Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study.

Background: China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China. Methods: We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results. Findings: Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening. Interpretation: Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China. Funding: Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.

Validation of an established TW3 artificial intelligence bone age assessment system: a prospective, multicenter, confirmatory study.

Background: In 2020, our center established a Tanner-Whitehouse 3 (TW3) artificial intelligence (AI) system using a convolutional neural network (CNN), which was built upon 9059 radiographs. However, the system, upon which our study is based, lacked a gold standard for comparison and had not undergone thorough evaluation in different working environments. Methods: To further verify the applicability of the AI system in clinical bone age assessment (BAA) and to enhance the accuracy and homogeneity of BAA, a prospective multi-center validation was conducted. This study utilized 744 left-hand radiographs of patients, ranging from 1 to 20 years of age, with 378 boys and 366 girls. These radiographs were obtained from nine different children's hospitals between August and December 2020. The BAAs were performed using the TW3 AI system and were also reviewed by experienced reviewers. Bone age accuracy within 1 year, root mean square error (RMSE), and mean absolute error (MAE) were statistically calculated to evaluate the accuracy. Kappa test and Bland-Altman (B-A) plot were conducted to measure the diagnostic consistency. Results: The system exhibited a high level of performance, producing results that closely aligned with those of the reviewers. It achieved a RMSE of 0.52 years and an accuracy of 94.55% for the radius, ulna, and short bones series. When assessing the carpal series of bones, the system achieved a RMSE of 0.85 years and an accuracy of 80.38%. Overall, the system displayed satisfactory accuracy and RMSE, particularly in patients over 7 years old. The system excelled in evaluating the carpal bone age of patients aged 1-6. Both the Kappa test and B-A plot demonstrated substantial consistency between the system and the reviewers, although the model encountered challenges in consistently distinguishing specific bones, such as the capitate. Furthermore, the system's performance proved acceptable across different genders and age groups, as well as radiography instruments. Conclusions: In this multi-center validation, the system showcased its potential to enhance the efficiency and consistency of healthy delivery, ultimately resulting in improved patient outcomes and reduced healthcare costs.

Spatiotemporal evolution trend and decoupling type identification of transport carbon emissions from economic development in China.

Carbon emissions are a major concern in China, and transportation is an important part of it. In this paper, data on China's 30 provinces' transport carbon emissions from 2005 to 2019 were selected to construct a spatial autocorrelation model and identified the decoupling types, which revealed the relationship between transport carbon emissions and economic development. This study suggests a regulation strategy for provincial transport carbon emissions in China based on the contribution rates of transport carbon emission variables. According to the findings, transport carbon emissions of China indicated a slow rise from 2005 to 2019, the annual growth rate has fluctuated downward, and petroleum products have been the most major source. The geographical correlation of transport carbon emissions has gradually improved, and the transport carbon emission intensity has become more significant. Differences in the transport carbon emission intensity slightly increased, which were significantly regionally correlated. There were seven forms of decoupling between yearly provincial transport carbon emissions and economic development, with weak decoupling accounting for the largest proportion, 45.24%. Decoupling was achieved in 83.33% of the provinces in the period of 2005-2019. As a consequence of factor decomposition, the energy intensity, transport intensity, and economic structure played an overall inhibitory role, while the carbon emission intensity, economic scale, and population played promoting roles. The economic scale was the most important influencing factor.

In Vitro Assessment of Berberine against Ichthyophthirius multifiliis in Goldfish.

Ichthyophthirius multifiliis is a pathogenic ciliate parasite, which infects almost all freshwater teleost fish and leads to significant economic losses. The present study aimed to evaluate the acute toxicity of berberine to the free-living stages of I. multifiliis, that is, theronts and tomonts. Our results indicated that 99.30% of I. multifiliis theronts were killed by a concentration of 15 mg/L berberine during the 4 h exposure time, while berberine had no effect on protomonts. Nevertheless, berberine at a concentration of 5 mg/L could effectively reduce the release of theronts from tomonts treated for 4 h. Additionally, according to the transmission electron microscopy results, berberine at 15 mg/L could strongly change the shape of protomonts, destroy their organelles, and significantly decrease the number of ribosomes. The median lethal concentration (LC50) of berberine for goldfish at 96 h was 528.44 mg/L, which was almost 67 times the median effective concentration (EC50) of berberine for killing theronts (7.86 mg/L). The results demonstrated that berberine could be an effective and safe potential parasiticide for killing I. multifiliis.

