Parametric analysis of the transmission dynamics during indigenous aggregated outbreaks caused by five SARS-CoV-2 strains in Nanjing, China.

Background: SARS-CoV-2 strains have been of great concern due to their high infectivity and antibody evasion. Methods: In this study, data were collected on indigenous aggregated outbreaks in Nanjing from January 2020 to December 2022, caused by five strains including the original strain, the Delta variant, and the Omicron variant (BA.2, BA.5.2, and BF.7). The basic epidemiological characteristics of infected individuals were described and then parametric analysis of transmission dynamics was performed, including the calculation of incubation period, serial interval (SI), the basic reproductive number (R0), and the household secondary attack rate (HSAR). Finally, we compared the trends of transmission dynamic parameters of different strains. Results: The incubation period for the original strain, the Delta variant, Omicron BA.2, Omicron BA.5.2, and Omicron BF.7 were 6 d (95% CI: 3.5-7.5 d), 5 d (95% CI: 4.0-6.0 d), 3 d (95% CI: 3.0-4.0 d), 3 d (95% CI: 3.0-3.0 d), and 2 d (95% CI: 2.0-3.0 d), respectively; Also, the SI of the five strains were 5.69 d, 4.79 d, 2.7 d, 2.12 d, and 2.43 d, respectively. Notably, the incubation period and SI of the five had both a progressive shortening trend (p < 0.001); Moreover, R0 of the five were 2.39 (95% CI: 1.30-4.29), 3.73 (95% CI: 2.66-5.15), 5.28 (95% CI: 3.52-8.10), 5.54 (95% CI: 2.69-11.17), 7.39 (95% CI: 2.97-18.76), with an increasing trend gradually (p < 0.01); HSAR of the five were 25.5% (95% CI: 20.1-31.7%), 27.4% (95% CI: 22.0-33.4%), 42.9% (95% CI: 34.3-51.8%), 53.1% (95% CI: 45.0-60.9%), 41.4% (95% CI, 25.5-59.3%), also with an increasing trend (p < 0.001). Conclusion: Compared to the original strain, the incubation period and SI decreased while R0 and HSAR increased, suggesting that transmission in the population was faster and the scope of the population was wider. Overall, it's crucial to keep implementing comprehensive measures like monitoring and alert systems, herd immunization plans, and outbreak control.

Four-dimensional digital subtraction angiography to assess cerebral arteriovenous malformations.

BACKGROUND AND PURPOSE: The performance of a novel prototype four-dimensional (4D) digital subtraction angiography (DSA) for cerebral arteriovenous malformation (AVM) diagnosis was evaluated and compared with that of two-dimensional (2D) and three-dimensional (3D) DSA. METHODS: In this retrospective study, 37 consecutive cerebral AVM patients were included. The standard diagnostic results were concluded from the 2D and 3D DSA. Two 4D DSA volumes were reconstructed for each patient by a commercial and a prototype software, then evaluated by two independent experienced neurosurgeons, who were blinded to the diagnosis and treatment process. The evaluation results were compared with the diagnostic results on Spetzler-Martin (SM) Grading Scale, number of feeding arteries, number of draining veins, and intranidal aneurysms. RESULTS: Complete agreement was achieved between 4D DSA and 2D and 3D DSA in SM Grading Scale and intracranial aneurysm identification (agreement coefficient: 1) for both reviewers. The agreement coefficients were .888 and .917 for both reviewers in feeding artery number determination using 4D DSA product and 4D DSA prototype, respectively. The agreement coefficients in draining vein number determination were all larger than .94 for both reviewers using both 4D DSA volumes. CONCLUSIONS: The performance of this prototype 4D DSA in cerebral AVMs diagnosis was largely equivalent to that of 2D and 3D DSA combination. Four-dimensional DSA can be regarded as a very good complement for 2D DSA in cerebral AVM diagnosis.

Influence of contest on Chinese college students' health literacy based on repeated cross-sectional studies.

Objective: Chinese college students' level of health literacy is low, so, we explored the effect of knowledge contests on health literacy (HL) among Chinese college students. Participants: Students from universities in Jiangsu, China. Methods: Two repeated cross-sectional studies were used to compare the effects of the college students' contests. Chi-square tests and variance analysis were used to compare the HL levels and scores, respectively; logistic regression was used for multivariate analysis. Results: The levels of HL after each contest were significantly higher than those in the baseline survey (p < .05). There were statistically significant score differences (p = .023 and p = .001) after the contests in the two studies. Multivariable analysis of HL contest showed that school, grade, profession, completion time, and contest history were statistically significant. Conclusions: HL among Chinese college students was low and it is helpful to regularly hold health knowledge contests to improve these levels, especially for most non-medical students.

The Clinical Efficacy Analysis of Treatment With a Willis Covered Stent in Traumatic Pseudoaneurysm of the Internal Carotid Artery.

