Development and validation of nomogram-based models for personalized survival assessment in pediatric hepatoblastoma patients.

Background: Hepatoblastoma (HB) is a prevalent form of liver cancer in pediatric patients, characterized by an embryonal malignant tumor. In the current study, a clinical prediction model was developed; that can effectively assess the likelihood of a patient's survival with HB. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database for cases of HB between 2010 and 2019 were used in this retrospective research. Information on clinicopathologic characteristics, therapeutic interventions, and survival outcomes were included in the data. The HB patients were randomly assigned to the training or validation cohort in a 7:3 ratio. Using univariate and multivariate Cox proportional hazards regression models, the prognostic indicators for overall survival (OS) and cancer-specific survival (CSS) were identified. The area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and concordance index (C-index) were used to evaluate the accuracy and calibration of these models. The clinical utility of the models was examined using decision curve analysis (DCA). Results: The multivariate Cox regression analysis revealed multiple autonomous prognostic determinants for the OS and CSS, including age, surgical interventions, and chemotherapy administration. Significantly, tumor size was found to be a strong predictor of OS. AUC values of 0.915, 0.846, and 0.847 for 1-, 3-, and 5-year OS, respectively, indicated that the nomogram-based models were highly accurate at predicting outcomes. Similarly, the AUC values for CSS were 0.871, 0.814, and 0.825. The C-index measurements, which quantify the discriminatory performance of the models, produced CSS values of 0.836 and OS values of 0.864. Furthermore, the calibration plots accurately represented the actual survival rates. Concurrently, the DCA had validated the clinical relevance of the nomogram-based models. Conclusions: The present study successfully developed and validated user-friendly nomogram-based models, allowing for accurate assessment of OS and CSS in pediatric HB patients. These tools enable personalized survival predictions, enhance risk stratification, and strengthen clinical decision-making for managing HB.

Allocating China's CO2 Emissions Based on Economic Welfare Gains from Environmental Externalities.

To achieve carbon neutrality (i.e., net zero carbon emissions) by 2060, China must make significant changes in its socioeconomic systems, including appropriately allocating emissions responsibility. Traditional methods of delineating responsibilities (such as production-based and consumption-based accounting) can lead to double counting when applied simultaneously and therefore difficulty in determining responsibilities of different agents. An alternative approach based on economic welfare gains from environmental externalities has been refined, ensuring that the responsibilities of consumers and producers add up to the total emissions. The application of this approach to 48 countries and 31 Chinese provinces reveals that regions with less elastic supply and demand, such as Hebei in China and Russia, have higher responsibilities. Furthermore, larger externalities associated with unitary product value shift the burden of obligations from producers to consumers. Regions with high levels of wealth and carbon-intensive imports, such as Zhejiang and Guangdong in China, as well as the United States, typically have higher consumer-based accounting (CBA) emissions than production-based accounting (PBA) emissions and, as a result, redistributed responsibilities between PBA and CBA emissions. The new distribution results vary significantly from PBA or CBA emissions, indicating opportunities for more comprehensive and accessible policy goals.

The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population.

BACKGROUND: In patients with advanced osteoarthritis (OA) of the bilateral knees, uncertainty remains as to whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged TKA (StTKA) is the treatment of choice. The purpose of this study was to investigate the safety and relative cost of SiTKA vs StTKA in Taiwan patients. METHODS: Using the Big Data Center of Taipei Veterans General Hospital, we retrospectively reviewed all patients who underwent SiTKA or StTKA due to OA or spontaneous osteonecrosis of the knee from January 2011 to December 2016. We assessed length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rate, 1-year reoperation rate, and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, including reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case. RESULTS: A total of 2016 patients (1565 SiTKA and 451 StTKA) were included in this study. The two groups had no significant differences in rates of complications, 30- and 90-day readmission, or 1-year reoperation. The length of stay was on average 5.0 days longer for StTKA ( p < 0.01). In terms of cost, all categories of medical costs were significantly lower for SiTKA, while the net hospital income was significantly higher for StTKA. CONCLUSION: SiTKA is a safe and cost-effective surgery. Both SiTKA and StTKA have similar rates of postoperative complications, readmission and reoperation, but SiTKA significantly reduces medical expenses for both the patient and the NHI.

Bolt Positioning Detection Based on Improved YOLOv5 for Bridge Structural Health Monitoring.

To improve the stability of the bridge structure, we detect bolts in the bridge which cause the symmetry failure of the bridge center. For data acquisition, bolts are small-scale objects under complex background in images, and their feature expression ability is limited. Due to those questions, we propose a new bolt positioning detection based on improved YOLOv5 for bridge structural health monitoring. This paper makes three major contributions. Firstly, according to the calibration anchor boxes of bolts, the size and proportion parameters of the initial anchor boxes are optimized by K-means++ clustering algorithm to solve the initial clustering problem of anchor boxes in object detection. Second, the hypercolumn (HC) technique fuses the low-level global features of the trunk and the high-level local features of three different scales to solve the problem of the inefficient distribution of anchors and insufficient extraction of classification features. In this way, we improve the detection accuracy and speed of bolt detection. Finally, we establish a dataset of bridge bolts through network collection and public datasets, including 1494 images. We compare and verify the new method in the collected bolt dataset. The experimental results show that the precision (P) of the improved YOLOv5x is up to 87.3%, and the average precision (AP) is up to 86.3%, which are 6.5% and 5.9% higher than the original YOLOv5x, respectively.

