Publications by authors named "Lan Gao"

251 Publications

Mitochondrial ROS-mediated ribosome stalling and GCN2 activation are partially involved in 1-nitropyrene-induced steroidogenic inhibition in testes.

Environ Int 2022 Jul 14;167:107393. Epub 2022 Jul 14.

Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei 230032, China. Electronic address:

In the past 50 years, testosterone (T) level in men has declined gradually. In this research, we discovered that acute exposure to 1-nitropyrene (1-NP), an environmental stressor from polluted atmosphere, reduced T contents by downregulating steroidogenic proteins in mouse testes and Leydig cells. Acute 1-NP exposure caused GCN2 activation and eIF2α phosphorylation, a marker of integrated stress, in mouse testes and Leydig cells. GCN2iB, a selective GCN2 kinase inhibitor, and siGCN2, the GCN2-targeted short interfering RNA, attenuated 1-NP-induced reduction of steroidogenic proteins in Leydig cells. Mechanistically, mitochondrial membrane potential was reduced and ATP5A, UQCRC2, SDHB and NDUFB8, four OXPHOS subunits, were reduced in 1-NP-exposed Leydig cells. Cellular mitochondrial respiration was inhibited and ATP production was reduced. Moreover, mitochondrial reactive oxygen species (ROS) were elevated in 1-NP-exposed Leydig cells. The interaction between GCN2 and uL10, a marker of ribosome stalling, was observed in 1-NP-exposed Leydig cells. MitoQ, a mitochondria-targeted antioxidant, attenuated1-NP-evoked ATP depletion and ribosome stalling in Leydig cells. Moreover, MitoQ suppressed 1-NP-caused GCN2 activation and eIF2α phosphorylation in Leydig cells. In addition, MitoQ alleviated 1-NP-induced steroidogenic inhibition in mouse testes. In conclusion, mitochondrial ROS-mediated ribosome stalling and GCN2 activation are partially involved in environmental stress-induced steroidogenic inhibition in testes.
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http://dx.doi.org/10.1016/j.envint.2022.107393DOI Listing
July 2022

Impaired Fanconi anemia pathway causes DNA hypomethylation in human angiosarcomas.

Hum Cell 2022 Jul 11. Epub 2022 Jul 11.

Department of Laboratory, Henan Provincial People's Hospital, NO. 7, Weiwu Road, Zhengzhou, 450003, Henan, China.

Angiosarcomas (AS) is a rare soft tissue sarcomas with poor treatment options and a dismal prognosis. The abnormal DNA methylation pattern has been determined as the certain clinical relevance with different angiosarcoma subtypes. However, the profound mechanism is not clear. In present study, we studied thirty-six AS with or without chronic lymphedema, and reported that DNA damage was an important factor causing DNA methylation abnormality. Furthermore, we determined that the impaired Fanconi anemia (FA) pathway contributed to severe DNA damage in AS with chronic lymphedema. We also observed that the activated FANCD2 could facilitate DNMT1 recruitment on genomic DNA. Our study uncovers a novel regulatory mechanism of FA pathway on DNA methylation, and is a benefit to advanced understanding the pathogenesis of AS, as well as providing the potential therapeutic targets for AS treatment.
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http://dx.doi.org/10.1007/s13577-022-00736-yDOI Listing
July 2022

Telemedicine for Stroke: Quantifying the Long-Term National Costs and Health Benefits.

Front Neurol 2021 20;12:804355. Epub 2022 Jun 20.

Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.

Objective: Few countries have established national programs to maximize access and reduce operational overheads. We aimed to use patient-level data up to 12 months to model the potential long-term costs and health benefits attributable to implementing such a program for Australia.

Methods: A Markov model was created for Australia with an inception population of 10,000 people with stroke presenting to non-urban or suburban hospitals without stroke medical specialists that could receive stroke telemedicine under a national program. Seven Markov states represented the seven modified Rankin Scale (mRS) scores (0 no disability to 6 dead) plus an absorbing state for all other causes of death. The literature informed inputs for the model; for the telemedicine program (including program costs and effectiveness) and patients, these were extrapolated from the Victorian Stroke Telemedicine (VST) program with the initial status of patients being their health state at day 365 as determined by their mRS score. Costs (2018 Australian dollars, healthcare, non-medical, and nursing home) and benefits were reported for both the societal and healthcare perspectives for up to a 25 years (lifetime) time horizon.

Results: We assumed 4,997 to 12,578 ischemic strokes would arrive within 4.5 h of symptom onset at regional hospitals in 2018. The average per person lifetime costs were $126,461 and $127,987 from a societal perspective or $76,680 and $75,901 from a healthcare system perspective and benefits were 4.43 quality-adjusted life years (QALYs) and 3.98 QALYs gained, respectively, for the stroke telemedicine program and practice without such program. The stroke telemedicine program was associated with a cost saving of $1,526 (from the societal perspective) or an additional $779 (from the healthcare system perspective) and an additional 0.45 QALY gained per patient over the lifetime. The incremental costs of the stroke telemedicine program ($2,959) and management poststroke ($813) were offset by cost savings from rehospitalization (-$552), nursing home care (-$2178), and non-medical resource use (-$128).

Conclusion: The findings from this long-term model provide evidence to support ongoing funding for stroke telemedicine services in Australia. Our estimates are conservative since other benefits of the service outside the use of intravenous thrombolysis were not included.
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http://dx.doi.org/10.3389/fneur.2021.804355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265143PMC
June 2022

Obesity and Bariatric Surgery in Australia: Future Projection of Supply and Demand, and Costs.

Obes Surg 2022 Jul 8. Epub 2022 Jul 8.

Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Precinct, 17 Liverpool Street, Hobart, TAS, 7000, Australia.

Introduction: The prevalence of obesity is increasing in developed countries, including Australia. There is evidence that bariatric surgery is effective in losing weight and reducing risk of chronic diseases. However, access to bariatric surgery remains limited in the public health sector.

Method: We modelled population-based estimates of the likely numbers of people eligible for bariatric surgery in Australia using the recent Australian New Zealand Metabolic and Obesity Surgery Society (ANZMOSS) framework and estimated the potential costs that would be incurred from primary and subsequent reoperations in both public and private sector.

Results: The annual number of newly eligible patients is expected to rise, and hence the gap in demand is increasing relative to current baseline supply. If a 5-year program to treat all currently eligible patients was implemented, the maximum yearly demand is projected to be 341,343 primary surgeries, more than eight times the existing capacity of public and private sector, which can only offer 41,534 surgeries/year. A nine-fold increase is expected if we treat currently eligible patients over a 5-year program and all newly eligible patients as they occur each year.