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study.

BACKGROUND: Coronary artery disease (CAD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). However, data related to the impact of CAD on outcomes of acute exacerbation of COPD (AECOPD) are limited and whether the relationship depends on sex remains unknown. Our aim was to determine the impact of comorbid CAD on clinical outcomes among men and women with AECOPD. METHODS: We used data from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study, which is a nationwide observational real-world study conducted between September 2017 and February 2020 at 163 centers in patients admitted with AECOPD as their primary diagnosis. Patients were stratified according to the presence or absence of CAD in men and women. The primary outcomes were the length of hospital stay and economic burden during hospitalization. RESULTS: Among 3906 patients included in our study, the prevalence of CAD was 17.0%, and it was higher in women than in men (19.5% vs. 16.3%; P = 0.034). Age and other cardiovascular diseases were common factors associated with comorbid CAD in men and women, while body-mass index, cerebrovascular disease, and diabetes were determinants in men and pre-admission use of long-acting beta-adrenoceptor agonist and home oxygen therapy were protective factors in women. Only in men, patients with CAD had a longer length of hospital stay (median 10.0 vs. 9.0 days, P < 0.001), higher total cost during hospitalization (median $1502.2 vs. $1373.4, P < 0.001), and more severe COPD symptoms at day 30 compared to those without CAD. No significant difference was found in women. Comorbid CAD showed no relationship with 30-day readmission or death regardless of sex. In our real-world study, mortality/readmission risk within 30 days increased in patients with previous frequent hospitalizations and poorer pulmonary function. CONCLUSIONS: In hospitalized AECOPD patients, comorbid CAD was significantly associated with poorer short-term outcomes in men. Clinicians should have heightened attention for men with comorbid CAD to achieve an optimal management of AECOPD patients.

Dietary exposure assessment of paralytic shellfish toxins through shellfish consumption in Shenzhen population, China.

Paralytic shellfish toxins (PSTs) produced by certain marine dinoflagellates accumulate in filter-feeding marine bivalves. We used LC-MS/MS to detect and quantify 13 PSTs in 188 shellfish samples of 14 species collected from Shenzhen city's Buji seafood wholesale market from March 2019 to February 2020. Twenty-six of 188 shellfish samples (13.8%) were PSTs detectable. Within 14 species, 10 out of 34 noble clam Chlamys nobilis samples contain detectable PSTs with the highest detection rate 29.4%. Seven out of 17 samples from Nan'ao island contained detectable PSTs with the highest detection rate 41.2% among 11 origins. Samples containing PSTs were concentrated in spring and winter, with the highest levels in March>December>January. Among PSTs detected, C1 was dominant. Acute dietary exposure assessment for Shenzhen residents were based on mean adult body weight, 99th percentile daily shellfish consumption of Shenzhen food consumption survey 2008 and maximum PSTs concentration for each shellfish species. The outcome for Chlamys nobilis was 2.4~3.7-fold higher than recommended ARfDs. Mean PSTs concentration, P99, and mean shellfish consumption were used to assess chronic dietary exposure. The results were lower than recommended ARfDs. In conclusion, residents in Shenzhen are at risk for acute PSTs poisoning, while relatively safe from chronic PSTs exposure.

Regional Disparities in Obesity Among a Heterogeneous Population of Chinese Children and Adolescents.

