution mechanism,and risk control system into a unified analysis framework.Through the simulation of multi-scenario examples,the CPLEXsolver inMATLAB software is used to optimize themodel.The proposed joint optimization scheme can increase the profit of VPP participating in carbon trading and green certificate market by 29%.The total revenue of distributed resources managed by VPP is 9%higher than that of individual participation.展开更多
Despite the widespread presence and frequent detection of polycyclic aromatic hydrocarbons(PAHs)in various aspects of life,there is limited research on their exposure levels in pregnant women and cumulative exposure f...Despite the widespread presence and frequent detection of polycyclic aromatic hydrocarbons(PAHs)in various aspects of life,there is limited research on their exposure levels in pregnant women and cumulative exposure from the living environment.This study included 1311 women in late pregnancy from the Zunyi birth cohort and measured the urinary concentrations of 10 hydroxylated PAH metabolites(OH-PAHs).Risk assessment was conducted based on the estimated daily intake to calculate the hazard quotient and hazard index(HI).A linear regression model was used to analyze the relationship between creatinine-adjusted OH-PAHs concentrations and living environment and lifestyle factors,while principal component analysis was applied to trace the sources of PAHs exposure.1-OHPYR was detected in all participants’urine,with naphthalene metabolites having the highest concentrations among creatinine-adjusted PAHs.OH-PAHs concentrations were associated with housing type,room number,cooking frequency,household size,exercise frequency,fuel type,distance from main road,and drinking water source.Pregnant women using traditional fuels and living in bungalows had higher health risks than those using clean energy and living in buildings.Those living within 100 m of a main road had higher HI than those farther away.Coal combustion was identified as the primary source of PAHs exposure.The study emphasizes the importance of reducing PAHs exposure,especially for pregnant women living in polluted environments.It recommends public health interventions such as improving indoor ventilation and providing clean energy to reduce related health risks.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
AIM:To assess risk factors for epiretinal membranes(ERM)and examine their interactions in a nationally representative U.S.dataset.METHODS:Data from the 2005–2008 National Health and Nutrition Examination Survey(NHANE...AIM:To assess risk factors for epiretinal membranes(ERM)and examine their interactions in a nationally representative U.S.dataset.METHODS:Data from the 2005–2008 National Health and Nutrition Examination Survey(NHANES)were analyzed,a nationally representative U.S.dataset.ERM was identified via retinal imaging based on the presence of cellophane changes.Key predictors included age group,eye surgery history,and refractive error,with additional demographic and health-related covariates.Weighted univariate and multiple logistic regression models were used to assess associations and interaction effects between eye surgery and refractive error.RESULTS:Totally 3925 participants were analyzed.Older age,eye surgery,and refractive errors were significantly associated with ERM.Compared to those under 65y,the odds ratio(OR)for ERM was 3.08 for ages 65–75y(P=0.0014)and 4.76 for ages 75+years(P=0.0069).Eye surgery increased ERM risk(OR=3.48,P=0.0018).Moderate to high hyperopia and myopia were also associated with ERM(OR=2.65 and 1.80,respectively).A significant interaction between refractive error and eye surgery was observed(P<0.0001).Moderate to high myopia was associated with ERM only in those without eye surgery(OR=1.92,P=0.0443).Eye surgery was most strongly associated with ERM in the emmetropic group(OR=3.60,P=0.0027),followed by the moderate to high myopia group(OR=3.01,P=0.0031).CONCLUSION:ERM is significantly associated with aging,eye surgery,and refractive errors.The interaction between eye surgery and refractive error modifies ERM risk and highlights the importance of considering combined effects in clinical risk assessments.These findings may help guide individualized ERM risk assessment that may inform personalized approaches to ERM prevention and management.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
Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and wheth...Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.展开更多
The demand response(DR)market,as a vital complement to the electricity spot market,plays a key role in evoking user-side regulation capability to mitigate system-level supply‒demand imbalances during extreme events.Wh...The demand response(DR)market,as a vital complement to the electricity spot market,plays a key role in evoking user-side regulation capability to mitigate system-level supply‒demand imbalances during extreme events.While the DR market offers the load aggregator(LA)additional profitable opportunities beyond the electricity spot market,it also introduces new trading risks due to the significant uncertainty in users’behaviors.Dispatching energy storage systems(ESSs)is an effective means to enhance the risk management capabilities of LAs;however,coordinating ESS operations with dual-market trading strategies remains an urgent challenge.To this end,this paper proposes a novel systematic risk-aware coordinated trading model for the LA in concurrently participating in the day-ahead electricity spot market and DR market,which incorporates the capacity allocation mechanism of ESS based on market clearing rules to jointly formulate bidding and pricing decisions for the dual market.First,the intrinsic coupling characteristics of the LA participating in the dual market are analyzed,and a joint optimization framework for formulating bidding and pricing strategies that integrates ESS facilities is proposed.Second,an uncertain user response model is developed based on price‒response mechanisms,and actual market settlement rules accounting for under-and over-responses are employed to calculate trading revenues,where possible revenue losses are quantified via conditional value at risk.Third,by imposing these terms and the capacity allocation mechanism of ESS,the risk-aware stochastic coordinated trading model of the LA is built,where the bidding and pricing strategies in the dual model that trade off risk and profit are derived.The simulation results of a case study validate the effectiveness of the proposed trading strategy in controlling trading risk and improving the trading income of the LA.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
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
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
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
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 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
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.