Conclusion: Our results highlighted the currently highly skewed distribution of bariatric surgeries between the private and public sectors. Improving access would bring substantial benefits to many Australians, given the demonstrated cost-effectiveness and cost savings. This requires a major increase in resourcing for publicly-funded access to bariatric surgery in the first instance. A national review of priorities and resourcing for all modes of obesity treatment is required in Australia.
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http://dx.doi.org/10.1007/s11695-022-06188-5DOI Listing
July 2022

Short-term effects of personal exposure to temperature variability on cardiorespiratory health based on subclinical non-invasive biomarkers.

Sci Total Environ 2022 Jun 28;843:157000. Epub 2022 Jun 28.

Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei 230032, China. Electronic address:

Growing literatures have explored the cardiorespiratory health effects of the daily temperature, but such effects of temperature variability remain unclear. We investigated the acute associations of personal levels of temperature variability with cardiorespiratory biomarkers. This is a panel study with four repeated measurements among forty eligible college students in Hefei, Anhui Province, China. We collected personal-level temperature data using temperature/humidity data loggers. Temperature variability parameters included diurnal temperature range (DTR), the standard-deviation of temperature (SDT) and temperature variability (TV). Cardiorespiratory health indicators included three BP parameters [systolic BP (SBP), diastolic BP (DBP) and mean article pressure (MAP)], fractional exhaled nitric oxide (FeNO), and four saliva biomarkers [C-reactive protein (CRP), cortisol, alpha-amylase and lysozyme]. Linear mixed-effect models were then used to assess the associations of temperature variability with these cardiorespiratory biomarkers. We found that short-term exposure to the three temperature variability parameters was associated with these cardiorespiratory biomarkers. The magnitude, direction and significance of these associations varied by temperature variability parameters, by biomarkers and by lags of exposure. Specifically, temperature variability parameters were inversely associated with BP and saliva lysozyme; positively associated with airway inflammation biomarkers (FeNO and saliva CRP) and stress response biomarkers (saliva cortisol and alpha-amylase). The results were robust to further control for air pollutants, and these associations were more prominent in females and in subjects with abnormal body mass index. Our findings suggested that acute exposure to temperature variability could significantly alter cardiorespiratory biomarker profiles among healthy young adults in China.
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http://dx.doi.org/10.1016/j.scitotenv.2022.157000DOI Listing
June 2022

DNA hydroxymethylation reprogramming of β-oxidation genes mediates early-life arsenic-evoked hepatic lipid accumulation in adult mice.

J Hazard Mater 2022 05 18;430:128511. Epub 2022 Feb 18.

Department of Toxicology, Anhui Medical University, Hefei 230032, China. Electronic address:

The metabolic disorders are becoming an epidemic disease endangering public health in countries. Environmental factors are mainly reason for the growth of metabolic disorders. Previous research suggests that DNA methylation is a potential mechanism. Recently, it has been reported that DNA hydroxymethylation is also a stable marker of epigenetic reprogramming. Hence, the study aims to investigate whether DNA hydroxymehylation mediates early-life environmental stress-evoked metabolic disorder in adulthood. Mice were orally administered with arsenic (As), an environmental stressor, throughout pregnancy. We show that early-life As exposure induces glucose intolerance and hepatic lipid accumulation in adulthood. Early-life As exposure alters epigenetic reprogramming and expression of lipid metabolism-related genes including β-oxidation-specific genes in adulthood. Of interest, early-life As exposure alters epigenetic reprogramming of hepatic lipid metabolism partially through reducing DNA hydroxymethylation modification of β-oxidation-related genes in developing liver. Mechanistically, early-life As exposure suppresses ten-eleven translocation (TET) activity through downregulating isocitrate dehydrogenases (Idh) and reducing alpha-ketoglutarate (α-KG) content in the developing liver. In addition, early-life As exposure inhibits TET1 binding to CpG-rich fragments of β-oxidation-related genes in developing liver. This study provide novel evidence that early-life environmental stress leads to later life metabolic disorders by altering hepatic DNA hydroxymethylation reprogramming.
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http://dx.doi.org/10.1016/j.jhazmat.2022.128511DOI Listing
May 2022

Total arsenic, dimethylarsinic acid, lead, cadmium, total mercury, methylmercury and hypertension among Asian populations in the United States: NHANES 2011-2018.

Ecotoxicol Environ Saf 2022 Aug 20;241:113776. Epub 2022 Jun 20.

Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Social Medicine and Public Health, School of Basic Medicine, Jiujiang University, Jiujiang, China. Electronic address:

Background: Non-Hispanic Asians (NHA) in USA have been reported with higher arsenic (As), lead (Pb), cadmium (Cd), mercury (Hg) and their specific species levels, comparing with non-NHA. This study aimed to investigate the associations of these metal/metalloid levels with blood pressure levels and prevalence of hypertension among general NHA using the 2011-2018 National Health and Nutrition and Examination Survey (NHANES) data.

Methods: The study included participants aged 20 years and older with determinations of As, Dimethylarsinic acid (DMA), Pb, Cd, Hg and methyl-Hg (MeHg) in blood (n = 10, 177) and urine (n = 5, 175). These metals/metalloid levels were measured by inductively coupled plasma mass spectrometry. Systolic (SBP) and diastolic blood pressure (DBP) levels were examined through a standardized protocol. Censored normal regression model and logistic regression model were employed to explore the associations of As, DMA, Pb, Cd, Hg and MeHg levels with blood pressure levels and prevalence of hypertension respectively, and potential confounders were adjusted in these regression models. Quantile-based g-computation approach was used to analysis joint effect of metals mixture on blood pressure level and hypertension.

Results: For NHA, urinary As and Hg levels were associated with increased DBP level; Higher blood Hg and MeHg levels were related to increased blood pressure levels and hypertension; However, negative association was observed between urinary Cd and SBP level; Blood metals mixture (including blood Pb, Cd and Hg) was associated with increased DBP level, but not for hypertension. For non-NHA, urinary As and DMA levels were associated with increased SBP level, but not DBP level and prevalence of hypertension; Urinary Pb level was associated with decreased DBP level; Nevertheless, positive associations were observed between blood Pb levels and SBP and prevalence of hypertension; Blood Hg level was associated with decreased DBP level and prevalence of hypertension; Furthermore, blood MeHg level was associated with decreased DBP level; Positive association was observed between blood metals mixture and increased SBP level among non-NHA.