Importance: Obesity is a public health challenge in China, but the geographical profiles of overweight and obesity among Chinese children are limited. Objective: To examine regional disparities in the prevalence of obesity among the heterogeneous population of Chinese children and adolescents to provide a more accurate profile of obesity among children in China. Design, Setting, and Participants: The Prevalence and Risk Factors for Obesity and Diabetes in Youth (PRODY) study was a cross-sectional survey study conducted from January 1, 2017, to December 31, 2019, among 201 098 children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that produced a sample of Chinese children with a full range of ages and wide geographical coverage using a multistage, stratified, cluster-sampling design. Exposures: Five regions geographically representative of China (northern, eastern, southern, western, and central). Main Outcomes and Measures: The body weights and heights of all participants were measured. Multilevel, multinomial logistic regression models were used to estimate the prevalence of overweight and obesity. Results: Among 201 098 healthy children (105 875 boys [52.6%]; mean [SD] age, 9.8 [3.8] years) from eastern, southern, northern, central, and western China, the highest obesity prevalence was estimated for children aged 8 to 13 years in northern China (from 18.8% [95% CI, 16.2%-21.7%] to 23.6% [95% CI, 20.5%-26.9%]) and for boys aged 3 to 6 years in western China (from 18.1% [95% CI, 10.4%-29.4%] to 28.6% [95% CI, 14.3%-49.0%]). Boys had a higher prevalence than girls of obesity only in eastern and northern China, with a mean difference in prevalence of 4.6% (95% CI, 3.8%-5.4%) and 7.6% (95% CI, 6.5%-8.6%), respectively. Conclusions and Relevance: In this survey study, substantial geographic disparities in the prevalence of obesity and overweight were found among the heterogeneous population of Chinese children. The results suggest that special attention should be paid to vulnerable children and that regionally adapted interventions are needed to efficiently mitigate obesity in children.

Identifying the natural and anthropogenic factors influencing the spatial disparity of population hollowing in traditional villages within a prefecture-level city.

In developing countries, the phenomena of rural depopulation have been an intense continuing, which have become a major bottleneck for the sustainable revitalization of traditional villages. However, the factors influencing the spatial disparity of population hollowing (SDPH) in traditional villages within a prefecture-level city have not been fully quantitatively researched. Based on the factors that influence general villages, this study incorporated historical and cultural factors related to traditional village characteristics to construct a targeted influencing factor index system and then identified the key factors by applying the geo-detector method. With the percentage of resident population (PRP) used as a metric, this study examined Lishui, one of China's traditional village agglomeration regions, as an example to explore SDPH in traditional villages. The results of this study were revealed in the following. (1) The average PRP value in traditional villages in Lishui was 0.68, with clear spatial disparities between the northern region (0.73) and the southern region (0.57). (2) The factors driving the SDPH included both natural and anthropogenic factors; of these, altitude, the number of public facilities, and the number of communication base stations were the most significant influencing factors. In contrast, historical and cultural factors have relatively low impacts. (3) The interaction relationships of pair factors were often enhanced on a bivariate basis, with the highest enhanced impact occurring from the interaction of two variables: the degree of intangible cultural inheritance and altitude. (4) The intervals of the variables leading to the hollowing of the population above a moderate level can be detected. This method can effectively analyze the factors influencing SDPH in traditional villages; can help reveal the interaction impact of pair factors; and can help identify the factors' risk intervals.

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.

Estimation of Health Effects and Economic Losses from Ambient Air Pollution in Undeveloped Areas: Evidence from Guangxi, China.

Guangxi Zhuang Autonomous Region, located in the southwest of China, has rapidly developed since the late 2000s. Similar to other regions, economic development has been accompanied by environmental problems, especially air pollution, which can adversely affect the health of residents in the area. In this study, we estimated the negative health effects of three major ambient pollutants, Particulate Matter with a diameter of 10 µm or less (PM10), Sulfur Dioxide (SO2) and Nitrogen Dioxide (NO2) in Guangxi from 2011 to 2016 using a log-linear exposure-response function. We monetarized the economic loss using the value of statistical life (VSL) and the cost of illness (COI) methods. The results show that the total possible short-term all-cause mortality values due to PM10, SO2, and NO2 were 28,396, with the confidence intervals from 14,664 to 42,014 (14,664-42,014), 24,618 (15,480-33,371), and 46,365 (31,158-61,423), respectively. The mortality from the three pollutants was 48,098 (19,972-75,973). The economic loss of the health burden from the three pollutants was 40,555 (24,172-57,585), which was 2.86% (1.70-4.06%) of the regional gross domestic product. The result of the comparative analysis among different cities showed that urbanization, industrialization, and residents' income are important factors in air-pollution-caused health damage and subsequent economic loss. We conclude that the health burden caused by ambient pollutants in developing regions, accompanied by its rapid socio-economic growth, is significant and tighter regulation is needed in the future to alleviate air pollution and mitigate the related health damage.

