Factors influencing willingness to participate in ophthalmic clinical trials and strategies for effective recruitment.

AIM: To explore the factors influencing individuals' willingness to participate in ophthalmic clinical trials. METHODS: A questionnaire survey was conducted from January to April 2021 among patients and their family members at Zhongshan Ophthalmic Center, Sun Yat-sen University, in Guangzhou, China. The survey gathered data on respondents' willingness, demographic and socioeconomic profiles, as well as their reasons and concerns regarding engagement in clinical trials. RESULTS: Of the 1078 residents surveyed (mean age 31.2±13.1y; 65.8% females) in Guangzhou, 749 (69.5%) expressed a willingness to participate in future ophthalmic clinical trials. Specific characteristics associated with greater willingness included a younger age, lower annual income, higher education, prior participation experience, previous ophthalmic treatment, and a better understanding of clinical trials. With the exception of age, these characteristics were significantly linked to a higher willingness. The primary barrier to participation, expressed by 64.8% of those willing and 54.4% of those unwilling, was "Uncertain efficacy". In terms of motivations, the willing group ranked "Better therapeutic benefits" (35.0%), "Professional monitoring" (34.3%), and "Trust in healthcare professionals" (33.1%) as their top three reasons, whereas the unwilling participants indicated "Full comprehension of the protocol" (46.2%) as the key facilitator. CONCLUSION: This study reveals a substantial willingness to participate in ophthalmic clinical trials and demonstrates the predictive role of demographic and socioeconomic factors. Variations in motivators and concerns between willing and unwilling participants highlight the significance of tailored recruitment strategies. Importantly, the need for and trust in healthcare professionals stand out as powerful motivations, underscoring the importance of enhancing physician-patient relationships, adopting patient-centered communication approaches, and addressing individualized needs to improve accrual rates.

Analysis of the spatial-temporal evolution of Green and low carbon utilization efficiency of agricultural land in China and its influencing factors under the goal of carbon neutralization.

Agricultural land is the most basic input factor for agricultural production and an essential component of terrestrial ecosystems, which plays a vital role in achieving carbon neutrality. Giving full play to the carbon-neutral contribution of agricultural land is a crucial part of China's economic transformation and green development. It incorporates carbon and pollution emissions from agricultural land use into the unexpected outputs of the Green and Low-carbon Utilization Efficiency of Agricultural Land (GLUEAL) evaluation system. The study utilized several advanced analytical tools, including the super-efficient Slacks-Based Measure (SBM) model, Exploratory Spatial-Temporal Data Analysis (ESTDA) method, Geodetector, and Geographically and Temporally Weighted Regression (GTWR) model. The objective was to examine the spatial-temporal evolution of GLUEAL and identify the factors that influenced it in all 31 provinces of China from 2005 to 2020. The results show that: (1) The overall spatial-temporal evolution of GLUEAL showed an increasing trend, but the disparity between provinces and regions became wider. (2) Most provinces have not yet made significant spatial and temporal jumps. They have high spatial cohesion with specific "path-dependent" characteristics. (3) The Geodetector results reveal that the Number of Rural Labor Force with Higher Education (NRLFHE) and Technology Support for Agriculture (TSA) have insufficient explanatory power on average for GLUEAL. Agricultural Economic Development Level (AEDL), Urbanization Level (UL), Multiple Crop Index (MCI), Planting Structure (PS), Degree of Crop Damage (DCD), Financial support for agriculture (FSA), and Agricultural mechanization level (AML) had stronger explanatory power on average for GLUEAL and were important factors influencing GLUEAL levels. (4) The average influence of AEDL, UL, FSA, and AML on GLUEAL changed from negative to positive. The average influence of MCI and DCD on GLUEAL was negative, and the average influence of PS on GLUEAL changed from positive to negative. This study provides a comprehensive description of the spatial and temporal evolution of GLUEAL in China. It reveals the key factors influencing GLUEAL and analyzes their spatial variations and impact patterns. These findings offer robust evidence for government policymakers to formulate policy measures for sustainable agricultural development and optimized resource allocation, promoting the transformation of agricultural land towards green and low-carbon practices and advancing the achievement of sustainable development goals.

Green finance network evolution and prediction: fresh evidence from China.