Conclusions: Highly exposed to Hg level among NHA was associated with increased blood pressure levels and prevalence of hypertension. Urinary As level was associated with increased DBP level among NHA. Furthermore, blood metals mixture was related to increased DBP level among NHA. Further prospective studies with larger sample size should be performed to warrant the results.
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http://dx.doi.org/10.1016/j.ecoenv.2022.113776DOI Listing
August 2022

Gadolinium chloride protects neurons by regulating the activation of microglia in the model of optic nerve crush.

Biochem Biophys Res Commun 2022 08 29;618:119-126. Epub 2022 May 29.

School of Life Sciences, Lanzhou University, Lanzhou, 730000, China. Electronic address:

The pathological basis of optic nerve crush (ONC) is the apoptosis of retinal ganglion cells (RGCs), which leads to an irreversible impairment of visual function. When stimulated by external stimuli, microglia polarize into different types and play different roles in repairing retinal injury. In this study, gadolinium chloride (GdCl) could inhibit the excessive proliferation and activation of microglia in the retina after ONC and significantly inhibited the morphological changes of microglia in the ganglion cell layer (GCL) and inner plexiform layer (IPL). In the early stage of optic nerve injury, blood-derived immune cells did not play an essential role in retinal repair. In addition, transcriptome analysis showed that GdCl inhibited the expression of microglia proliferation-related factors and regulated signaling pathways related to skeletonization and inflammation. After GdCl treatment, M1 markers were significantly down-regulated, while M2 markers were increased. In conclusion, this study demonstrated that GdCl could regulate the distribution and morphological change of the retinal microglia and protect the ganglion cells by eliminating M1 microglia selectively, which provided a theoretical basis for further localizing different types of microglia in retina related diseases.
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http://dx.doi.org/10.1016/j.bbrc.2022.05.088DOI Listing
August 2022

Inhibition of Ciliogenesis Enhances the Cellular Sensitivity to Temozolomide and Ionizing Radiation in Human Glioblastoma Cells.

Biomed Environ Sci 2022 May;35(5):419-436

Key Laboratory of Space Radiobiology of Gansu Province & CAS Key Laboratory of Heavy Ion Radiation Biology and Medicine, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, Gansu, China;University of Chinese Academy of Sciences, Beijing 100049, China.

Objective: To investigate the function of primary cilia in regulating the cellular response to temozolomide (TMZ) and ionizing radiation (IR) in glioblastoma (GBM).

Methods: GBM cells were treated with TMZ or X-ray/carbon ion. The primary cilia were examined by immunostaining with Arl13b and γ-tubulin, and the cellular resistance ability was measured by cell viability assay or survival fraction assay. Combining with cilia ablation by IFT88 depletion or chloral hydrate and induction by lithium chloride, the autophagy was measured by acridine orange staining assay. The DNA damage repair ability was estimated by the kinetic curve of γH2AX foci, and the DNA-dependent protein kinase (DNA-PK) activation was detected by immunostaining assay.

Results: Primary cilia were frequently preserved in GBM, and the induction of ciliogenesis decreased cell proliferation. TMZ and IR promoted ciliogenesis in dose- and time-dependent manners, and the suppression of ciliogenesis significantly enhanced the cellular sensitivity to TMZ and IR. The inhibition of ciliogenesis elevated the lethal effects of TMZ and IR the impairment of autophagy and DNA damage repair. The interference of ciliogenesis reduced DNA-PK activation, and the knockdown of DNA-PK led to cilium formation and elongation.

Conclusion: Primary cilia play a vital role in regulating the cellular sensitivity to TMZ and IR in GBM cells through mediating autophagy and DNA damage repair.
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http://dx.doi.org/10.3967/bes2022.058DOI Listing
May 2022

Carbon and N conservation during composting: A review.

Sci Total Environ 2022 Sep 30;840:156355. Epub 2022 May 30.

College of Environmental Science and Engineering, Hunan University, Changsha 410082, PR China; Key Laboratory of Environmental Biology and Pollution Control, Hunan University, Ministry of Education, Changsha 410082, PR China.

Composting, as a conventional solid waste treatment method, plays an essential role in carbon and nitrogen conservation, thereby reducing the loss of nutrients and energy. However, some carbon- and nitrogen-containing gases are inevitably released during the process of composting due to the different operating conditions, resulting in carbon and nitrogen losses. To overcome this obstacle, many researchers have been trying to optimize the adjustment parameters and add some amendments (i.e., pHysical amendments, chemical amendments and microbial amendments) to reduce the losses and enhance carbon and nitrogen conservation. However, investigation regarding mechanisms for the conservation of carbon and nitrogen are limited. Therefore, this review summarizes the studies on physical amendments, chemical amendments and microbial amendments and proposes underlying mechanisms for the enhancement of carbon and nitrogen conservation: adsorption or conversion, and also evaluates their contribution to the mitigation of the greenhouse effect, providing a theoretical basis for subsequent composting-related researchers to better improve carbon and nitrogen conservation measures. This paper also suggests that: assessing the contribution of composting as a process to global greenhouse gas mitigation requires a complete life cycle evaluation of composting. The current lack of compost clinker impact on carbon and nitrogen sequestration capacity of the application site needs to be explored by more research workers.
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http://dx.doi.org/10.1016/j.scitotenv.2022.156355DOI Listing
September 2022

Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke.

Front Neurol 2022 13;13:871999. Epub 2022 May 13.

Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.

Background And Purpose: Pre-hospital severity-based triaging using the Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST) algorithm has been demonstrated to substantially reduce time to endovascular thrombectomy in Melbourne, Australia. We aimed to model the cost-effectiveness of an ACT-FAST bypass system from the healthcare system perspective.

Methods: A simulation model was developed to estimate the long-term costs and health benefits associated with diagnostic accuracy of the ACT-FAST algorithm. Three-month post stroke functional outcome was projected to the lifetime horizon to estimate the long-term cost-effectiveness between two strategies (ACT-FAST vs. standard care pathways). For ACT-FAST screened true positives (i.e., screened positive and eligible for EVT), a 52 mins time saving was applied unanimously to the onset to arterial time for EVT, while 10 mins delay in thrombolysis was applied for false-positive (i.e., screened positive but was ineligible for EVT) thrombolysis-eligible infarction. Quality-adjusted life year (QALY) was employed as the outcome measure to calculate the incremental cost-effectiveness ratio (ICER) between the ACT-FAST algorithm and the current standard care pathway.