[Contamination Characteristics and Safety Risk Assessment of Perflurorinated Alkylated Substances in Aquatic Products from Guangzhou].

To investigate the contamination characteristics of PFASs in aquatic products, 254 samples belonging to 6 species, including fishes, crustaceans, cephalopods, etc., were collected from Guangzhou, and 23 PFASs were determined by UPLC-MS/MS. The total detection rates of the various sample species ranged from 93.5% to 100%, and the concentrations of PFASs were relatively higher in the fishes and crustaceans. 13 PFAS components were detected in the fish samples, but only 6 PFAS components were detected in haliotis samples, and obvious differences were observed among the different species sampled. PFOA and PFOS were the predominant pollutants, with detection rates of 75.6% and 76.8%. The concentrations of PFOS were in the range of 0.19-192.27 µg·kg-1, which were obviously higher than those of the other PFAS components, and their total contamination contribution factor reached the highest percentage of 35.15%. PFOS was a major contributing factor to the PFAS contamination of fishes, crustaceans, siphonopods, and processed products; however, the predominant pollutant in Haliotis samples was PFBA. The results of the risk assessment indicated that the concentrations of PFOA and PFOS would not give rise to timely harm to the consumers.

A Peak Price Tracking-Based Learning System for Portfolio Selection.

We propose a novel linear learning system based on the peak price tracking (PPT) strategy for portfolio selection (PS). Recently, the topic of tracking control attracts intensive attention and some novel models are proposed based on backstepping methods, such that the system output tracks a desired trajectory. The proposed system has a similar evolution with a transform function that aggressively tracks the increasing power of different assets. As a result, the better performing assets will receive more investment. The proposed PPT objective can be formulated as a fast backpropagation algorithm, which is suitable for large-scale and time-limited applications, such as high-frequency trading. Extensive experiments on several benchmark data sets from diverse real financial markets show that PPT outperforms other state-of-the-art systems in computational time, cumulative wealth, and risk-adjusted metrics. It suggests that PPT is effective and even more robust than some defensive systems in PS.

Common genetic variation in the glucokinase gene (GCK) is associated with type 2 diabetes and rates of carbohydrate oxidation and energy expenditure.

AIMS/HYPOTHESIS: Glucokinase (GCK) plays a role in glucose metabolism and glucose-stimulated insulin secretion. Rare mutations in GCK cause MODY. We investigated whether common variation (minor allele frequency ≥0.01) in GCK is associated with metabolic traits and type 2 diabetes. METHODS: Four exonic single-nucleotide polymorphisms (SNPs) and three SNPs predicted to cause loss of promoter function were identified in whole-genome sequence data from 234 Pima Indians. These seven tag SNPs and rs4607517, a type 2 diabetes variant established in other studies, were analysed in 415 full-heritage non-diabetic Pima Indians characterised for metabolic traits, and 7,667 American Indians who had data on type 2 diabetes and BMI. RESULTS: A novel 3' untranslated region (3'UTR) SNP, chr7:44184184-G/A, was associated with the rate of carbohydrate oxidation post-absorptively (ß = 0.22 mg [kg estimated metabolic body size (EMBS)](-1) min(-1), p = 0.005) and during a hyperinsulinaemic-euglycaemic clamp (ß = 0.24 mg [kg EMBS](-1) min(-1), p = 0.0002), the rate of carbohydrate oxidation in a respiratory chamber (ß = 311 kJ/day, p = 0.03) and 24 h energy expenditure, which was attributable to the thermic effect of food (ß = 520 kJ/day, p = 3.39 × 10(-6)). This 3'UTR SNP was also associated with diabetes (OR 1.36, 95% CI 1.11, 1.65, p = 0.002), where the A allele (allele frequency 0.05) was associated with a lower rate of carbohydrate oxidation, lower 24 h energy expenditure and higher risk for diabetes. In a Cox proportional hazards model, a rate of insulin-stimulated carbohydrate oxidation lower than the mean rate at baseline predicted a higher risk for developing diabetes than for those above the mean (hazard rate ratio 2.2, 95% CI 1.3, 3.6, p = 0.002). CONCLUSIONS/INTERPRETATION: Common variation in GCK influences the rate of carbohydrate oxidation, 24 h energy expenditure and diabetes risk in Pima Indians.