基金supported by Hebei Natural Science Foundation(No.JZX2023018)Hebei Natural Science Foundation(No.C2022201042)the 100 Foreign Experts Plans of Hebei Province(No.606080123001).
文摘Antibiotics are widespread in aquatic environments due to their extensive use in human healthcare and ani-mal husbandry.However,research on the occurrence and bioaccumulation of antibiotics in aquatic organisms within shallow wetland lakes remains limited.This study investigated the occurrence and bioaccumulation of ten commonly used antibiotics in the Baiyang Lake,northern China’s largest shallow wetland lake.The results indicated that sulfonamides and fluoroquinolones were the predominant antibiotics in surface water,whereas fluoroquinolones and macrolides were more prevalent in sediment.Fluoroquinolones demonstrated significant potential for bioaccumulation in targeted aquatic organisms,including both animals and plants(Carassius au-ratus and Phragmites australis).The bioaccumulation of antibiotics in Carassius auratus was correlated with their solubility,whereas in Phragmites australis,this was associated with their octanol-water partition coefficients and molecular weights.Ecological risk assessment indicated that most antibiotics posed minimal to low risk levels.However,four antibiotics were exceptions:clarithromycin(12.5%)and sulfamethoxazole(6.25%)presented a high risk in surface water samples,while norfloxacin(25.0%)and ciprofloxacin(25.0%)posed a high risk in sediment samples.Norfloxacin,ciprofloxacin,and roxithromycin were identified as key indicator antibiotics for enhancing the local monitoring and control of antibiotic contamination based on four criteria:(1)high con-centrations,(2)frequent detection,(3)capacity for bioaccumulation,and(4)ecological risk levels.This study contributes to a deeper understanding of the status of antibiotic contamination,bioaccumulation characteristics,and ecological risk in Baiyang Lake,thereby supporting efforts to monitor and regulate antibiotic pollution.
基金funded by Medical and Health Science and Technology Project of Zhejiang province(Grant number:2023KY633).
文摘Objective:To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine(IIV3)under the context of Zhejiang province.Methods:A state transition simulation model was constructed to estimate the health and economic outcomes of IIV3 vaccination program compared to no vaccination for hypothetical cohorts of Zhejiang province stratified by age and risk status.Model input parameters were chosen based on published literatures and expert advices.The analysis used societal perspectives and a one-year time horizon,and permanent outcomes were also included.The primary outcome was the incremental cost-effectiveness ratio(ICER),with expression of US dollars per quality adjusted life years(QALYs)gained.Results:In subgroups not at high risk for influenza-related complications(non-high risk subgroup),ICER ranged from $6268/QALY(for adults aged 50-64 years)to $11260/QALY(for children aged from 6 months to 4 years).In subgroups at high risk for influenza-related complications(high risk subgroup),ICER ranged from cost-saving(adults aged≥65 years)to $5260/QALY(for children aged from 6 months to 4 years).ICER were most sensitive to changes in probability of influenza illness,cost of hospitalization,and probability of death for adults aged 18-49 years with non-high risk status.Conclusions:ICERs of annual influenza vaccination varied by age and risk status but were less than the Gross Domestic Product(GDP)per capita of Zhejiang province($17745 in 2023),which remained cost-effective for all-age and different risk status groups from a societal perspective.
基金supported by the National Natural Science Foundation of China(42361144880)the Science and Technology Program of Xizang Autonomous Region,China(XZ202402ZD0001)the Qinghai Province Basic Research Program Project,China(2024-ZJ-904).