Results: Over the lifetime, ACT-FAST was associated with lower costs (-$45) and greater QALY gains (0.006) compared to the current standard care pathway, resulting in it being the dominant strategy (less costly but more health benefits). Implementing ACT-FAST triaging led to higher proportion of patients received EVT procedure (30 more additional EVT performed per 10,000 patients). The total Net Monetary Benefit from ACT-FAST care estimated at A$0.76 million based on its implementation for a single year.

Conclusions: An ACT-FAST severity-triaging strategy is associated with cost-saving and increased benefits when compared to standard care pathways. Implementing ACT-FAST triaging increased the proportion of patients who received EVT procedure due to more patients arriving at EVT-capable hospitals within the 6-h time window (when imaging selection is less rigorous).
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http://dx.doi.org/10.3389/fneur.2022.871999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9136079PMC
May 2022

A multicenter prospective study on quality of life and pain relief for cancer patient after I seed implantation.

Asia Pac J Oncol Nurs 2022 Aug 13;9(8):100065. Epub 2022 Apr 13.

Radiation Oncology Department, Peking University Third Hospital, Beijing, China.

Objective: To prospectively explore the efficacy of I seed implantation on quality of life and pain relief in cancer patient.

Methods: Consecutive cancer patients who underwent I seed implantation in three centers in China between October 1, 2020 and March 31, 2021, were assessed. The Functional Assessment of Cancer Therapy and Brief Pain Inventory were used to evaluate patients' quality of life and pain relief on the day before, 1 week, 1 month, and 3 months after seed implantation.

Results: A total of 104 cancer patients were enroled. Total score of quality of life was not statistically different 3 months after seed implantation compared with before implantation, while patients' quality of life was worse one week after seed implantation but then recovered. A total of 43 (41.3%) patients had pain before seed implantation, of which 16 (37.2%) patients had severe pain and 27 (62.8%) had mild-to-moderate pain. In patients with severe pain, the worst pain scores decreased significantly 3 months after implantation. In patients with mild-to-moderate pain, pain severity and pain interference score increased significantly after implantation compared with pre-implantation. Compared with pain before implantation, patients' quality of life of patients without pain was higher.

Conclusions: I seed implantation maintains the quality of life of patients within 3 months. For patients with severe pain, seed implantation has obvious pain relief, which improves the quality of life of the patients. Nurses should provide personalized guidance for patients with different degrees of pain.
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http://dx.doi.org/10.1016/j.apjon.2022.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131158PMC
August 2022

1-Nitropyrene disrupts testosterone biogenesis via AKAP1 degradation promoted mitochondrial fission in mouse Leydig cell.

Environ Pollut 2022 Aug 22;307:119484. Epub 2022 May 22.

Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes & Department of Toxicology, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, China. Electronic address:

Previous study found 1-NP disrupted steroidogenesis in mouse testis, but the underlying mechanism remained elusive. The current work aims to explore the roles of ROS-promoted AKAP1 degradation and excessive mitochondrial fission in 1-NP-induced steroidogenesis disruption in MLTC-1 cells. Transmission electron microscope analysis found 1-NP promoted excessive mitochondrial fission. Further data showed 1-NP disrupted mitochondrial function. pDRP1 (Ser637), a negative regulator of mitochondrial fission, was reduced in 1-NP-treated MLTC-1 cells. Mechanistically, 1-NP caused degradation of AKAP1, an upstream regulator of pDRP1 (Ser637). MG132, a proteasome inhibitor, attenuated 1-NP-induced AKAP1 degradation and downstream pDRP1 (Ser637) reduction, thereby ameliorating 1-NP-downregulated steroidogenesis. Further analysis found that cellular ROS was elevated and NOX4, HO-1 and SOD2 were upregulated in 1-NP-exposed MLTC-1 cells. NAC, a well-known commercial antioxidant, alleviated 1-NP-induced excessive ROS and oxidative stress. 1-NP-induced AKAP1 degradation and subsequent downregulation of pDRP1 (Ser637) were prevented by NAC pretreatment. Moreover, NAC attenuated 1-NP-resulted T synthesis disturbance in MLTC-1 cells. The present study indicates that ROS mediated AKAP1 degradation and subsequent pDRP1 (Ser637) dependent mitochondrial fission is indispensable in 1-NP caused T synthesis disruption. This study provides a new insight into 1-NP-induced endocrine disruption, and offers theoretical basis in public health prevention.
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http://dx.doi.org/10.1016/j.envpol.2022.119484DOI Listing
August 2022

Hot Spot Evolution Measured by High-Resolution X-Ray Spectroscopy at the National Ignition Facility.

Phys Rev Lett 2022 May;128(18):185002

Faculty of Physics, Weizmann Institute of Science, Rehovot 7610001, Israel.

Evolution of the hot spot plasma conditions was measured using high-resolution x-ray spectroscopy at the National Ignition Facility. The capsules were filled with DD gas with trace levels of Kr and had either a high-density-carbon (HDC) ablator or a tungsten (W)-doped HDC ablator. Time-resolved measurement of the Kr Heβ spectra, absolutely calibrated by a simultaneous time-integrated measurement, allows inference of the electron density and temperature through observing Stark broadening and the relative intensities of dielectronic satellites. By matching the calculated hot spot emission using a collisional-radiative code to experimental observations, the hot spot size and areal density are determined. These advanced spectroscopy techniques further reveal the effect of W dopant in the ablator on the hot spot parameters for their improved implosion performance.
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http://dx.doi.org/10.1103/PhysRevLett.128.185002DOI Listing
May 2022

Cost-effectiveness of the Victorian Stroke Telemedicine program.

Aust Health Rev 2022 Jun;46(3):294-301

Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia; and Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia.

