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
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 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
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
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
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
·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
we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cance...we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cancer progression have recently been described in extensive clinical research,and should be included in this analysis to achieve a more accurate prognosis.These factors include inflammation,gut microbiota composition,immune status and nutritional balance,as they influence the post-surgical survival profile of patients with stage II colorectal cancer.We also address the clinical implementation and limitations of these analyses.Evaluation of the patient´s entire context is essential for selection of the most appropriate therapy.展开更多
To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforce...To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.展开更多
BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postope...BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postoperative complications,in-cluding pulmonary infections,due to weakened immune function and metabolic abnormalities.Postoperative pulmonary infection(PPI)is a predominant com-plication after thoracoscopic radical resection of LC,significantly affecting patient outcomes and increasing healthcare burdens.Determining risk factors for PPI in this vulnerable population is crucial for improving surgical outcomes and redu-cing infection rates.AIM To develop and validate a predictive model for PPI in elderly patients with dia-betes undergoing thoracoscopic radical resection for LC and to assess its reliability and validity.METHODS This retrospective study included 212 patients with LC who received treatment at our hospital from March 2015 to March 2022.General clinical information,sur-gical treatment details,and laboratory test results were collected and analyzed.Patients were grouped according to infection occurrence during the postoperative hospitalization period.Risk factors for PPIs were determined through logistic regression analysis,and a nomogram prediction model was established using R software to assess its predictive accuracy and performance.RESULTS Among the 212 patients[median age:72 years(interquartile range:60-82 years)],41 developed PPI(19.34%),with Gram-negative bacteria being the predominant pathogens(64.14%).Factors,such as age of≥70 years,presence of respiratory diseases,maximum tumor diameter of≥4 cm,stages II-III,receiving neoadjuvant chemotherapy of≥2 times preoperatively,surgery duration of≥3 hours,chest drainage tube placement duration of≥3.5 days,preoperative fasting blood glucose levels,hemoglobin A1c(HbA1c)levels,and multi-leaf resection,were markedly higher in the infection group than in the non-infection group.Conversely,forced expiratory volume in 1 second(FEV1)of≥80%and albumin(Alb)levels were lower in the infection group.Multivariate logistic regression analysis revealed that receiving neoadjuvant chemotherapy of≥2 times[odds ratio(OR)=2.987;P=0.036],maximum tumor diameter of≥4 cm(OR=3.959;P=0.013),multi-leaf resection(OR=3.18;P=0.036),preoperative FEV1 of≤80%(OR=3.305;P=0.029),and high HbA1c levels(OR=2.39;P=0.003)as key risk factors for PPI,whereas high Alb levels(OR=0.507;P<0.001)was protective.The nomogram model demonstrated excellent diagnostic ability(area under the curve=0.901,0.915),and calibration curves and decision curve analysis revealed good predictive performance and clinical applicability of the model.CONCLUSION The primary pathogens of PPI in elderly patients with diabetes and LC undergoing thoracoscopic radical resection are Gram-negative bacteria.The nomogram model,based on preoperative neoadjuvant chemotherapy cycles,maximum tumor diameter,range of resection,and preoperative FEV1,Alb,and HbA1c levels,shows high clinical value in predicting the risk of PPI in this patient population.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
With the increase of international trade activities and the gradual melting of the polar ice cap,the importance of the Arctic route for marine transportation has been emphasized.Prediction of the polar navigation wind...With the increase of international trade activities and the gradual melting of the polar ice cap,the importance of the Arctic route for marine transportation has been emphasized.Prediction of the polar navigation window period is crucial for navigating in the Arctic route,which is of great significance to the selection of the route and the optimization of navigation.This paper introduces the establishment of a risk index system,determination of risk index weight,establishment of a risk evaluation model,and prediction algorithm for the window period.In addition,data sources of both environmental factors and ship factors are introducted,and their shortcomings are analyzed,followed by introduction of various methods involved in window prediction and analysis of their advantages and disadvantages.The quantitative risk evaluation and window period algorithm can provide a reference for the research of polar navigation window period prediction.展开更多