Bisphenol A (BPA) Found in Humans and Water in Three Geographic Regions with Distinctly Different Levels of Economic Development.

The suspected endocrine disruptor bisphenol A (BPA) is associated with the manufacture, distribution, and use of epoxy resins and polycarbonate plastics; thus, studies of this compound have focused primarily on urban areas in developed countries. This small study investigating urinary BPA of 109 people was conducted in the urban United States, urban Jamaica, and rural Ghana. Additionally, local drinking and surface water samples were collected and analyzed from areas near study participants. Levels of BPA in both urine and water were comparable among all three sites. Thus, future studies of BPA should consider expanding investigations to rural areas not typically associated with the compound.

[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.

Evidence-based assessment of the impact of the WHI on women's health.

Following the announcement of the first results of the Women's Health Initiative (WHI) to the media in 2002, prior to their scientific publication, the resulting panic headlines had an immediate and lasting negative effect on use of menopausal hormone replacement therapy (HRT) around the world. Rates of use dropped by 40-80%. Symptomatic women then sought multiple alternative therapies but the majority of these have no greater effect than the effect seen from placebo in well-conducted trials of HRT. Some of these therapies have risks. Although anecdotally most menopause practitioners after 2002 can attest to having to counsel large numbers of women with debilitating menopausal symptoms who were too frightened to consider HRT, it is difficult to document loss of health-related quality of life in large population studies as they were not conducted. Similarly, the positive or negative effects of the marked decline in HRT on long-term morbidities and mortality have yet to be fully assessed. Recent studies have shown an increase in postmenopausal fractures and in some, but not all, populations a small temporary decline in breast cancer. Cardiovascular outcomes may not be apparent for another decade. Short-term, randomized, placebo-controlled trials confirm that HRT is the only therapy that effectively improves health-related quality of life in symptomatic women through a reduction in vasomotor and urogenital symptoms, joint pains and insomnia, while improving sexuality. The results of the re-analyses of the WHI data and new data from other studies do not justify the continuing negative attitude to HRT in symptomatic women who start HRT near menopause.

The assessment of efficacy of Diascorea alata for menopausal symptom treatment in Taiwanese women.

OBJECTIVE: The aim of this study was to assess the efficacy and safety of Diascorea alata for treatment of menopausal symptoms. MATERIALS AND METHODS: Two-center, randomized, double-blind, placebo-controlled clinical investigation on 50 menopausal women randomly assigned to two groups, treated for 12 months with either placebo or two sachets daily of Diascorea extracts containing 12 mg/sachet. Primary outcome measures were changes in the Greene Climacteric Scale caused by Diascorea compared with placebo; secondary outcomes were changes in plasma hormone profiles. One-way ANCOVA test was performed to investigate the significance. RESULTS: At 6 months and at the end of treatment, those women who received Diascorea showed general improvement in almost all the clinical symptoms investigated. A significant reduction was noted in the total Greene scores in the Diascorea group assessed at the end of 12 months' treatment (p < 0.01). This phenomenon was more significant for the psychological parameters of anxiety than for other parameters. Apparent improvements were noted in the parameters 'feeling tense or nervous' (p = 0.007), 'insomnia' (p = 0.004), 'excitable' (p = 0.047) and 'musculoskeletal pain' (p = 0.019) among those receiving Diascorea. Diascorea consumption also resulted in positive effects on blood hormone profiles. CONCLUSIONS: Compared with placebo, Diascorea alata improves symptoms, particularly the psychological parameters in menopausal women. Safety monitoring indicated that standardized extracts of Diascorea alata were safe during daily administration over a period of 12 months.