Objective Stroke telemedicine improves the provision of reperfusion therapies in regional hospitals, yet evidence of its cost-effectiveness using patient-level data is lacking. The aim of this study was to estimate the cost per quality-adjusted life year (QALY) gained from stroke telemedicine. Methods As part of the Victorian Stroke Telemedicine (VST) program, stroke telemedicine provided to 16 hospitals in regional Victoria was evaluated using a historical-control design. Patient-level costs from a societal perspective (2018 Australian dollars (A$)) and QALYs up to 12 months after stroke were estimated using data from medical records, surveys at 3 months and 12 months after stroke and multiple imputation. Multivariable regression models and bootstrapping were used to estimate differences between periods. Results Costs and health outcomes were estimated from 1024 confirmed strokes suffered by patients arriving at hospital within 4.5 h of stroke onset (median age 76 years, 55% male, 83% ischaemic stroke; 423 from the control period). Total costs to 12 months post stroke were estimated to be A$82 449 per person for the control period and A$82 259 in the intervention period (P  = 0.986). QALYs at 12 months were estimated to be 0.43 per person for the control period and 0.5 per person in the intervention period (P  = 0.02). Following 1000 iterations of bootstrapping, in comparison to the control period, the VST intervention was more effective and cost saving in 50.6% of iterations and cost-effective (A$0 and A$50 000 per QALY gained) in 10.4% of iterations. Conclusion The VST program was likely to be cost saving or cost-effective. Our findings provide confidence in supporting wider implementation of telemedicine for acute stroke care in Australia.
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http://dx.doi.org/10.1071/AH21377DOI Listing
June 2022

Sitting less and moving more for improved metabolic and brain health in type 2 diabetes: 'OPTIMISE your health' trial protocol.

BMC Public Health 2022 05 10;22(1):929. Epub 2022 May 10.

Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.

Background: Clinical practice guidelines recommend that adults with type 2 diabetes (T2D) sit less and move more throughout the day. The 18-month OPTIMISE Your Health Clinical Trial was developed to support desk-based workers with T2D achieve these recommendations. The two-arm protocol consists of an intervention and control arms. The intervention arm receives 6 months health coaching, a sit-stand desktop workstation and an activity tracker, followed by 6 months of text message support, then 6 months maintenance. The control arm receives a delayed modified intervention after 12 months of usual care. This paper describes the methods of a randomised controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of the intervention, compared to a delayed intervention control.

Methods: This is a two-arm RCT being conducted in Melbourne, Australia. Desk-based workers (≥0.8 full-time equivalent) aged 35-65 years, ambulatory, and with T2D and managed glycaemic control (6.5-10.0% HbA1c), are randomised to the multicomponent intervention (target n = 125) or delayed-intervention control (target n = 125) conditions. All intervention participants receive 6 months of tailored health coaching assisting them to "sit less" and "move more" at work and throughout the day, supported by a sit-stand desktop workstation and an activity tracker (Fitbit). Participants receive text message-based extended care for a further 6-months (6-12 months) followed by 6-months of non-contact (12-18 months: maintenance). Delayed intervention occurs at 12-18 months for the control arm. Assessments are undertaken at baseline, 3, 6, 12, 15 and 18-months. Primary outcomes are activPAL-measured sitting time (h/16 h day), glycosylated haemoglobin (HbA1c; %, mmol/mol) and, cognitive function measures (visual learning and new memory; Paired Associates Learning Total Errors [adjusted]). Secondary, exploratory, and process outcomes will also be collected throughout the trial.

Discussion: The OPTIMISE Your Health trial will provide unique insights into the benefits of an intervention aimed at sitting less and moving more in desk-bound office workers with T2D, with outcomes relevant to glycaemic control, and to cardiometabolic and brain health. Findings will contribute new insights to add to the evidence base on initiating and maintaining behaviour change with clinical populations and inform practice in diabetes management.

Trial Registration: ANZCTRN12618001159246 .
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http://dx.doi.org/10.1186/s12889-022-13123-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086419PMC
May 2022

Comparison of brachial-ankle pulse wave velocity and carotid-femoral pulse wave velocity in association with albuminuria in a community of Beijing: a cross-sectional study.

J Hum Hypertens 2022 Apr 26. Epub 2022 Apr 26.

Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.

This study was performed to investigate and compare the association of albuminuria with the brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) in a community-based population in Beijing. Subjects were enrolled from a follow-up survey conducted in 2018 from an atherosclerosis cohort in Shijingshan district, Beijing, China. The baPWV and cfPWV were measured using a BP-203 RPE III arteriosclerosis detection device and PulsePen, respectively. Albuminuria was defined as a urinary albumin-creatinine ratio of ≥30 mg/g. A multivariate logistic regression model was used to evaluate the impacts of different PWV measurements on the prevalence of albuminuria. In total, 5605 subjects were included in the analyses. Their mean age was 62.22 ± 7.55 years, and the prevalence of albuminuria was 8.22%. In the multivariate logistic regression model adjusted for potential covariates, both baPWV (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03-1.10; P < 0.001) and cfPWV (OR, 1.07; 95% CI, 1.01-1.14; P = 0.018) were significantly associated with albuminuria. Furthermore, when baPWV and cfPWV were entered into the logistic regression model simultaneously, only baPWV was significantly associated with albuminuria using either continuous value (OR, 1.05; 95% CI, 1.01-1.10; P = 0.007) or classified into quartiles (highest vs. lowest value group: OR, 1.55; 95% CI, 1.01-2.37; P for trend = 0.019). Both cfPWV and baPWV were positively associated with albuminuria, while baPWV had a stronger relationship than cfPWV. Thus, baPWV measurement could be considered for the purpose of community health screening.
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http://dx.doi.org/10.1038/s41371-022-00697-7DOI Listing
April 2022

Disruption of mitochondrial redox homeostasis as a mechanism of antimony-induced reactive oxygen species and cytotoxicity.

Ecotoxicol Environ Saf 2022 Jun 19;237:113519. Epub 2022 Apr 19.

Bioelectromagnetics Laboratory, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China. Electronic address:

Occupational and environmental Sb exposure has been associated with increased risk of respiratory diseases and lung cancer, but the toxicities and molecular mechanisms of Sb have been less investigated. In the present study, we first analyzed the Sb toxicity profile of lung adenocarcinoma A549 cells, and found that Sb dose-dependently decreased the cell viability and arrested cell cycle at G2/M but did not induce apoptosis. We next investigated the role of reactive oxygen species (ROS) involved in Sb-induced cytotoxicity. The results showed that Sb did not significantly induce cytosolic ROS production by NADPH oxidase (NOX) and the NOX inhibitors did not ameliorate the Sb-induced cell viability loss in A549 cells. However, the level of mitochondrial ROS (mtROS) was significantly increased in Sb-exposed cells and the mitochondria-targeted antioxidant significantly improved cell viability. These results suggested that mitochondria but not NOX is the major source of ROS production and mtROS plays a critical role in Sb-induced cytotoxicity. Furthermore, we found that Sb induced mitochondria dysfunction including the significant decrease of ATP level and mitochondrial membrane potential. Finally, Sb exposure decreased the activity of complex I and complex III, the level of -SH and GSH in mitochondria, and the activity of mitochondrial GR, GPx and TrxR, but increased the mitochondrial SOD activity, suggesting the disruption of mitochondrial redox homeostasis. Taken together, these findings suggested that Sb impaired mitochondrial redox homeostasis, resulting in formation of mtROS, thereby inhibited mitochondrial function and led to cytotoxicity.
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http://dx.doi.org/10.1016/j.ecoenv.2022.113519DOI Listing
June 2022

Psychometric Evaluation of the Mandarin HeartQoL Health-Related Quality of Life Questionnaire Among Patients With Ischemic Heart Disease in China.