The Vulnerability of the Power Grid Structure: A System Analysis Based on Complex Network Theory.

The safety and reliability of the power grid are related to national power security, economic development and people's daily life. The occurrence of extreme weather changes the external environment greatly. Including generators and transmission lines, many power grid units cannot resist such a huge attack and get damaged easily, which forces units to quit from the power grid running system for a while. Furthermore, if the number of influenced units is high enough, the whole power system will be destroyed by cascading failure caused by extreme weather. Aiming at dealing with the cascading failure emergencies, this paper is trying to improve the traditional power structural vulnerability model so that it can be used to discuss extreme weather and propose a theoretical topological model to help scholars measure the damage caused by extreme cases. Based on previous research in this field, this paper utilizes complex network knowledge to build the power grid topology model. Then, considering extreme cases and the three attack modes simulation process, this paper makes use of the characteristic parameters of the power grid topology model and designs an algorithm, according to the realistic situation of the propagation mechanism of cascading failure of the power grid model as well as extreme weather research. Finally, taking IEEE-30 and IEEE-118 node bus system as examples, which shows that the structural vulnerability method proposed in this paper can properly address the mechanism of unbalanced load of cascading failure of power grid units under extreme conditions and can provide theoretical reference for preventing and reducing the impact of extreme cases on power grid which improves the reliability of the power grid.

Global burden of acute viral hepatitis and its association with socioeconomic development status, 1990-2019.

BACKGROUND & AIMS: Acute viral hepatitis (AVH) represents an important global health problem; however, the progress in understanding AVH is limited because of the priority of combating persistent HBV and HCV infections. Therefore, an improved understanding of the burden of AVH is required to help design strategies for global intervention. METHODS: Data on 4 major AVH types, including acute hepatitis A, B, C, and E, excluding D, were collected by the Global Burden of Disease (GBD) 2019 database. Age-standardized incidence rates and disability-adjusted life year (DALY) rates for AVH were extracted from GBD 2019 and stratified by sex, level of socio-demographic index (SDI), country, and territory. The association between the burden of AVH and socioeconomic development status, as represented by the SDI, was described. RESULTS: In 2019, there was an age-standardized incidence rate of 3,615.9 (95% CI 3,360.5-3,888.3) and an age-standardized DALY rate of 58.0 (47.3-70.0) per 100,000 person-years for the 4 major types of AVH. Among the major AVH types, acute hepatitis A caused the heaviest burden. There was a significant downward trend in age-standardized DALY rates caused by major incidences of AVH between 1990 and 2019. In 2019, regions or countries located in West and East Africa exhibited the highest age-standardized incidence rates of the 4 major AVH types. These rates were stratified by SDI: high SDI and high-middle SDI locations recorded the lowest incidence and DALY rates of AVH, whereas the low-middle SDI and low SDI locations showed the highest burden of AVH. CONCLUSIONS: The socioeconomic development status and burden of AVH are associated. Therefore, the GBD 2019 data should be used by policymakers to guide cost-effective interventions for AVH. LAY SUMMARY: We identified a negative association between socioeconomic development status and the burden of acute viral hepatitis. The lowest burden of acute viral hepatitis was noted for rich countries, whereas the highest burden of acute viral hepatitis was noted for poor countries.

Global environmental inequality: Evidence from embodied land and virtual water trade.

The trade-off between economic growth and environmental conservation is the focus of national environmental management. Previous studies have proved that global trade can bring both economic benefits and environmental costs to all countries. However, for different countries, it is not clear whether the environmental costs match their economic benefits in global trade. Also, whether the global trade exacerbates or mitigates the uneven distribution of natural resources among countries need to be further investigated. This study aims to fill these research gaps by providing evidence of global environmental inequality from land and water perspective, thus inspire new thinking on the optimization of global trade patterns. We construct an environmental inequality index based on the world Multi-Regional Input-Output (MRIO) model, and perform a case study for land and water. Results show that most of countries with low per capita land resources are net importers of embodied land, while many countries with extreme water shortages are net exporters of virtual water, such as India, Pakistan, Iran and Egypt, indicating that the global trade encourages the optimal distribution of land resources but exacerbates the uneven distribution of water resources. The environmental cost of developed countries is much lower than that of developing countries compared to their economic gains from global trade, and the inequality of virtual water trade is higher than that of embodied land trade. High-income countries mainly export high value-added products with low environmental costs, while developing countries are just the opposite. We suggest that due to the lack of a unified global natural resource market, resource tax may be an effective means to reduce global environmental inequality and resource mismatch, and policies aimed at reducing environmental inequality can help achieve coordinated management of land and water resources.

Future outcomes and health needs of chronic hepatitis C patients after receiving antiviral therapy.