Objective: To investigate the safety and efficacy of Willis covered stents (WCS) in the treatment of traumatic pseudoaneurysm of the cranial internal carotid artery (CICA). Methods: Fifteen patients with traumatic pseudoaneurysm of the intracranial segment of the ICA treated with the WCS system at our institution from 2013 to 2019 were analyzed retrospectively. Follow-up observation and digital subtraction angiography (DSA) examination were conducted ~6 months after the treatment. Results: DSA performed immediately after stent deployment revealed that complete occlusion of the lesion was achieved in 13 patients and that endoleak occurred in two patients. In 12 patients, postoperative DSA examination indicated that the lesions were completely occluded. In two patients who had a second stent implantation at the break of the ICA, traumatic ICA rupture was essentially completely obstructed in 1 patient. The endoleak remained in one patient with carotid cavernous sinus fistula because the placement of the second stent system was difficult with his ICA tortuosity. No recurrence of aneurysms, hemorrhage, or other lesions was observed, and the patients' parent arteries were patent without stenosis. No procedure-related complications or ischemic strokes occurred during the follow-up period of ~6 months. Conclusions: For treatment of traumatic pseudoaneurysm of the CICA, Willis covered stent implantation in some appropriate cases, is safe and effective. However, large-sample controlled studies and multicenter studies are needed for further confirmation.

Co-combustion of Oil Sludge Char with Raw/Hydrothermally Treated Biomass: Interactions, Kinetics, and Mechanism Analysis.

Comprehensive thermochemical treatment (pyrolysis and combustion) is considered to be an efficient method for treatment of oil sludge (OS) or utilization as a heat source. However, combustion of oil sludge char (OSC), the byproduct from OS pyrolysis, is difficult and energy-consuming due to the high ash content and low heating value. In this study, co-combustion of OSC with biomass is proposed, aiming at the efficient thermal treatment with heat recovery. The thermal characteristics, kinetics, and interactive mechanisms of co-combustion of OSC with raw wood (RW) or hydrothermally treated wood (HW) employing thermogravimetric analysis were investigated. The obtained results indicated that RW blending with OSC resulted in negative interactions with decreasing the apparent activation energies (E) of RW, attributed to the inhibited diffusion of volatiles. The developed porous structure in HW effectively promoted volatile matter diffusion. Coupled with the catalytic support by metal oxides in OSC, HW blending yielded positive interactions during co-combustion despite the increased E. The results showed that diffusion models were the most efficient mechanism for OSC/RW combustion. However, chemical reactions were found to be the rate-determining steps for OSC/HW combustion. The catalytic effect of inorganic elements and their physical influence on heat and mass transfer can control the co-combustion performance of OSC and biomass. The findings could offer reference information for understanding OSC co-combustion and provide a basis for implementing and optimizing the co-combustion between biomass and ash-rich waste.

Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: a meta-analysis and systematic review.

OBJECTIVE: To evaluate the overall diagnostic value related to magnetic resonance imaging (MRI) in patients with early osteonecrosis of the femoral head. METHODS: By searching multiple databases and sources, including PubMed, Cochrane, and Embase database, by the index words updated in December 2017, qualified studies were identified and relevant literature sources were also searched. The qualified studies included prospective cohort studies and cross-sectional studies. Heterogeneity of the included studies were reviewed to select proper effect model for pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were performed for meniscal tears. RESULTS: Forty-three studies related to diagnostic accuracy of MRI to detect early osteonecrosis of the femoral head were involved in the meta-analysis. The global sensitivity and specificity of MRI in early osteonecrosis of the femoral head were 93.0% (95% CI 92.0-94.0%) and 91.0% (95% CI 89.0%-93.0%), respectively. The global positive likelihood ratio and global negative likelihood ratio of MRI in early osteonecrosis of the femoral head were 2.74 (95% CI 1.98-3.79) and 0.18 (95% CI 0.14-0.23), respectively. The global DOR was 27.27 (95% CI 17.02-43.67), and the area under the SROC was 93.38% (95% CI 90.87%-95.89%). CONCLUSIONS: This review provides a systematic review and meta-analysis to evaluate the diagnostic accuracy of MRI in early osteonecrosis of the femoral head. Moderate to strong evidence indicated that MRI appears to be significantly associated with higher diagnostic accuracy for early osteonecrosis of the femoral head.

Health economic evaluation of immunization strategies of hepatitis E vaccine for elderly population.

Objective This study was conducted to assess the cost-effectiveness of hepatitis E vaccination of elderly population in the sporadic regions in China. Methods We used a decision tree-Markov model to evaluate the cost-effectiveness of 3 kinds of hepatitis E virus vaccination strategies from societal perspectives. Parameter estimates were obtained from published researches and experts' opinion. The time horizon was 16 years, and the discounted rate was 3% annually. Costs are expressed in 2016 US dollars. Results The universal vaccination strategy had an incremental cost-effectiveness ratio (ICER) of US$ 8475.90 per QALY gained versus no vaccination. The implementation of screening and vaccination strategy would have an ICER of US$ 4044.28, compared with no vaccination. The vaccination was cost-effective (ICER< 3 times China's per capital gross domestic product/quality-adjusted life years). The QALY of asymptomatic infection, vaccine coverage and vaccine protection are the important parameters impacting the ICER in one-way sensitivity analysis and screening and vaccination being the dominant strategy in probabilistic sensitivity analysis. Conclusion This analysis indicates that screening and vaccination is the most cost-effective hepatitis E intervention strategy of elderly population in sporadic region in China.