Value Health Reg Issues 2022 Apr 15;31:53-60. Epub 2022 Apr 15.

School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.

Objectives: This study evaluated the psychometric properties of the Mandarin version of the HeartQoL questionnaire, a core ischemic heart disease (IHD) health-related quality of life (HRQL) instrument, in patients with angina, myocardial infarction (MI), and ischemic heart failure (IHF).

Methods: The English version of HeartQoL was translated into Mandarin. A cross-sectional study was then conducted in mainland China using the Mandarin HeartQoL, Short Form-12 Health Survey, and Hospital Anxiety and Depression Scale. Factor analysis was used to establish the HeartQoL structure and internal consistency reliability and construct validity were assessed.

Results: Patients with IHD (n = 412; angina = 112, MI = 151, and IHF = 149) were enrolled. Significantly higher HeartQoL HRQL scores were reported by patients with either angina or MI than by patients with IHF. The 2-factor structure was confirmed by Mokken scale analysis in the total group with strong H coefficients on the global scale (0.64) and both the physical (0.70) and emotional (0.80) subscales. Internal consistency reliability was strong with Cronbach's α ranging from 0.90 to 0.95. Convergent validity was confirmed with strong correlations between similar physical and mental HeartQoL and Short Form-12 Health Survey subscales ranging from 0.77 to 0.82 with divergent validity confirmed with significantly lower correlations between dissimilar constructs. Discriminative validity was confirmed for 72% of the a priori sociodemographic and clinical hypotheses.

Conclusions: The Mandarin version of the HeartQoL HRQL questionnaire demonstrates acceptable internal consistency reliability and convergent, divergent, and discriminative validity in patients with IHD and in each diagnostic subgroup. The data support the use of the HeartQoL to assess and compare HRQL in Mandarin-speaking patients with IHD.
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http://dx.doi.org/10.1016/j.vhri.2022.03.001DOI Listing
April 2022

Cost-Effectiveness of Monitoring Patients Post-Stroke With Mobile ECG During the Hospital Stay.

J Am Heart Assoc 2022 04 12;11(8):e022735. Epub 2022 Apr 12.

The Melbourne Brain Centre at the Royal Melbourne Hospital and the University of Melbourne Parkville Australia.

Background The effectiveness of a nurse-led in-hospital monitoring protocol with mobile ECG (iECG) was investigated for detecting atrial fibrillation in patients post-ischemic stroke or post-transient ischemic attack. The study aimed to assess the cost-effectiveness of using iECG during the initial hospital stay compared with standard 24-hour Holter monitoring. Methods and Results A Markov microsimulation model was constructed to simulate the lifetime health outcomes and costs. The rate of atrial fibrillation detection in iECG and Holter monitoring during the in-hospital phase and characteristics of modeled population (ie, age, sex, CHA2DS2-VASc) were informed by patient-level data. Costs related to recurrent stroke, stroke management, medications (new oral anticoagulants), and rehabilitation were included. The cost-effectiveness analysis outcome was calculated as an incremental cost per quality-adjusted life-year gained. As results, monitoring patients with iECG post-stroke during the index hospitalization was associated with marginally higher costs (A$31 196) and greater benefits (6.70 quality-adjusted life-years) compared with 24-hour Holter surveillance (A$31 095 and 6.66 quality-adjusted life-years) over a 20-year time horizon, with an incremental cost-effectiveness ratio of $3013/ quality-adjusted life-years. Monitoring patients with iECG also contributed to lower recurrence of stroke and stroke-related deaths (140 recurrent strokes and 20 deaths avoided per 10 000 patients). The probabilistic sensitivity analyses suggested iECG is highly likely to be a cost-effective intervention (100% probability). Conclusions A nurse-led iECG monitoring protocol during the acute hospital stay was found to improve the rate of atrial fibrillation detection and contributed to slightly increased costs and improved health outcomes. Using iECG to monitor patients post-stroke during initial hospitalization is recommended to complement routine care.
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http://dx.doi.org/10.1161/JAHA.121.022735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238470PMC
April 2022

Modelling the potential health and economic benefits of reducing population sitting time in Australia.

Int J Behav Nutr Phys Act 2022 03 19;19(1):28. Epub 2022 Mar 19.

Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.

Background: Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives.

Methods: A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014-2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings.

Results: According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year.

Conclusions: Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.
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http://dx.doi.org/10.1186/s12966-022-01276-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934131PMC
March 2022

Mitochondria-derived reactive oxygen species are involved in renal cell ferroptosis during lipopolysaccharide-induced acute kidney injury.

Int Immunopharmacol 2022 Jun 10;107:108687. Epub 2022 Mar 10.

The Second Affiliated Hospital, Anhui Medical University, Hefei, China. Electronic address:

Our earlier studies indicated that reactive oxygen species (ROS) were involved in lipopolysaccharide (LPS)-induced acute kidney injury (AKI). The present study aimed to explore the role of mitochondria-derived ROS on renal cell ferroptosis during LPS-induced AKI. Male CD-1 mice were intraperitoneally injected with LPS (2.0 mg/kg). Renal MDA and 4HNE residue, two markers of lipid peroxidation, were increased in LPS-exposed mice. Oxidized lipids were detected in LPS-treated human HK-2 cells. In vivo, ferroptosis-characteristic ultrastructure changes, including cell volume reduction, nuclear pyknosis and smaller mitochondria, were shown in renal cortex. In vitro, abnormal alteration of mitochondrial membrane potential was observed in LPS-treated human HK-2 cells. Ferrostatin-1, a specific inhibitor of ferroptosis, attenuated LPS-evoked renal lipid peroxidation, ferroptosis-characteristic mitochondrial damage and renal cell death. Mechanistically, mitochondria-derived ROS were elevated in LPS-stimulated HK-2 cells. MitoQ, a mitochondria-targeted antioxidant, almost completely scavenged LPS-stimulated mitochondrial ROS in human HK-2 cells. Moreover, pretreatment with MitoQ attenuated LPS-induced GSH depletion and lipid peroxidation in mouse kidney. Finally, pretreatment with MitoQ alleviated LPS-induced renal cell death and AKI. Taken together, these results suggest that mitochondria-derived ROS contribute, at least partially, to renal cell ferroptosis during LPS-induced AKI. Mitochondria-targeted antioxidants may be potential therapeutic agents for sepsis-induced AKI.
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http://dx.doi.org/10.1016/j.intimp.2022.108687DOI Listing
June 2022

The Professional Identity and Career Attitude of Chinese Medical Students During the COVID-19 Pandemic: A Cross-Sectional Survey in China.