Automated assessment of midline shift in head injury patients.

OBJECTIVES: Midline shift (MLS) is an important quantitative feature for evaluating severity of brain compression by various pathologies, including traumatic intracranial hematomas. In this study, we sought to determine the accuracy and the prognostic value of our computer algorithm that automatically measures the MLS of the brain on computed tomography (CT) images in patients with head injury. PATIENTS AND METHODS: Modelling the deformed midline into three segments, we had designed an algorithm to estimate the MLS automatically. We retrospectively applied our algorithm to the initial CT images of 53 patients with head injury to determine the automated MLS (aMLS) and validated it against that measured by human (hMLS). Both measurements were separately used to predict the neurological outcome of the patients. RESULTS: The hMLS ranged from 0 to 30 mm. It was greater than 5 mm in images of 17 patients (32%). In 49 images (92%), the difference between hMLS and aMLS was <1 mm. To detect MLS >5 mm, our algorithm achieved sensitivity of 94% and specificity of 100%. For mortality prediction, aMLS was no worse than hMLS. CONCLUSION: In summary, automated MLS was accurate and predicted outcome as well as that measured manually. This approach might be useful in constructing a fully automated computer-assisted diagnosis system.

Direct electrochemistry of horseradish peroxidase on Nafion/[bmim]PF(6)/agarose composite film modified glassy carbon electrode.

A new strategy to construct electrochemical biosensor for direct electrochemistry of horseradish peroxidase (HRP) on glassy carbon electrode (GCE) based on Nafion, agarose hydrogel and hydrophobic room-temperature ionic liquid (RTIL) 1-butyl-3-methylimidazolium hexafluorophosphate ([bmim]PF(6)) composite as sensing platform has been described. [bmim]PF(6) has good conductivity and wide electrochemical windows and agarose can maintain biological activity well. Nafion/[bmim]PF(6)/agarose composite combines the advantages of [bmim]PF(6) and agarose. Electrochemical impedance spectroscopy (EIS), ultraviolet visible spectroscopy (UV-vis), fourier transform infrared (FT-IR) spectroscopy and cyclic voltammetry (CV) were used to characterize the composite film, showing that the composite film could be effectively constructed on the GCE surface and greatly enhance the electron transfer between HRP and electrode. The factors influencing the performance of the resulting biosensor were studied in detail. The biosensor responded to H(2)O(2) in the linear range from 2x10(-6) to 1.6x10(-4)M with a detection limit of 1.2x10(-7)M (based on the S/N=3). The studied biosensor exhibited good accuracy and high sensitivity. Moreover, the proposed method was economical and efficient.

Geant4 estimation model of high Z atom concentration for tumor vessel ablation.

In our novel technique of tumor vessels treatment, High Z (HZ) contrast atoms are injected into the blood vessel and the tumor region is irradiated with "narrowband" fluorescence photon (FP) beam tuned to the "resonance energies". Theoretically, this technique guarantees a dose 10(2) - 10(3) higher than that achieved in conventional radiation therapy (RT). Meanwhile, this high dose is confined to a region of tens of micrometers. This will minimize the side effects caused by the high dose to the surrounding tissues. The FPs are generated by electrons impinging onto target made of the same material as the HZ contrast. In order to support the experiment, an estimation model has been developed based on Geant4 Monte Carlo (MC) simulation. This model takes into account physical and biological factors, which can be determined separately. In this work, the derivation of the model was described in detail, and four HZ atoms, gadolinium (Gd), platinum (Pt), gold (Au) and uranium (U) were evaluated using the model. The scaling law for the capability to yield FPs from IEs had been deduced for these HZ atoms. The results also showed that the minimum molar concentration required for apoptosis of tumor endothelial cells (ECs) for Gd, Pt, Au and U in normal experimental condition were 220.44 nmol/ml, 55.57 nmol/ml, 49.78 nmol/ml and 9.05 nmol/ml, respectively.