Green finance has become an important reform force to promote the sustainable development of China's economy. Therefore, it has a great significance for in-depth analysis of the advantages and disadvantages of regional green finance development, to further promote it by clarifying and predicting the regional differences and dynamic evolution trends. Based on this, this paper will select the relevant index from 2001 to 2020 to construct China Green Finance Core Network (CGFCN) in different years by using Space-L method at the first, then analyze its network characteristics and spatial evolution pattern in depth, and finally predict the future development trend of CGFCN by link prediction. The research results show that: firstly, the evolution of CGFCN is mainly divided into three stages: rapid development, stable development and optimal development, and the closeness of CGFCN is constantly improving. Besides, two strong relationship networks are gradually forming, that is Beijing-Tianjin region and the Yangtze River Detla region. Secondly, with the development of green finance, the community division has changed. It is mainly divided into four communities, named the Beijing-Tianjin-Hebei leading community, the eastern provincial community, the Yangtze River Delta community and the central and southern joint community. Different communities will have different integration in different periods. Thirdly, the future development direction of green finance network is mainly Beijing-Tianjin-Hebei region and Yangtze River Delta regions, and their outward radiation are mainly shown in the eastern coastal and central regions, which also have strong development potential. In this regard, it is proposed to coordinate development across provinces to speed up the "urban integration" of green finance services; Establish an efficient community development mechanism and promote the interconnection of green finance markets and infrastructure between different regions; Strengthen the resource flow among regions and coordinate the resource competition of green finance.

The Spatial-Temporal Transition and Influencing Factors of Green and Low-Carbon Utilization Efficiency of Urban Land in China under the Goal of Carbon Neutralization.

Urban-land development and utilization is one of the main sources of carbon emissions. Improving the green and low-carbon utilization efficiency of urban land (GLUEUL) under the goal of carbon neutrality is crucial to the low-carbon transition and green development of China's economy. Combining the concept of green and low-carbon development in urban land use, carbon emissions and industrial-pollution emissions are incorporated into the unexpected outputs of the GLUEUL evaluation system. The super-efficient slacks-based measure (SBM) model, Exploratory Spatial-Temporal Data Analysis (ESTDA) method and Geographically and Temporally Weighted Regression (GTWR) model were used to analyze the spatial-temporal transition and the influencing factors of GLUEUL in 282 cities in China from 2005 to 2020. The result shows that: (1) From 2005 to 2020, the green and low-carbon land-utilization efficiency of Chinese cities shows an increasing temporal-evolution trend, but the gap between cities is gradually widening. (2) From the spatial-temporal dynamic characteristics of Local Indicators of Spatial Association (LISA), regions with the highest GLUEUL have strong dynamics and instability, while cities at the lowest level have a relatively stable spatial structure. On the whole, the local-spatial-transfer direction of GLUEUL of each city is stable, with certain path-dependent characteristics. (3) There are differences in the degree of influence and direction of action of different factors on GLUEUL. The economic development level, industrial-structure upgrading, financial support, wealth level, and green-technology-innovation ability have positive effects on overall GLUEUL, with industrial-structure upgrading promoting GLUEUL the most, while urban population size, foreign-investment scale, and financial-development level play a negative role. This study can provide some empirical and theoretical references for the improvement of GLUEUL.

A New Evidential Reasoning Rule-Based Safety Assessment Method With Sensor Reliability for Complex Systems.

In current studies of safety assessment for complex systems with the evidential reasoning (ER) rule, the evidence reliability is generally given by experts, which makes the observation data by sensors ignored. However, sensors are inevitably affected by such various uncertainties as perturbations in engineering practice, which can reduce their quality and tracking ability. As such, the observation data may become unreliable, and the modeling accuracy of the ER rule is decreased. In this article, a new ER rule-based safety assessment method with sensor reliability for complex systems is proposed, where sensor reliability and perturbation are considered. The coefficient of the variation-based weighting (CVBW) method is employed to obtain sensor weight. The sensor reliability is calculated by static reliability and dynamic reliability, which are determined by experts and the distance-based method, respectively. The perturbation is quantified as a bounded parameter defined as the perturbation factor, which is used to describe uncertainties and aggregate static reliability and dynamic reliability. The performance analysis of safety assessment is conducted to demonstrate the rationality of perturbation and position poor sensors, followed by a safety assessment algorithm. A case study is carried out to validate the effectiveness of the proposed method.

The Assessment of Sleep Quality in Patients Following Valve Repair and Valve Replacement for Infective Endocarditis: A Retrospective Study at a Single Center.

