Cost-effectiveness analysis of artificial intelligence-based diabetic retinopathy screening in rural China based on the Markov model.

This study assessed the cost-effectiveness of different diabetic retinopathy (DR) screening strategies in rural regions in China by using a Markov model to make health economic evaluations. In this study, we determined the structure of a Markov model according to the research objectives, which required parameters collected through field investigation and literature retrieval. After perfecting the model with parameters and assumptions, we developed a Markov decision analytic model according to the natural history of DR in TreeAge Pro 2011. For this model, we performed Markov cohort and cost-effectiveness analyses to simulate the probabilistic distributions of different developments in DR and the cumulative cost-effectiveness of artificial intelligence (AI)-based screening and ophthalmologist screening for DR in the rural population with diabetes mellitus (DM) in China. Additionally, a model-based health economic evaluation was performed by using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios. Last, one-way and probabilistic sensitivity analyses were performed to assess the stability of the results. From the perspective of the health system, compared with no screening, AI-based screening cost more (the incremental cost was 37,257.76 RMB (approximately 5,211.31 US dollars)), but the effect was better (the incremental utility was 0.33). Compared with AI-based screening, the cost of ophthalmologist screening was higher (the incremental cost was 14,886.76 RMB (approximately 2,070.19 US dollars)), and the effect was worse (the incremental utility was -0.31). Compared with no screening, the incremental cost-effectiveness ratio (ICER) of AI-based DR screening was 112,146.99 RMB (15,595.47 US dollars)/QALY, which was less than the threshold for the ICER (< 3 times the per capita gross domestic product (GDP), 217,341.00 RMB (30,224.03 US dollars)). Therefore, AI-based screening was cost-effective, which meant that the increased cost for each additional quality-adjusted life year was merited. Compared with no screening and ophthalmologist screening for DR, AI-based screening was the most cost-effective, which not only saved costs but also improved the quality of life of diabetes patients. Popularizing AI-based DR screening strategies in rural areas would be economically effective and feasible and can provide a scientific basis for the further formulation of early screening programs for diabetic retinopathy.

Marein Alleviates High Glucose-Induced Human Retinal Microvascular Endothelial Cell Injury by Up-Regulating SNHG7 Expression.

BACKGROUND: Marein has been shown to possess therapeutic effects against diabetic retinopathy, but whether it can protect against high glucose (HG)-induced human retinal microvascular endothelial cell (HRMEC) injury remains unclear. Our study aimed to explore the effect of marein on HG-induced HRMEC injury and the mechanism underlying this purported therapeutic effect. METHODS: HRMEC was divided into normal glucose group, high glucose (HG) group, HG+marein low, medium and high (L, M, H) concentrations group, HG+pcDNA group, HG+pcDNA-small nucleolar RNA host gene 7 (SNHG7) group, HG+marein+si-negative control (NC) group, and HG+marein+si-SNHG7 group. Flow cytometry and Western blotting were performed to determine apoptosis rate and apoptosis-related protein levels. Superoxide dismutase (SOD) activity, lactate dehydrogenase (LDH) level and malondialdehyde (MDA) content were detected to assess cellular oxidative stress. SNHG7 expression was examined using real-time quantitative PCR. RESULTS: After treatment with low, medium and high concentrations of marein, apoptosis rate, Bax level, LDH level and MDA content were decreased, while B-cell lymphoma-2 (Bcl-2) level, SOD activity, and SNHG7 expression were promoted in HG-induced HRMEC injury in a concentration-dependent manner (p < 0.05). After overexpression of SNHG7, apoptosis rate, Bax level, LDH level and MDA content were decreased, while Bcl-2 level and SOD activity were enhanced in HG-induced HRMEC injury (p < 0.05). In contrast, SNHG7 knockdown reversed the effect of marein on HG-induced HRMEC injury. CONCLUSIONS: Marein could alleviate HG-induced HRMEC injury by up-regulating SNHG7 expression.

Phytoremediation of cadmium from soil, air and water.

Potentially toxic elements (PTEs) pose a great threat to ecosystems and long-term exposure causes adverse effects to wildlife and humans. Cadmium induces a variety of diseases including cancer, kidney dysfunction, bone lesions, anemia and hypertension. Here we review the ability of plants to accumulate cadmium from soil, air and water under different environmental conditions, focusing on absorption mechanisms and factors affecting these. Cadmium possess various transport mechanisms and pathways roughly divided into symplast and apoplast pathway. Excessive cadmium concentrations in the environment affects soil properties, pH and microorganism composition and function and thereby plant uptake. At the same time, plants resist cadmium toxicity by antioxidant reaction. The differences in cadmium absorption capacity of plants need more exploration to determine whether it is beneficial for crop breeding or genetic modification. Identify whether plants have the potential to become hyperaccumulator and avoid excessive cadmium uptake by edible plants. The use of activators such as wood vinegar, GLDA (Glutamic acid diacetic acid), or the placement of earthworms and fungi can speed up phytoremediation of plants, thereby reducing uptake of crop varieties and reducing human exposure, thus accelerating food safety and the health of the planet.

Pyrolysis of Aesculus chinensis Bunge Leaves as for Extracted Bio-Oil Material.