文摘Debris flow events are frequent in Tajikistan,yet comprehensive investigations at the regional scale are limited.This study integrates remote sensing,Geographic Information System,and machine learning techniques to evaluate debris flow susceptibility and associated hazards across Tajikistan.A dataset comprising 405 documented debris flow points and 14 influencing factors,encompassing geological,climatic-hydrological,and anthropogenic variables,was established.Three machine learning algorithms—Random Forest,Support Vector Machine(SVM),and Multi-layer Perceptron—were applied to generate susceptibility maps and delineate debris flow risk zones.The results indicate that the areas of higher and high susceptibility accounted for 20.43%and 4.41%of the national area,respectively,and were predominantly concentrated along the Zeravshan and Vakhsh river basins.Among the evaluated models,SVM model demonstrated the highest predictive performance.Beyond conventional topographic and environmental controls,drought conditions were identified as a critical factor influencing debris flow occurrence within the arid and semi-arid mountainous regions of Tajikistan.These findings provide a scientific basis for regional debris flow risk management and disaster mitigation planning,and offer practical guidance for selecting conditioning factors in machine-learning-based susceptibility assessments in other dry mountainous environments.
基金supported by the Northeast Geological Science and Technology Innovation Center of China Geological Survey(Grant NO.QCJJ2022-43)the Natural Resources Comprehensive Survey Project(Grant Nos.DD20230470,DD20230508)the National Groundwater Monitoring Network Operation and Maintenance Program(Grant No.DD20251300109).
文摘Excessive levels of Fluoride(F−)and Cadmium(Cd)in drinking groundwater may pose health risks.This study assessed the health risks associated with F−and Cd contamination in rural drinking groundwater sources in Wutai County,Shanxi Province,China,to support population health protection,water resource management,and environmental decision-making.Groundwater samples were collected and analyzed,and a Human Health Risk Model(HHRA)was applied to evaluate groundwater quality.The results showed that both contents of F−and Cd in groundwater exceeded the Class III limits of China's national groundwater quality standard(GB/T 14848—2024).Fluoride levels met the Class V threshold,with enrichment area mainly located in the east part of the study area.Cadmium levels reached Class IV,with elevated concentrations primarily observed in the western and northwestern regions.Correlation analysis revealed that F−showed weak or no correlation with other measured substances,indicating independent sources.Health risk assessment results indicated that F−poses potential health risks to rural residents,while cadmium,due to its relatively low concentrations,does not currently present a significant health risk.Among different demographic groups,the health risk levels of F−exposure followed the order:Infants>children>adult females>adult males.The findings highlight that fluoride is the primary contributor to health risks associated with groundwater consumption in the study area.Strengthened monitoring and prevention of F−contamination are urgently needed.This research provides a scientific basis for the prevention and control of fluoride pollution in groundwater and offers practical guidance for safeguarding drinking water safety in rural China.
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.
基金funded by the Department of Education of Liaoning Province and was supported by the Basic Scientific Research Project of the Department of Education of Liaoning Province(Grant No.LJ222411632051)and(Grant No.LJKQZ2021085)Natural Science Foundation Project of Liaoning Province(Grant No.2022-BS-222).
文摘Virtual power plant(VPP)integrates a variety of distributed renewable energy and energy storage to participate in electricity market transactions,promote the consumption of renewable energy,and improve economic efficiency.In this paper,aiming at the uncertainty of distributed wind power and photovoltaic output,considering the coupling relationship between power,carbon trading,and green cardmarket,the optimal operationmodel and bidding scheme of VPP in spot market,carbon trading market,and green card market are established.On this basis,through the Shapley value and independent risk contribution theory in cooperative game theory,the quantitative analysis of the total income and risk contribution of various distributed resources in the virtual power plant is realized.Moreover,the scheduling strategies of virtual power plants under different risk preferences are systematically compared,and the feasibility and accuracy of the combination of Shapley value and independent risk contribution theory in ensuring fair income distribution and reasonable risk assessment are emphasized.A comprehensive solution for virtual power plants in the multi-market environment is constructed,which integrates operation strategy,income distribution mechanism,and risk control system into a unified analysis framework.Through the simulation of multi-scenario examples,the CPLEXsolver inMATLAB software is used to optimize themodel.The proposed joint optimization scheme can increase the profit of VPP participating in carbon trading and green certificate market by 29%.The total revenue of distributed resources managed by VPP is 9%higher than that of individual participation.
基金supported by the National Key R&D Program of China(Nos.2018YFC1004300 and 2018YFC1004302)the Science&Technology Program of Guizhou Province(Nos.QKHHBZ[2020]3002,QKHPTRC-GCC[2022]039-1 and QKHPTRCCXTD[2022]014)the Scientific Research Program of Guizhou Provincial Department of Education(No.QJJ[2023]019).