BACKGROUND The aim of this study was to measure sleep quality among patients who underwent infective endocarditis (IE) surgery and identify the risk factors involved in sleep disorders. MATERIAL AND METHODS In this study, we used actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleep Scale (ESS) to determine the clinical characteristics of sleep disorders in 116 patients with IE who were in rehabilitation after surgery. RESULTS Our results showed that 46 (39.7%) patients had sleep efficiency over 85%, while 70 (60.3%) patients had sleep efficiency below 85%. The correlation analysis showed that sleep efficiency was related to the duration of the disease, with a longer duration leading to lower sleep efficiency (P=0.031). The sleep efficiency of patients with IE following surgery was also affected by alcohol consumption; however, surprisingly, patients with "heavy" alcohol consumption had higher sleep efficiency (P=0.030). We found a significant correlation between sleep efficiency and postoperative interleukin-6 (IL) levels, C-reactive protein (CRP) levels, and preoperative erythrocyte sedimentation rate (P<0.05). No significant correlation was found between brain natriuretic peptide levels and sleep efficiency, PSQI score, or ESS score. Postoperative hemoglobin (Hb) level was associated with sleep efficiency (R=0.194, P=0.036), but there was no statistically significant correlation between the PSQI and ESS scores. Postoperative alanine transaminase (ALT) showed a significant negative correlation with sleep efficiency (R=-0.27, P=0.003). CONCLUSIONS We found a high prevalence of sleep disorders in patients with IE along with an increase in inflammatory factors, including postoperative IL-6, CRP, ALT, and Hb levels.

Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks.

Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally.

Diagnostic performance of convolutional neural network-based Tanner-Whitehouse 3 bone age assessment system.

BACKGROUND: Bone age can reflect the true growth and development status of a child; thus, it plays a critical role in evaluating growth and endocrine disorders. This study established and validated an optimized Tanner-Whitehouse 3 artificial intelligence (TW3-AI) bone age assessment (BAA) system based on a convolutional neural network (CNN). METHODS: A data set of 9,059 clinical radiographs of the left hand was obtained from the picture archives and communication systems (PACS) between January 2012 and December 2016. Among these, 8,005/9,059 (88%) samples were treated as the training set for model implementation, 804/9,059 (9%) samples as the validation set for parameters optimization, and the remaining 250/9,059 (3%) samples were used to verify the accuracy and reliability of the model compared to that of 4 experienced endocrinologists and 2 experienced radiologists. The overall variation of TW3-metacarpophalangeal, radius, ulna and short bones (RUS) and TW3-Carpal bone score, as well as each bone (13 RUS + 7 Carpal) between reviewers and the AI, were compared by Bland-Altman (BA) chart and Kappa test, respectively. Furthermore, the time consumption between the model and reviewers was also compared. RESULTS: The performance of TW3-AI model was highly consistent with the reviewers' overall estimation, and the root mean square (RMS) was 0.50 years. The accuracy of the BAA of the TW3-AI model was better than the estimate of the reviewers. Further analysis revealed that human interpretations of the male capitate, hamate, the first distal and fifth middle phalanx and female capitate, the trapezoid, and the third and fifth middle phalanx, were most inconsistent. The average image processing time was 1.5±0.2 s in the TW3-AI model, which was significantly shorter than manual interpretation. CONCLUSIONS: The diagnostic performance of CNN-based TW3 BAA was accurate and timesaving, and possesses better stability compared to diagnostics made by experienced experts.

3D pulmospheres serve as a personalized and predictive multicellular model for assessment of antifibrotic drugs.

Idiopathic pulmonary fibrosis (IPF) is a fatal progressive fibrotic lung disease characterized by the presence of invasive myofibroblasts in the lung. Currently, there are only two FDA-approved drugs (pirfenidone and nintedanib) for the treatment of IPF. There are no defined criteria to guide specific drug therapy. New methodologies are needed not only to predict personalized drug therapy, but also to screen novel molecules that are on the horizon for treatment of IPF. We have developed a model system that exploits the invasive phenotype of IPF lung tissue. This ex vivo 3D model uses lung tissue from patients to develop pulmospheres. Pulmospheres are 3D spheroids composed of cells derived exclusively from primary lung biopsies and inclusive of lung cell types reflective of those in situ, in the patient. We tested the pulmospheres of 20 subjects with IPF and 9 control subjects to evaluate the responsiveness of individual patients to antifibrotic drugs. Clinical parameters and outcomes were also followed in the same patients. Our results suggest that pulmospheres simulate the microenvironment in the lung and serve as a personalized and predictive model for assessing responsiveness to antifibrotic drugs in patients with IPF.

Screening targeted testis­specific genes for molecular assessment of aberrant sperm quality.

