Evaluation of Water Resources Sustainable Utilization in Wuhan Based on the Model of SUDE

SUDE model is a systematic sustainable use model based on the view of the whole life cycle of water resources. The analysis of the model water resources has been divided into four stages according to the state of motion water resourcesat different times in its life cycle, namely the water supply stage (“S”),water use phase (“U”),water collection,treatment anddrainage stage (“D”) and water return to natural ecological (ecology) environment for dilution, degradation stage (“E”).on the analysis above,SUDE theoretical model of water system has been built and corresponding evaluation index systemhas therefore been established. Then, we use entropy weight TOPSIS method to evaluate thesustainability of water resource during 2013∼2017 yearsin Wuhan, and finally the corresponding conclusions and suggestion have been drawn according to the result of evaluation in the paper.

Sensitivity and Specificity of Mandibular Third Molar Calcification at Chronological Age and Hand Wrist Maturation Stage to Discriminate Between Female and Male at Pubertal Growth Period

Background: The mandibular third molar is the last tooth that is not completely developed by the time pubertal growth has been finished. Maturation of the mandibular third molar is one of the physiological maturation indicators that can be used to determine the stage of pubertal growth. Objective: The aim of the study was to determine the sensitivity and specificity of mandibular third molar calcification at chronological age and hand wrist maturation stage to discriminate between female and male at pubertal growth period. Methods: It is a retrospective study with a cross-sectional approach using panoramic and hand-wrist digital radiographs of 279 females and 144 males, age 8-17 years, with a total of 423 panoramic radiographs and 423 hand-wrist radiographs. Statistical analysis was performed using Excel Mega Stat. ANOVA to analyze the differences between mandibular third molar calcification at chronological age and hand-wrist maturation stage, and t-test was used to analyze the differences between females and males. Spearman rank correlation was used for the analysis of the correlation between mandibular third molar calcification with chronological age and hand-wrist maturation stage; sensitivity and specificity were used to discriminate the pubertal growth period between mandibular third molar calcification and hand-wrist maturation stage. Results: There were significant differences found in mandibular third molar crown maturation stage B and C, but no significant difference was observed between mandibular third molar stage A, D, E, F, G and H, between females and males. The highest percentage of mandibular third molar crown formation in females was observed at stage D (6.68%) at MP3u, and in males, it was observed at stage D (8.83%) at SMI-4. The highest percentage of root formation in females was stage E (8.24%) at the SMI-10 stage, and males stage F (4.86%) at MP3u. The correlation was observed between mandibular third molar calcification with hand-wrist, females 0.22 and males 0.43, and chronological age 0.60 for females and 0.69 for males. The highest sensitivity of mandibular third molar calcification of 97.0% was observed in female at SMI-4 of hand-wrist maturation with specificity of 100%, while in male, a sensitivity of 94.5% was observed at SMI-2 stage with a specificity of 99.99%. Conclusion: There were significant differences found in mandibular third molar calcification between females and males except for stage B and stage C; weak correlation was observed between mandibular third molar calcification and hand-wrist, and moderate correlation was observed with chronological age. The sensitivity and specificity in females and males indicate that mandibular third molar calcification is only useful for diagnosing the pre-pubertal growth phase.

Guidance for Timely and Appropriate Referral of Patients With Advanced Heart Failure: A Scientific Statement From the American Heart Association

Among the estimated 6.2 million Americans living with heart failure (HF), ≈5%/y may progress to advanced, or stage D, disease. Advanced HF has a high morbidity and mortality, such that early recognition of this condition is important to optimize care. Delayed referral or lack of referral in patients who are likely to derive benefit from an advanced HF evaluation can have important adverse consequences for patients and their families. A 2-step process can be used by practitioners when considering referral of a patient with advanced HF for consideration of advanced therapies, focused on recognizing the clinical clues associated with stage D HF and assessing potential benefits of referral to an advanced HF center. Although patients are often referred to an advanced HF center to undergo evaluation for advanced therapies such as heart transplantation or implantation of a left ventricular assist device, there are other reasons to refer, including access to the infrastructure and multidisciplinary team of the advanced HF center that offers a broad range of expertise. The intent of this statement is to provide a framework for practitioners and health systems to help identify and refer patients with HF who are most likely to derive benefit from referral to an advanced HF center.