文摘Despite the widespread presence and frequent detection of polycyclic aromatic hydrocarbons(PAHs)in various aspects of life,there is limited research on their exposure levels in pregnant women and cumulative exposure from the living environment.This study included 1311 women in late pregnancy from the Zunyi birth cohort and measured the urinary concentrations of 10 hydroxylated PAH metabolites(OH-PAHs).Risk assessment was conducted based on the estimated daily intake to calculate the hazard quotient and hazard index(HI).A linear regression model was used to analyze the relationship between creatinine-adjusted OH-PAHs concentrations and living environment and lifestyle factors,while principal component analysis was applied to trace the sources of PAHs exposure.1-OHPYR was detected in all participants’urine,with naphthalene metabolites having the highest concentrations among creatinine-adjusted PAHs.OH-PAHs concentrations were associated with housing type,room number,cooking frequency,household size,exercise frequency,fuel type,distance from main road,and drinking water source.Pregnant women using traditional fuels and living in bungalows had higher health risks than those using clean energy and living in buildings.Those living within 100 m of a main road had higher HI than those farther away.Coal combustion was identified as the primary source of PAHs exposure.The study emphasizes the importance of reducing PAHs exposure,especially for pregnant women living in polluted environments.It recommends public health interventions such as improving indoor ventilation and providing clean energy to reduce related health risks.
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.
基金Supported by Chengdu Municipal Science and Technology Bureau Key R&D Support Program(No.2023-YF09-00041-SN)。
文摘AIM:To assess risk factors for epiretinal membranes(ERM)and examine their interactions in a nationally representative U.S.dataset.METHODS:Data from the 2005–2008 National Health and Nutrition Examination Survey(NHANES)were analyzed,a nationally representative U.S.dataset.ERM was identified via retinal imaging based on the presence of cellophane changes.Key predictors included age group,eye surgery history,and refractive error,with additional demographic and health-related covariates.Weighted univariate and multiple logistic regression models were used to assess associations and interaction effects between eye surgery and refractive error.RESULTS:Totally 3925 participants were analyzed.Older age,eye surgery,and refractive errors were significantly associated with ERM.Compared to those under 65y,the odds ratio(OR)for ERM was 3.08 for ages 65–75y(P=0.0014)and 4.76 for ages 75+years(P=0.0069).Eye surgery increased ERM risk(OR=3.48,P=0.0018).Moderate to high hyperopia and myopia were also associated with ERM(OR=2.65 and 1.80,respectively).A significant interaction between refractive error and eye surgery was observed(P<0.0001).Moderate to high myopia was associated with ERM only in those without eye surgery(OR=1.92,P=0.0443).Eye surgery was most strongly associated with ERM in the emmetropic group(OR=3.60,P=0.0027),followed by the moderate to high myopia group(OR=3.01,P=0.0031).CONCLUSION:ERM is significantly associated with aging,eye surgery,and refractive errors.The interaction between eye surgery and refractive error modifies ERM risk and highlights the importance of considering combined effects in clinical risk assessments.These findings may help guide individualized ERM risk assessment that may inform personalized approaches to ERM prevention and management.
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financial support fromthe Chung Shan Medical University Hospital,Taiwan(CSH-2022-A-009).
文摘Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.
基金supported by National Natural Science Foundation of China(52407126).
文摘The demand response(DR)market,as a vital complement to the electricity spot market,plays a key role in evoking user-side regulation capability to mitigate system-level supply‒demand imbalances during extreme events.While the DR market offers the load aggregator(LA)additional profitable opportunities beyond the electricity spot market,it also introduces new trading risks due to the significant uncertainty in users’behaviors.Dispatching energy storage systems(ESSs)is an effective means to enhance the risk management capabilities of LAs;however,coordinating ESS operations with dual-market trading strategies remains an urgent challenge.To this end,this paper proposes a novel systematic risk-aware coordinated trading model for the LA in concurrently participating in the day-ahead electricity spot market and DR market,which incorporates the capacity allocation mechanism of ESS based on market clearing rules to jointly formulate bidding and pricing decisions for the dual market.First,the intrinsic coupling characteristics of the LA participating in the dual market are analyzed,and a joint optimization framework for formulating bidding and pricing strategies that integrates ESS facilities is proposed.Second,an uncertain user response model is developed based on price‒response mechanisms,and actual market settlement rules accounting for under-and over-responses are employed to calculate trading revenues,where possible revenue losses are quantified via conditional value at risk.Third,by imposing these terms and the capacity allocation mechanism of ESS,the risk-aware stochastic coordinated trading model of the LA is built,where the bidding and pricing strategies in the dual model that trade off risk and profit are derived.The simulation results of a case study validate the effectiveness of the proposed trading strategy in controlling trading risk and improving the trading income of the LA.
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.
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.
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.
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.
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.
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.