AIMS: To study the future outcomes and health needs of chronic hepatitis C (CHC) patients after receiving direct-acting antiviral (DAA) therapy based on the health promotion perspectives and cardiometabolic risks in a rural setting. DESIGN: This cross-sectional study was conducted from May to December 2019 in coastal western and southern Taiwan. METHODS: We included CHC patients who were diagnosed and transferred by the gastroenterologist and hepatologist in outpatient clinics and completed DAA treatments. Data on demographic characteristics, health-related behaviours and physiological biomarkers were collected through one-on-one interview using a questionnaire and from medical records obtained from a teaching hospital. RESULTS: In total, 124 participants were enrolled. Most participants (87.1%) had no side effects and 79.8% felt satisfied after treatment. However, 62.1% had metabolic syndrome, 48.4% had hypertension and 37.9% had diabetes. Furthermore, 71.8% patients were considered to have medium-to-high risk based on Framingham risk scores. In the multiple regression model, after adjusting for education level, other chronic diseases were negatively associated with health-promoting behaviours in participants. CONCLUSIONS: Although there were few side effects and most patients were satisfied after treatment, there was a high prevalence of cardiometabolic risk factors and cardiometabolic diseases and less adoption of healthy behaviours in CHC patients. Despite the small sample size, the study suggests that clinicians can reduce the burden of the aforementioned comorbidities by providing adequate treatment and individualized lifestyle modification. IMPACT: This study highlights that primary healthcare providers should consider the health needs of CHC patients after DAA treatment since many patients have high cardiometabolic risks, but only a few adopt a healthy lifestyle. Further studies are needed to initiate health-promoting programs for these patients to reduce further injury to vital organs.

Opportunities for low-carbon socioeconomic transition during the revitalization of Northeast China: Insights from Heilongjiang province.

The Strategies of Reviving the Old Industrial Bases provide opportunities for low-carbon transition in Northeast China, which is one of the earliest regions to industrialize and the largest rustbelt in China, but study on the impacts of its socioeconomic factors on CO2 emissions is still in short, though it is essential for guiding the pathways to achieve low-carbon socioeconomic transition. We adopted the structural decomposition analysis (SDA) to identify the main contributors to emissions increase in Heilongjiang province during 2002-2012, which is the heartland of Northeast revitalization. The results show that the increase in CO2 emissions was mainly driven by growth in per-capita final demand, which generated 203.8 Mt (153.6%) upstream CO2 emissions between 2002 and 2012. Changes in production structure and final demand structure had smaller impacts on CO2 emissions increase (36.1 Mt and 27.0 Mt). However, the positive influences were largely overwhelmed by change in emission intensity, which avoided 135.4 Mt (-102%) CO2 emissions. Therefore, appropriate measures related to energy structure optimization and efficiency improvement should be implemented. Especially, increasing the proportion of wind, solar and biomass energy in Heilongjiang, where renewable energy is abundant, would reduce the CO2 emissions significantly. In addition, domestic export took the lead position in driving the CO2 emissions in Heilongjiang, accounting for 37.6%-43.1% annual emissions between 2002 and 2012. Thus, some financial instrument, such as tax relief for less carbon intensive exports could be adopted to prompt upstream suppliers to decarbonize their production processes.

Fabrication of high quality and low cost microlenses on a glass substrate by direct printing technique.

The fabrication of high quality and low cost microlenses on a glass substrate using a simple, rapid, and precise direct microplotting technique is shown in this paper. The fabrication method is based on the use of a microplotter system, which is significantly different from the existing inkjet, roll-to-roll printing, and reactive ion etching technology and could work with higher viscosity materials. By optimizing the parameters of voltage, dispense time, and concentration of the polymer solution, high quality microlenses with a diameter of 20 µm could be obtained. The geometrical and optical characteristics of the microlenses are analyzed by measurement of the surface profile and the imaging properties in the near-field and far-field zones as well as the diffraction pattern. We think that the fabricated microlenses could be attractive for enhancing the light extraction efficiency of light emitting diodes.

Innovative trident fixation technique for allograft knee arthrodesis for high-grade osteosarcoma around the knee.

OBJECTIVE: Reconstruction for osteosarcoma around the knee after wide resection faces the challenge of great bone defect and future limb length discrepancy in the skeletally immature patients. Modern prosthetic reconstruction may provide good results, but the longevity may be of concern and may not be affordable in certain communities. Allograft knee arthrodesis still has its role in light of bone stock preservation and cost-effectiveness. METHODS: We developed the innovative trident fixation technique utilizing three Steinmann pins to minimize limb length inequality without jeopardizing knee fusion stability. Twelve patients were enrolled. The mean age was 11.5 (10-13) years. Two had high-grade osteosarcoma in proximal tibia and others in distal femur. RESULTS: Two patients died of oncological disease. The median follow-up of the disease-free 10 patients was 47 (41-60) months. All allograft-host bone junctions healed uneventfully without major complications except one allograft fracture. The average limb length discrepancy was 1.45 (1.0-2.1) cm at latest follow-up. CONCLUSIONS: This straightforward technique was successful in knee arthrodesis with minimized limb length inequality. Accordingly, in light of bone stock preservation and longevity for the young children, it may be a surgical alternative for malignant bone tumors around the knee.