Programmed Death-Ligand 1 (PD-L1) Gene Polymorphisms as Predictive Markers for Development of Hepatocellular Carcinoma in Chronic Hepatitis C Virus Patients

Background Hepatocellular carcinoma is the sixth most common cause of cancer, and ranks fourth among the causes of cancer-related death. Major risk factors for HCC include chronic alcohol consumption, hepatitis B, hepatitis C and non-alcoholic fatty liver disease. Other, less common causes are Wilson’s disease, hereditary hemochromatosis, alpha1-antitrypsin deficiency, primary biliary cirrhosis and autoimmune hepatitis. Objective To investigate the associations of the genetic variants of PD-L1 (rs4143815 and rs2297136) with the risk of HCC in the Egyptian population. Patients and Methods This study was conducted in co-operation between Gastroenterology and Hepatology Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute “between” March 2020 to July 2020. It included total participants of 138 Divided to Group (A): 35 normal people as control. Group (B): 51 patients with HCV infection and cirrhosis Group (c): 52 patients with HCV infection and cirrhosis with HCC. The patients were recruited from the outpatient clinic of Theodor Bilharz Research Institute Hospital (after consents were obtained). Results Also, the present study demonstrated that the functional polymorphisms (rs4143815) (CG) of the PD-L1 gene were associated with HCC risk as it is expressed in (53.3%) in HCC, (25.6%) in cirrhosis and (23.1%) in control group. And, rs4143815 (CG) show significant increase in Child C patients as (75%) Child C vs. (10%) Child A and (45%) was MELD/NA (20-29) vs. (10%) <9 with (61%) of patients were stage D in BCLC. There is significant increase in rs4143815 (CG) with age as 95% of gene positive patients more than 50years.With no significant in gender as 70% males and 30% females and there is no significant in smoking and DM. So, PDL-1 gene polymorphism rs4143815 (CG) could be used as a predictive marker for HCC after validation by larger studies or met analysis. Conclusion The present study demonstrated that the functional polymorphisms (rs4143815) (CG) of the PD-L1 gene were associated with HCC risk as it is expressed in (53.3%) of HCC, (25.6%) of cirrhosis and (23.1) % of control group. There is significant increase in rs4143815 (CG) with age as 95% of gene positive patients more than 50 years with no significance in gender smoking and DM. rs4143815 (CG) show significant increase in Child C patients as (75%) Child C vs. (10%) Child A and (45%) of patients was MELD/NA (20-29) vs. (10%) <9 and (70%) of patients were stage D in BCLC.

Impact of Age on Outcomes in Patients With Cardiogenic Shock

Background: Advanced age is associated with poor outcomes in cardiovascular emergencies. We sought to determine the association of age, use of support devices and shock severity on mortality in cardiogenic shock (CS).Methods: Characteristics and outcomes in CS patients included in the Cardiogenic Shock Work Group (CSWG) registry from 8 US sites between 2016 and 2019 were retrospectively reviewed. Patients were subdivided by age into quintiles and Society for Cardiovascular Angiography & Interventions (SCAI) shock severity.Results: We reviewed 1,412 CS patients with a mean age of 59.9 ± 14.8 years, including 273 patients > 73 years of age. Older patients had significantly higher comorbidity burden including diabetes, hypertension and coronary artery disease. Veno-arterial extracorporeal membrane oxygenation was used in 332 (23%) patients, Impella in 410 (29%) and intra-aortic balloon pump in 770 (54%) patients. Overall in-hospital survival was 69%, which incrementally decreased with advancing age (p < 0.001). Higher age was associated with higher mortality across all SCAI stages (p = 0.003 for SCAI stage C; p < 0.001 for SCAI stage D; p = 0.005 for SCAI stage E), regardless of etiology (p < 0.001).Conclusion: Increasing age is associated with higher in-hospital mortality in CS across all stages of shock severity. Hence, in addition to other comorbidities, increasing age should be prioritized during patient selection for device support in CS.