Viral hepatitis vaccination during pregnancy.

Viral hepatitis is a serious global public health problem. It is also a common cause of jaundice and gestational complications in pregnant women. Moreover, infected mothers can transmit the virus to their fetus or neonate, which may increase disease burden and decrease quality of life. To date, commercial vaccines have been developed for hepatitis A, B, and E and are available to the general population. The Advisory Committee on Immunization Practices currently accepts emergency vaccination against hepatitis A and B during pregnancy due to benefits that overweight the potential risks. While there are limited data from trials with limited numbers of samples that suggest the efficacy or safety of hepatitis B and E vaccines in pregnant women, additional data are necessary to provide evidence of vaccination during pregnancy.

A preliminary cost-effectiveness analysis of hepatitis E vaccination among pregnant women in epidemic regions.

Objective To estimate the cost-effectiveness of hepatitis E vaccination among pregnant women in epidemic regions. Methods A decision tree model was constructed to evaluate the cost-effectiveness of 3 hepatitis E virus vaccination strategies from societal perspectives. The model parameters were estimated on the basis of published studies and experts' experience. Sensitivity analysis was used to evaluate the uncertainties of the model. Results Vaccination was more economically effective on the basis of the incremental cost-effectiveness ratio (ICER< 3 times China's per capital gross domestic product/quality-adjusted life years); moreover, screening and vaccination had higher QALYs and lower costs compared with universal vaccination. No parameters significantly impacted ICER in one-way sensitivity analysis, and probabilistic sensitivity analysis also showed screening and vaccination to be the dominant strategy. Conclusion Screening and vaccination is the most economical strategy for pregnant women in epidemic regions; however, further studies are necessary to confirm the efficacy and safety of the hepatitis E vaccines.

Comparison of Accelerated and Standard Hepatitis B Vaccination Schedules in High-Risk Healthy Adults: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Selecting the most efficient vaccination schedule is an important issue. OBJECTIVE: To assess the beneficial and harmful effects of accelerated hepatitis B vaccination schedules in high-risk healthy adults. METHODS: We searched controlled trial registers of The Cochrane Library as well as MEDLINE, EMBASE, VIP Database for Chinese Technical Periodicals, and the Chinese National Knowledge Infrastructure databases for randomized controlled trials published up to December 2013 that compared accelerated hepatitis B vaccine schedules to the standard schedule in adults. The results were presented as relative risk with 95% confidence intervals. Fixed or random effect models were used for analysis. RESULTS: We identified 10 randomized trials, all with one or more methodological weaknesses. Compared to the standard schedule, most accelerated schedules resulted in higher proportions of healthy vaccines more rapidly reaching anti-hepatitis B antibody levels >10 IU/L (P<0.05) initially and maintaining similar seroprotection rates after 6 months (P>0.05). Although accelerated schedules produced anti-hepatitis B levels higher than the standard schedule for the first month after the initial vaccine dose, they were significantly lower than the standard schedule after 6 months, except for an accelerated schedule that called for a fourth booster injection 12 months after the initial dose. Subjects administered accelerated vaccine schedules had similar compliance rate as those administered the standard schedule over the first 6 months of vaccination (relative risk = 1.00, 95% confidence interval: 0.84-1.21). CONCLUSION: For rapid seroconversion and almost immediate short-term protection, accelerated vaccination schedules could be useful for at-risk groups. However, additional studies on the long-term protection and effectiveness of the primary doses of accelerated schedules are necessary.

Immunization interventions to interrupt hepatitis B virus mother-to-child transmission: a meta-analysis of randomized controlled trials.

BACKGROUND: This study aimed to determine the clinical efficacy of various immune interventions on mother-to-child transmission (MTCT) of hepatitis B virus (HBV). METHODS: We retrieved different immune strategies on how to prevent MTCT reported in the literature from Chinese and English electronic databases from the viewpoint of intrauterine and extrauterine prevention. Relative risk (RR) and 95% confidence interval (CI) methods were used. RESULTS: Twenty-five articles on intrauterine prevention and 16 on extrauterine prevention were included in the analysis. Intrauterine prevention could reduce infants' HBV infection rate (RR = 0.36, 95% CI: 0.28-0.45) and increase their anti-hepatitis B surface-positive rate (RR = 2.42, 95% CI: 1.46-4.01) at birth. Compared with passive immunization, passive-active immunization could reduce infants' HBV infection rate (RR = 0.66, 95% CI: 0.52-0.84) at birth, even at more than 12 months of age (RR = 0.54, 95% CI: 0.42-0.69). Subgroup analysis demonstrated similar results except for pregnant women who were hepatitis B surface antigen-positive. Funnel plots and Egger's tests showed publication bias mainly in intrauterine prevention not in extrauterine one. CONCLUSIONS: The long-term protective effect of pregnant women injected with hepatitis B immunoglobulin during pregnancy should be further validated by large-scale randomized trials. Newborns of pregnant women who carried HBV should undergo a passive-active immunization strategy.