Due to their persistence,bioaccumulation,and resistance to degradation,perfluorinated substances(PFASs)have significant impacts on the environment and human health.This study comprehensively analyzed and assessed the ...Due to their persistence,bioaccumulation,and resistance to degradation,perfluorinated substances(PFASs)have significant impacts on the environment and human health.This study comprehensively analyzed and assessed the occurrence characteristics,sources,and potential ecological risks of 13 PFASs in the Yangtze River.The results indicated that the concentrations ofΣPFASs range from 5.1 to 57.7 ng/L,with more severe pollution downstream and perfluorobutane sulfonate(PFBuS)being the main pollutant.ΣPFASs showed a positive correlation with total organic carbon and absorbance under the condition of UV wavelength 254 nm(UV_(254)),and a negative correlation with total dissolved solids.Positive matrix factorization model analysis revealed that the primary sources of PFASs in the study area are food packaging,the electroplating industry,and the manufacturing and processing of fluoropolymer-containing products.The total ecological risk value of PFASs indicated that the ecological risks to algae,invertebrates,and fish are negligible.The annual load of ΣPFASs in the Yangtze River was 39.00 t,with the highest concentrations of pollutants being PFBuS(26.41 t/year),perfluorobutanoic acid(6.47 t/year),and perfluorooctanoic acid(PFOA,3.19t/year).While PFASs have not yet posed a risk to aquatic organisms,the increase in the use of short-chain PFASs substitutes(C4-C7)due to the regulation of PFOA and perfluorooctane sulfonate highlights the need for continued monitoring of short-chain PFASs pollution.展开更多
Agricultural soil is related to food security and human health,antibiotics and heavy metals(HMs),as two typical pollutants,possess a high coexistence rate in the environmental medium,which is extremely prone to induci...Agricultural soil is related to food security and human health,antibiotics and heavy metals(HMs),as two typical pollutants,possess a high coexistence rate in the environmental medium,which is extremely prone to inducing antibiotic-HMs combined pollution.Recently,frequent human activities have led to more prominent antibiotics-HMs combined contamination in agricultural soils,especially the production and spread of antibiotic resistance genes(ARGs),heavy metal resistance genes(MRGs),antibiotic resistant bacteria(ARB),and antibiotics-HMs complexes(AMCs),which seriously threaten soil ecology and human health.This review describes the main sources(Intrinsic and manmade sources),composite mechanisms(co-selective resistance,oxidative stress,and Joint toxicity mechanism),environmental fate and the potential risks(soil ecological and human health risks)of antibiotics and HMs in agricultural soils.Finally,the current effective source blocking,transmission control,and attenuation strategies are classified for discussion,such as the application of additives and barrier materials,as well as plant and animal remediation and bioremediation,etc.,pointing out that future research should focus on the whole chain process of“source-processterminal”,intending to provide a theoretical basis and decision-making reference for future research.展开更多
Abandoned mines,especially pyrite-rich ones,release acid mine drainage(AMD)with high acidity and excessive amounts of heavy metals,threatening regional ecosystems.Six samples of mine drainage,nine samples of surface w...Abandoned mines,especially pyrite-rich ones,release acid mine drainage(AMD)with high acidity and excessive amounts of heavy metals,threatening regional ecosystems.Six samples of mine drainage,nine samples of surface water,and twelve samples of sediment were analyzed in this case study of the Dashu pyrite mine in southwest China.A comprehensive analysis of the pollution levels,pollution sources,and potential hazards of eight metals(Ni,Cd,Cu,Zn,Fe,Al,Pb,and Mn)that exceeded regulatory standardswas conducted bymonitoring 24 conventional and characteristic indicators.Ultimately,this research evaluated the environmental hazards associated with abandonedmine water using the"pressure-response"model,thereby providing valuable insights for the effective