Teratospermia is a heterogeneous and complex disorder, which is closely associated with male fertility. Genes and gene products associated with teratospermia may serve as targeted biomarkers that help understand the underlying mechanisms of male infertility; however, systematic information on the subject remains to be elucidated. The present study performed a comparative bioinformatics analysis to identify biomarkers associated with sperm quality, particular focusing on testis­specific biomarkers. A stepwise screening approach identified 1,085 testis/epididymis­specific genes and 3,406 teratospermia­associated genes, resulting in 348 testis­specific genes associated with aberrant sperm quality. These genes were functionally associated with the reproduction process. Gene products corresponding to heat shock protein family A (Hsp70) member 4 like (HSPA4L) and phosphoglycerate kinase 2 were characterized at the cellular level in human testes and ejaculated spermatozoa. HSPA4L expression in sperm was revealed to be associated with sperm quality. The present study provided a novel insight into the understanding of sperm quality, and a potential method for the diagnosis and assessment of sperm quality in the event of male infertility.

[Quantitative assessment of intrahepatic fat content in children and adolescents with non-alcoholic fatty liver disease].

OBJECTIVE: To quantitatively evaluate clinical significance of intrahepatic fat (IHF) content in children and adolescents with non-alcoholic fatty liver disease (NAFLD). METHODS: Ninety-three obese children were enrolled in this study. Physical parameters, liver function, serum lipids, glycemic and insulin related parameters were measured. Liver B-mode ultrasound (US) examination was performed. IHF content was quantified by 1H magnetic resonance spectroscopy (1H MRS). Three subgroups were classified according to the conditional diagnostic criteria for obese children: simple obesity (n=31), NAFLD-1 (US fatty liver and normal alanine aminotransterase, n=33) and NAFLD-2 (US fatty liver and elevated alanine aminotransterase, n=29). Twenty healthy age- and sex-matched children served as a control group. IHF content among the four groups was compared. The relationship of IHF content with other common clinical laboratory parameters and independent factors influencing increased IHF content were investigated. RESULTS: IHF content measured by 1H MRS was 0.80% (0.4%-1.0%), 2.9% (1.7%-4.30%), 14.0% (7.2%-17.5%) and 18.8% (14.0%-29.1%) respectively in the control, simple obese, NAFLD-1 and NAFLD-2 groups. There were significant differences in IHF content between the groups. Univariate correlation analysis demonstrated that IHF content was positively correlated with waist circumference, hip circumference, waisttohip ratio, body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminoreansferase, γ-glutamic acid transtetase, triglyceride, low-density lipoprotein, OGTT 2-hour plasma glucose, fasting insulin, 2-hour insulin and insulin resisfence, and negatively correlated with high-density lipoprotein. Multivariate linear regression analysis demonstrated three independent risk factors for increased IHF content: increased waist circumference, increased 2-hour plasma glucose and decreased high-density lipoprotein levels. CONCLUSIONS: IHF content determined by 1H MRS can reflect early hepatic fatty infiltration and is closely related to the occurrence and progress of NAFLD in obese children and adolescents. There is a significant correlation between most of common clinical laboratory parameters and IHF content, and waist circumference, high-density lipoprotein and OGTT 2-hour plasma glucose are independent factors impacting IHF content.

Performance assessment of a novel two-step multiple displacement amplification-PCR assay for detection of Mycobacterium tuberculosis complex in sputum specimens.

A novel two-step multiple displacement amplification-PCR (MDA-PCR) assay for tuberculosis detection in 200 sputum specimens was evaluated. The MDA-PCR assay indicated a significant increase in sensitivity and specificity compared with those of standard PCR alone.

In vitro and in vivo assessment of an intelligent artificial anal sphincter in rabbits.

Artificial sphincters have been developed for patients with fecal incontinence, but finding a way to make such sphincters more "intelligent" remains a problem. We assessed the function of a novel intelligent artificial anal sphincter (IAAS) in vitro and in vivo in rabbits. After the prosthesis was activated, rabbits were continent of feces during 81.4% of the activation time. The fecal detection unit provided 100% correct signals on stool in vitro and 65.7% in vivo. The results indicated that the IAAS could efficiently maintain continence and detect stool; however, the IAAS is still in the preliminary experimental stage and more work is needed to improve the system.

[Analysis of international application of complementary and alternative medicine].

Traditional Chinese medicine (TCM) is an important part of complementary and alternative medicine (CAM) in the world medical market. The basis of globalization of TCM was to make sure the current situation of CAM and the role that TCM plays. It will improve the application and reputation of TCM by analyzing the global usage rate, sort of diseases, social-demographic characteristics of users and medical economics of CAM.