Biomass rapid pyrolysis technology is easy to implement in continuous production and industrial application, and has become one of the leading technologies in the field of world renewable energy development. Agricultural and forestry waste is an important resource of renewable energy in China. In general, abandoned leaves in forest areas cause serious waste of resources. Its utilization may help to settle the problems of energy deficiency and environment pollution. In this study, Aesculus chinensis Bunge leaves (A. Bunge) are used as the research object to study the pyrolysis and extract. The results showed that there are a lot of bioactive components in A. Bunge leaves extract, including acetamide, 5-hydroxymethylfurfural, R-limonene, d-mannose, and dihydroxyacetone. The active components of A. Bunge leaves supply scientific evidence for the exploration and exploitation of this plant. The pyrolysis products of A. Bunge leaves are rich in organic acids, aldehydes, and ketones, which means that A. Bunge leaves can be used as a crude material for the manufacturing of bio-oil or bio-fuel. The pyrolysis products include batilol, pregnenolone, benzoic acid, butyrolactone, and propanoic acid, which can be used in biological medicine, chemical crude materials, and industrial raw material reagents. Therefore, A. Bunge leaves can be used as a good crude material for bio-oil or biofuel production. Combining A. Bunge leaves and fast pyrolysis methods can effectively solve the problem of forestry and agricultural residues in the future.

Nano Catalysis of Biofuels and Biochemicals from Cotinus coggygria Scop. Wood for Bio-Oil Raw Material.

Cotinus coggygria Scop. as a precious landscape shrub and a good afforestation species that is used in the pharmaceutical industry. In this paper, TG-FTIR, TG-DTG, and Py-GC/MS were used to study the biomaterials of Cotinus coggygria used as biofuels and biochemicals under the catalysis of nano-Mo/Fe2O3. The wood powder was extracted using a methanol/benzene solution, and the extract was analyzed by FTIR and GC-MS. The results showed that the pyrolysis products of Cotinus coggygria wood were rich in phenols, alcohols, and biofuels. The metal nano-Mo powder played a catalytic role in the interpretation of the gas in the species, where it accelerates gas products. Metal nano-Fe2O3 has a certain flame-retardant effect on the burning process of Cotinus coggygria wood, and the residual amount of pyrolysis is greater. The contents of the extract Formamide, 1-Hexanol, Levodopa, and 9,12-Octadecadienoic acid (Z,Z)- are not only widely used industrially but also play an important role in medicine. Cotinus coggygria is therefore an excellent biomaterial for biofuels and biochemicals.

Clinical evaluation of AI-assisted screening for diabetic retinopathy in rural areas of midwest China.

BACKGROUND: Although numerous studies have described the application of artificial intelligence (AI) in diabetic retinopathy (DR) screening among diabetic populations, studies among populations in rural areas are rare. The purpose of this study was to evaluate the application value of an AI-based diagnostic system for DR screening in rural areas of midwest China. METHODS: In this diagnostic accuracy study, diabetes mellitus (DM) patients in the National Basic Public Health Information Systems of Licheng County and Lucheng County of Changzhi city from July to December 2020 were selected as the target population. A total of 7824 eyes of 3933 DM patients were enrolled in this screening; the patients included 1395 males and 2401 females, with an average age of 19-87 years (63±8.735 years). All fundus photographs were collected by a professional ophthalmologist under natural pupil conditions in a darkroom using the Zhiyuan Huitu fundus image AI analysis software EyeWisdom. The AI-based diagnostic system and ophthalmologists were tasked with diagnosing the photos independently, and the consistency rate, sensitivity and specificity of the two methods in diagnosing DR were calculated and compared. RESULTS: The prevalence rates of DR according to the ophthalmologist and AI diagnoses were 22.7% and 22.5%, respectively; the consistency rate was 81.6%. The sensitivity and specificity of the AI system relative to the ophthalmologists' grades were 81.2% (95% confidence interval [CI]: 80.3% 82.1%) and 94.3% (95% CI: 93.7% 94.8%), respectively. There was no significant difference in diagnostic outcomes between the methods (χ2 = 0.329, P = 0.566, P>0.05), and the AI-based diagnostic system had high consistency with the ophthalmologists' diagnostic results (κ = 0.752). CONCLUSION: Our research demonstrated that DR patients in rural area hospitals can be screened feasibly. Compared with that of the ophthalmologists, however, the accuracy of the AI system must be improved. The results of this study might lend support to the large-scale application of AI in DR screening among different populations.

Incorporation of Nanocatalysts for the Production of Bio-Oil from Staphylea holocarpa Wood.

Biomass has been recognized as the most common source of renewable energy. In recent years, researchers have paved the way for a search for suitable biomass resources to replace traditional fossil fuel energy and provide high energy output. Although there are plenty of studies of biomass as good biomaterials, there is little detailed information about Staphylea holocarpa wood (S. holocarpa) as a potential bio-oil material. The purpose of this study is to explore the potential of S. holocarpa wood as a bio-oil. Nanocatalyst cobalt (II) oxide (Co3O4) and Nickel (II) oxide (NiO) were used to improve the production of bio-oil from S. holocarpa wood. The preparation of biofuels and the extraction of bioactive drugs were performed by the rapid gasification of nanocatalysts. The result indicated that the abundant chemical components detected in the S. holocarpa wood extract could be used in biomedicine, cosmetics, and biofuels, and have a broad industrial application prospect. In addition, nanocatalyst cobalt tetraoxide (Co3O4) could improve the catalytic cracking of S. holocarpa wood and generate more bioactive molecules at high temperature, which is conducive to the utilization and development of S. holocarpa wood as biomass. This is the first time that S. holocarpa wood was used in combination with nanocatalysts. In the future, nanocatalysts can be used to solve the problem of sustainable development of biological resources.

13,27-Cycloursane, ursane and oleanane triterpenoids from the leaves of Lucuma nervosa.

One hitherto unknown 24-nor-13,27-cycloursane-type triterpenoid, lucumic acid A (1), one new 24-nor-ursane triterpenoid, lucumic acid B (2), along with six known triterpenoids were isolated from the ethanol extract of the leaves of Lucuma nervosa. Their structures were established on the basis of spectroscopic data interpretation. Lucumic acid A (1) is the first example of a 24-nor-triterpenoid with a 13,27-cyclopropane ring.