Front Psychiatry 2022 15;13:774467. Epub 2022 Feb 15.

Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China.

Background: Although professional identity is a strong predictor of career choice, only a few studies have reported on medical students' career attitude during a public health emergency. This study investigates the changes in medical students' professional identity and career attitude during the COVID-19 pandemic, evaluates their mental health and social support system under stress, and explores the relationship between their career attitude and other factors.

Methods: An online survey of 6,226 Chinese medical students was conducted to collect information on demographics, professional identity, and career attitude. The collected data were assessed using the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Social Support Rating Scale.

Results: The results revealed that most (80.8%) of the participants did not change their career attitude and the professional identity of most participants strengthened, and they preferred to participate on the frontline during the COVID-19 pandemic. The prevalence of depression and anxiety among medical students was 22.86% and 35.43%. Low social support, depressive symptoms, male gender, and higher grades were factors that negatively affected career attitude.

Conclusions: After the outbreak of the pandemic, it was necessary to conduct diversified professional identity research to support medical students, especially those with low social support and depressive symptoms.
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http://dx.doi.org/10.3389/fpsyt.2022.774467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886109PMC
February 2022

MiR-501-5p alleviates cardiac dysfunction in septic patients through targeting NR4A3 to prevent its binding with Bcl-2.

Cell Cycle 2022 05 1;21(9):961-971. Epub 2022 Mar 1.

Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Sepsis-induced myocardial dysfunction is a common complication in septic patients. To date, a limited number of biomarkers that could predict cardiomyocyte apoptosis have been explored. In this study, we successfully established a cecal ligation and puncture (CLP)-induced septic model, and it was found that miR-501-5p expression was down-regulated in peripheral blood samples of septic patients with cardiac dysfunction, lipopolysaccharide (LPS)-induced cardiomyocytes, and the myocardium and peripheral blood in the septic model. Moreover, it was revealed that miR-501-5p overexpression could increase left ventricular diastolic pressure (LVDP), fractional shortening (FS), ejection fraction (EF), and maximum rate of the rise of left ventricular pressure (+dp/dt) , while it decreased the levels of myocardial injury-related indicators. In addition, LPS induction accelerated apoptosis and elevated the inflammation in HL-1 and HCM cells, which could be reversed by miR-501-5p overexpression. Mechanistically, we considered nuclear receptor subfamily 4 group A member 3 (NR4A3) as the target of miR-501-5p, and it was found that miR-501-5p prevented the binding between NR4A3 and Bcl-2. It was found that miR-501-5p exerted an inhibitory effect on cardiomyocyte apoptosis and inflammation in a NR4A3-dependent manner. Overall, our results may provide evidence for consideration of miR-501-5p in the therapy of sepsis.
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http://dx.doi.org/10.1080/15384101.2022.2035618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9037443PMC
May 2022

Brachial-ankle pulse wave velocity as a measurement for increased carotid intima-media thickness: A comparison with carotid-femoral pulse wave velocity in a Chinese community-based cohort.

J Clin Hypertens (Greenwich) 2022 04 25;24(4):409-417. Epub 2022 Feb 25.

Department of Cardiology, Peking University First Hospital, Beijing, China.

Carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) act as two most frequently applied indicators to evaluate arterial stiffness. Limited studies have systematically compared the relationships between cfPWV/baPWV and increased carotid intima-media thickness (cIMT). This study aimed to investigate the associations of the two PWV indices with cIMT in a Chinese community-based population. A total of 6026 Chinese participants from an atherosclerosis cohort were included in our analysis. Increased cIMT was defined as the maximum of cIMT > 0.9 mm in end-systolic period of carotid artery. Mean (SD) cfPWV and baPWV were 8.55±1.83  and 16.79±3.35 m/s, respectively. The prevalence of increased cIMT was 59.58%. In multivariable logistic regression, both PWVs were independently associated with increased cIMT after adjustment for various confounders (for 1 m/s increase of cfPWV: OR = 1.07, 95% CI: 1.02-1.11; for 1 m/s increase of baPWV: OR = 1.03, 95% CI: 1.00-1.05). The highest cfPWV and baPWV quartile groups had higher prevalence of increased cIMT when compared with the lowest quartile groups (for cfPWV: OR = 1.28, 95% CI: 1.06-1.55; for baPWV: OR = 1.23, 95% CI: 1.00-1.50). However, when both PWVs were added into multivariable model simultaneously, only cfPWV was associated with odds of increased cIMT. Subgroup analyses further showed cfPWV was more strongly associated with increased cIMT than baPWV in males, participants aged ≥65 years, and those with other cardiovascular risk factors. In conclusion, both cfPWV and baPWV are associated with increased cIMT in a Chinese community-based population. Furthermore, cfPWV is more strongly correlated with increased cIMT compared to baPWV.
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http://dx.doi.org/10.1111/jch.14448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989757PMC
April 2022

Correction to: The economic and health burden of stroke among younger adults in Australia from a societal perspective.

BMC Public Health 2022 Feb 23;22(1):383. Epub 2022 Feb 23.

Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.

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http://dx.doi.org/10.1186/s12889-022-12712-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867767PMC
February 2022

Clinical effectiveness and cost-effectiveness of ambulatory heart failure nurse-led services: an integrated review.

BMC Cardiovasc Disord 2022 02 22;22(1):64. Epub 2022 Feb 22.

School of Health Economics, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.

Background: Globally the burden of heart failure is rising. Hospitalisation is one of the main contributors to the burden of heart failure and unfortunately, the majority of heart failure patients will experience multiple hospitalisations over their lifetime. Considering the high health care cost associated with heart failure, a review of economic evaluations of post-discharge heart failure services is warranted.

Aim: An integrated review of the economic evaluations of post-discharge nurse-led heart failure services for patients hospitalised with acute heart failure.