protection of the environment in mining regions.The primary pollutants in mine water were determined to be SO_(4)^(2−),Fe,and Mn,with concentrations of 7700,1450,and 6.78mg/L,respectively.A clear"source-sink"dynamic was observed between themine water and the surrounding water system.surface water was primarily polluted by Ni and Mn,while water system sediments were primarily polluted by Cu and Hg.Ion ratio and Pearson correlation analyses indicated heavy metals in surface water and sediments originated from the same AMD source.The"pressureresponse"model was used to assess the environmental hazards of water from abandoned mines.Mines W1,W2,W5,and W6 were classified as high-risk,while W3 and W4 were medium-risk.This study offers a novel approach and valuable reference for identifying and classifying environmental risks in abandoned mines and targeting AMD treatment.展开更多
BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity va...BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity variables affect MDD.We hypothesize that high-level trait-and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.AIM To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.METHODS In this prospective study,281 MDD patients were enrolled from a tertiary care setting.High-level stress-sensitivity factors were classified as trait anxiety,state anxiety,perceived stress,and neuroticism,with a total score in the top quartile of the research cohort.The cumulative effects of stress-sensitivity factors on cognitive dysfunction,disability and functional impairment,suicide risk,and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis.Correlations were investigated further using multiple regression analysis.RESULTS Regarding high-level stress-sensitivity factors,53.40%of patients had at least one at baseline,and 29.61%had two or more.Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline(all P<0.001).Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms(partialη^(2)=0.153;standardizedβ=0.195;P<0.05).The follow-up outcomes were significantly impacted only by the high-level trait-related components,mainly when it came to depressive symptoms and suicide risk,which were predicted by trait anxiety and neuroticism,respectively(partialη^(2)=0.204 and 0.156;standardizedβ=0.247 and 0.392;P<0.05).CONCLUSION To enhance outcomes of MDD and lower the suicide risk,screening for stress-sensitivity factors and considering multifaceted measures,mainly focusing on trait-related ones,should be addressed clinically.展开更多
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.
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 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 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(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.
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.
基金Supported by Consejo Nacional de Investigaciones Científicas y Técnicas,No.PIP11220200103061COAgencia Nacional de promoción Científica y Tecnológica,No.PICT-2020-SERIEA-03440Universidad Nacional del Sur,No.PGI 24/B303 and No.PGI 24/ZB01.
文摘we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cancer progression have recently been described in extensive clinical research,and should be included in this analysis to achieve a more accurate prognosis.These factors include inflammation,gut microbiota composition,immune status and nutritional balance,as they influence the post-surgical survival profile of patients with stage II colorectal cancer.We also address the clinical implementation and limitations of these analyses.Evaluation of the patient´s entire context is essential for selection of the most appropriate therapy.
基金Supported by National Key Research and Development Program of China(Grant No.2022YFE0117100)National Science Foundation of China(Grant No.52102468,52325212)Fundamental Research Funds for the Central Universities。
文摘To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.
文摘BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postoperative complications,in-cluding pulmonary infections,due to weakened immune function and metabolic abnormalities.Postoperative pulmonary infection(PPI)is a predominant com-plication after thoracoscopic radical resection of LC,significantly affecting patient outcomes and increasing healthcare burdens.Determining risk factors for PPI in this vulnerable population is crucial for improving surgical outcomes and redu-cing infection rates.AIM To develop and validate a predictive model for PPI in elderly patients with dia-betes undergoing thoracoscopic radical resection for LC and to assess its reliability and validity.METHODS This retrospective study included 212 patients with LC who received treatment at our hospital from March 2015 to March 2022.General clinical information,sur-gical treatment details,and laboratory test results were collected and analyzed.Patients were grouped according to infection occurrence during the postoperative hospitalization period.Risk factors for PPIs were determined through logistic regression analysis,and a nomogram prediction model was established using R software to assess its predictive accuracy and performance.RESULTS Among the 212 patients[median age:72 years(interquartile range:60-82 years)],41 developed PPI(19.34%),with Gram-negative bacteria being the predominant pathogens(64.14%).Factors,such as age of≥70 years,presence of respiratory diseases,maximum tumor diameter of≥4 cm,stages II-III,receiving neoadjuvant chemotherapy of≥2 times preoperatively,surgery duration of≥3 hours,chest drainage tube placement duration of≥3.5 days,preoperative fasting blood glucose levels,hemoglobin A1c(HbA1c)levels,and multi-leaf resection,were markedly higher in the infection group than in the non-infection group.Conversely,forced expiratory volume in 1 second(FEV1)of≥80%and albumin(Alb)levels were lower in the infection group.Multivariate logistic regression analysis revealed that receiving neoadjuvant chemotherapy of≥2 times[odds ratio(OR)=2.987;P=0.036],maximum tumor diameter of≥4 cm(OR=3.959;P=0.013),multi-leaf resection(OR=3.18;P=0.036),preoperative FEV1 of≤80%(OR=3.305;P=0.029),and high HbA1c levels(OR=2.39;P=0.003)as key risk factors for PPI,whereas high Alb levels(OR=0.507;P<0.001)was protective.The nomogram model demonstrated excellent diagnostic ability(area under the curve=0.901,0.915),and calibration curves and decision curve analysis revealed good predictive performance and clinical applicability of the model.CONCLUSION The primary pathogens of PPI in elderly patients with diabetes and LC undergoing thoracoscopic radical resection are Gram-negative bacteria.The nomogram model,based on preoperative neoadjuvant chemotherapy cycles,maximum tumor diameter,range of resection,and preoperative FEV1,Alb,and HbA1c levels,shows high clinical value in predicting the risk of PPI in this patient population.
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.
文摘With the increase of international trade activities and the gradual melting of the polar ice cap,the importance of the Arctic route for marine transportation has been emphasized.Prediction of the polar navigation window period is crucial for navigating in the Arctic route,which is of great significance to the selection of the route and the optimization of navigation.This paper introduces the establishment of a risk index system,determination of risk index weight,establishment of a risk evaluation model,and prediction algorithm for the window period.In addition,data sources of both environmental factors and ship factors are introducted,and their shortcomings are analyzed,followed by introduction of various methods involved in window prediction and analysis of their advantages and disadvantages.The quantitative risk evaluation and window period algorithm can provide a reference for the research of polar navigation window period prediction.
基金supported by the Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDB0750000)the National Natural Science Foundation of China(Nos.52270012 and 52470018)the Ministry of Science and Technology of China(Nos.2022YFC3203705 and2021YFC3200904)。
文摘Due to their persistence,bioaccumulation,and resistance to degradation,perfluorinated substances(PFASs)have significant impacts on the environment and human health.This study comprehensively analyzed and assessed the occurrence characteristics,sources,and potential ecological risks of 13 PFASs in the Yangtze River.The results indicated that the concentrations ofΣPFASs range from 5.1 to 57.7 ng/L,with more severe pollution downstream and perfluorobutane sulfonate(PFBuS)being the main pollutant.ΣPFASs showed a positive correlation with total organic carbon and absorbance under the condition of UV wavelength 254 nm(UV_(254)),and a negative correlation with total dissolved solids.Positive matrix factorization model analysis revealed that the primary sources of PFASs in the study area are food packaging,the electroplating industry,and the manufacturing and processing of fluoropolymer-containing products.The total ecological risk value of PFASs indicated that the ecological risks to algae,invertebrates,and fish are negligible.The annual load of ΣPFASs in the Yangtze River was 39.00 t,with the highest concentrations of pollutants being PFBuS(26.41 t/year),perfluorobutanoic acid(6.47 t/year),and perfluorooctanoic acid(PFOA,3.19t/year).While PFASs have not yet posed a risk to aquatic organisms,the increase in the use of short-chain PFASs substitutes(C4-C7)due to the regulation of PFOA and perfluorooctane sulfonate highlights the need for continued monitoring of short-chain PFASs pollution.