Methods: Electronic databases were searched using EBSCOHost: CINAHL complete, Medline complete, Embase, Scopus, EconLit, Global Health, and Health source (Consumer and Nursing/Academic) for published articles until 22nd June 2021. The searches focussed on papers that examined the cost-effectiveness of nurse-led clinics or telemonitoring involving nurses to follow-up patients after hospitalisation for acute heart failure. GRADE criteria and CHEERS checklist were used to determine the quality of the evidence and the quality of reporting of the economic evaluation.

Results: Out of 453 studies identified, eight studies were included: four in heart failure clinics and four in telemonitoring programs. Five of the articles were cost-effectiveness analyses, one a cost comparison and two studies involved economic modelling The GRADE criteria were rated as high in five studies. In which, four studies examined the cost-effectiveness of telemonitoring programs. Based on the CHEERS checklist for reporting quality of economic evaluations, the majority of economic evaluations were rated between 86 and 96%. All the studies found the intervention to be cost-effective compared to usual care with Incremental Cost Effectiveness Ratios ranging from $18 259 (Canadian dollars)/life year gained to €40,321 per Quality Adjusted Life Years gained.

Conclusion: Nurse-led heart failure clinics and telemonitoring programs were found to be cost-effective. Certainly, this review has shown that heart failure clinics and telemonitoring programs do represent value for money with their greatest impact and cost savings through reducing rehospitalisations.
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http://dx.doi.org/10.1186/s12872-022-02509-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862539PMC
February 2022

Uncertainty or trust? Political trust, perceived uncertainty and public acceptance of personal carbon trading policy.

Environ Geochem Health 2022 Feb 7. Epub 2022 Feb 7.

School of Economics, Hefei University of Technology, Hefei, 230009, Anhui Province, People's Republic of China.

Achieving carbon neutrality has become a global consensus, and plenty of measures and policies have been proposed in various industries to obtain this ambitious goal. As an innovative and radical environmental policy tool, personal carbon trading (PCT) policy which aims to reduce carbon emissions from the private consumption sector has aroused the attention. For a new policy tool, public support and acceptance is critical to obtain policy legitimacy and policy implementation. To implement PCT policy smoothly, the current research aims to explore the antecedents of public acceptance. From the emotional reaction perspective, this research mainly evaluated how political trust, perceived uncertainty and associated emotions matter for public acceptance of PCT policy. Based on the survey data, this research revealed that political trust has a direct positive impact on public acceptance of PCT policy. Meanwhile, political trust also has an indirect impact on public acceptance of PCT policy via emotions. Specifically, political trust is positively associated with positive emotions and negatively associated with negative emotions. Positive emotions promote public to accept PCT policy, while negative emotions inhibit public to accept PCT policy. The negative emotions exert a more powerful impact on public acceptance than positive emotions. Additionally, we found that perceived uncertainty exerts a negative effect on public acceptance and negatively regulates the relationship between political trust and public acceptance. That is, perceived uncertainty has a significant substitution effect on political trust. According to the research findings, policy implications to improve public acceptance of PCT policy were explored.
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http://dx.doi.org/10.1007/s10653-022-01214-yDOI Listing
February 2022

The economic and health burden of stroke among younger adults in Australia from a societal perspective.

BMC Public Health 2022 02 3;22(1):218. Epub 2022 Feb 3.

Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.

Background: To estimate the short term (5 years) and long term (30 years) economic burden of stroke among younger adults (18-64 years), and to calculate the loss of health-related quality of life in these individuals, in Australia.

Methods: A Markov microsimulation model was built to simulate incidence of stroke among younger adults in Australia. Younger adults with stroke commenced in the model via health states defined by the modified Rankin Scale at 12 months from the AVERT study (A Very Early Rehabilitation Trial), and transitioned through these health states. Costs in Australian dollars (AUD) were measured from a societal perspective for a 2018 reference year and categorised into medical, non-medical and indirect costs. Probabilistic sensitivity analyses were performed to test the robustness around the cost of illness estimates. The loss of health-related quality of life due to stroke among younger adults was calculated by determining the difference in estimated quality-adjusted life years (QALYs) between the stroke population and the general population. This was determined by multiplying the predicted remaining life years for the modelled stroke cohort and the age-matched general population, by their corresponding age-dependent utilities.

Results: The economic burden of stroke among younger adults was estimated to be AUD2.0 billion over 5 years, corresponding to a mean of $149,180 per stroke patient. Over 30 years, the economic impact was AUD3.4 billion, equating to a mean of $249,780 per case. Probabilistic sensitivity analyses revealed a mean cost per patient of $153,410 in the short term, and a mean cost per patient of $273,496 in the long term. Compared to the age-matched general population, younger adults with stroke experienced a loss of 4.58 life years and 9.21 QALYs.

Conclusions: The results of our study suggests high economic and health burden of stroke among younger adults and highlights the need for preventive interventions targeting this age group.

Trial Registration: ACTRN12606000185561 , retrospectively registered.
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http://dx.doi.org/10.1186/s12889-021-12400-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811989PMC
February 2022

Economic Burden of Dementia Caused by Cardiovascular Disease in Australia.

J Alzheimers Dis 2022 ;86(2):601-612

Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.

Background: The established link between cardiovascular disease (CVD) and dementia may provide new insights into dementia prevention.

Objective: It aims to quantify the burden of dementia attributable to people with CVD.

Methods: A Markov microsimulation model was developed to simulate the lifetime cost and quality-adjusted life-years (QALYs) related to people with and without CVD in Australia. A de-novo systematic review was undertaken to identify all evidence around the association between CVD [i.e., stroke, myocardial infarction (MI), atrial fibrillation (AF), and heart failure (HF)] and the risk of developing dementia. Incremental costs and QALY losses were estimated for people by type of CVD compared to the general Australian population without CVD.

Results: Of the comprehensive literature search, 19 observational studies were included in the qualitative synthesis. Patients who had CVD incurred both higher healthcare costs over their lifetime (ranging from $73,131 for patients with AF to $127,396 for patients with HF) and fewer QALYs gains (from -1.099 for patients with MI to -5.163 for patients with stroke), compared to people who did not have CVD. The total incremental economic burden of dementia from patients aged 65 years and over with CVD was $6.45 billion (stroke), $11.89 billion (AF), $17.57 billion (MI), or $7.95 billion (HF) over their remaining life expectancy.

Conclusion: The results highlighted the importance of CVD prevention to reduce the CVD burden and decrease the prevalence of dementia. Interventions that target patients with dementia risk factors like CVD may prove to be effective and cost-effective strategies.
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http://dx.doi.org/10.3233/JAD-215368DOI Listing
April 2022
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