基金supported by the National Natural Science Foundation of China(No.32171615)the National Key R&D Program of China(2019YFC1804102)。
文摘Agricultural soil is related to food security and human health,antibiotics and heavy metals(HMs),as two typical pollutants,possess a high coexistence rate in the environmental medium,which is extremely prone to inducing antibiotic-HMs combined pollution.Recently,frequent human activities have led to more prominent antibiotics-HMs combined contamination in agricultural soils,especially the production and spread of antibiotic resistance genes(ARGs),heavy metal resistance genes(MRGs),antibiotic resistant bacteria(ARB),and antibiotics-HMs complexes(AMCs),which seriously threaten soil ecology and human health.This review describes the main sources(Intrinsic and manmade sources),composite mechanisms(co-selective resistance,oxidative stress,and Joint toxicity mechanism),environmental fate and the potential risks(soil ecological and human health risks)of antibiotics and HMs in agricultural soils.Finally,the current effective source blocking,transmission control,and attenuation strategies are classified for discussion,such as the application of additives and barrier materials,as well as plant and animal remediation and bioremediation,etc.,pointing out that future research should focus on the whole chain process of“source-processterminal”,intending to provide a theoretical basis and decision-making reference for future research.
基金supported by the National Key Research and Development Program of China(No.2023YFC3710000)the National Natural Science Foundation of China(Nos.42277078 and 42307118).
文摘Abandoned mines,especially pyrite-rich ones,release acid mine drainage(AMD)with high acidity and excessive amounts of heavy metals,threatening regional ecosystems.Six samples of mine drainage,nine samples of surface water,and twelve samples of sediment were analyzed in this case study of the Dashu pyrite mine in southwest China.A comprehensive analysis of the pollution levels,pollution sources,and potential hazards of eight metals(Ni,Cd,Cu,Zn,Fe,Al,Pb,and Mn)that exceeded regulatory standardswas conducted bymonitoring 24 conventional and characteristic indicators.Ultimately,this research evaluated the environmental hazards associated with abandonedmine water using the"pressure-response"model,thereby providing valuable insights for the effective protection of the environment in mining regions.The primary pollutants in mine water were determined to be SO_(4)^(2−),Fe,and Mn,with concentrations of 7700,1450,and 6.78mg/L,respectively.A clear"source-sink"dynamic was observed between themine water and the surrounding water system.surface water was primarily polluted by Ni and Mn,while water system sediments were primarily polluted by Cu and Hg.Ion ratio and Pearson correlation analyses indicated heavy metals in surface water and sediments originated from the same AMD source.The"pressureresponse"model was used to assess the environmental hazards of water from abandoned mines.Mines W1,W2,W5,and W6 were classified as high-risk,while W3 and W4 were medium-risk.This study offers a novel approach and valuable reference for identifying and classifying environmental risks in abandoned mines and targeting AMD treatment.
基金Supported by Science and Technology Innovation 2030-Major Projects,No.2021ZD0202000National Key Research and Development Program of China,No.2019YFA0706200+2 种基金National Natural Science Foundation of China,No.82371535Science and Technology Innovation Program of Hunan Province,No.2023RC3083Fundamental Research Funds for the Central Universities of Central South University,No.2023ZZTS0838.
文摘BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity variables affect MDD.We hypothesize that high-level trait-and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.AIM To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.METHODS In this prospective study,281 MDD patients were enrolled from a tertiary care setting.High-level stress-sensitivity factors were classified as trait anxiety,state anxiety,perceived stress,and neuroticism,with a total score in the top quartile of the research cohort.The cumulative effects of stress-sensitivity factors on cognitive dysfunction,disability and functional impairment,suicide risk,and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis.Correlations were investigated further using multiple regression analysis.RESULTS Regarding high-level stress-sensitivity factors,53.40%of patients had at least one at baseline,and 29.61%had two or more.Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline(all P<0.001).Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms(partialη^(2)=0.153;standardizedβ=0.195;P<0.05).The follow-up outcomes were significantly impacted only by the high-level trait-related components,mainly when it came to depressive symptoms and suicide risk,which were predicted by trait anxiety and neuroticism,respectively(partialη^(2)=0.204 and 0.156;standardizedβ=0.247 and 0.392;P<0.05).CONCLUSION To enhance outcomes of MDD and lower the suicide risk,screening for stress-sensitivity factors and considering multifaceted measures,mainly focusing on trait-related ones,should be addressed clinically.
