Lamb wave-based damage assessment for composite laminates using a deep learning approach.

With the increasing utilization of composite materials due to their superior properties, the need for efficient structural health monitoring techniques rises rapidly to ensure the integrity and reliability of composite structures. Deep learning approaches have great potential applications for Lamb wave-based damage detection. However, it remains challenging to quantitatively detect and characterize damage such as delamination in multi-layered structures. These deep learning architectures still lack a certain degree of physical interpretability. In this study, a convolutional sparse coding-based UNet (CSCUNet) is proposed for ultrasonic Lamb wave-based damage assessment in composite laminates. A low-resolution image is generated using delay-and-sum algorithm based on Lamb waves acquired by transducer array. The encoder-decoder framework in the proposed CSCUNet enables the transformation of low-resolution input image to high-resolution damage image. In addition, the multi-layer convolutional sparse coding block is introduced into encoder of the CSCUNet to improve both performance and interpretability of the model. The proposed method is tested on both numerical and experimental data acquired on the surface of composite specimen. The results demonstrate its effectiveness in identifying the delamination location, size, and shape. The network has powerful feature extraction capability and enhanced interpretability, enabling high-resolution imaging and contour evaluation of composite material damage.

Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups.

INTRODUCTION: For individuals with mobility limitations, virtual exercise programmes can address the challenges of in-person participation in community exercise programmes. A synthesis of studies of virtual exercise programmes targeting mobility limitations provided outside of conventional rehabilitation services and strategies used to optimise equitable access and inclusivity in these programmes is lacking. We aim to characterise evaluations of virtual exercise programmes for adults with mobility limitations, and the nature of and extent to which equity, diversity and inclusion considerations are integrated in the research process. METHODS AND ANALYSIS: A scoping review following a six-stage methodological framework, including a consultation exercise, is proposed. A comprehensive strategy will be used to search Medline, Embase, PEDro, CINAHL and Scopus to identify peer-reviewed studies evaluating virtual exercise programmes for adults with mobility limitations living in the community. Three trained reviewers will select studies independently. Data (eg, study methodology, programme structure and content, participant characteristics) will be extracted using a standardised form, and collated and summarised using quantitative and qualitative methods. The PROGRESS-Plus and International Classification of Functioning, Disability and Health frameworks will be used to classify participant characteristics and study outcomes, respectively. During the consultation exercise, key knowledge users, including exercise participants, programme providers and coordinators, and members of community organisations for persons living with disabilities and under-represented groups, will be asked to provide insights regarding the applicability of review findings. A directed content analysis of data from the consultation exercise will be performed. ETHICS AND DISSEMINATION: The research ethics board at the University of Toronto approved the consultation exercise. Findings will be disseminated through peer-reviewed publications and conference presentations. Findings will enhance understanding of current research evaluating virtual exercise programmes and inform future research and strategies for promoting equitable access and outcomes for individuals with mobility limitations. REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/X5JMA.

Characteristics of herbaceous plant community composition, niche and stability under different main-tenance measures at Sanxingdui City Wall, Sichuan, China.

To understand the distribution characteristics and restoration status of vegetation at Sanxingdui City Wall, we sampled five typical communities of the city wall at the Sanxingdui site and explored the stability and niche characteristics of herbaceous plant communities under different maintenance measures (natural regeneration, planting, abandoned field, shrub removal, and pruning) following the niche theory and the improved contribution law method. A total of 87 herbaceous species belonging to 73 genera and 31 families were recorded. Compositae and Gramineae were dominant, and perennial herbs were the majority. There were differences in the niche breadth of major herbaceous species under different maintenance measures. The niche breadth of annual plants was higher under natural regeneration and shrub removal, and that of perennial plants was higher under planting, abandoned field, and pruning measures. The niche overlap and similarity of herbaceous plants were higher under natural regene-ration, shrub removal and pruning measures, and were the lowest under planting measure. The importance values were positively correlated with the niche breadth, but the ranking was not completely consistent. Species with higher niche breadth usually had higher probability of niche overlap and higher niche similarity. Combined with the M-Godron's stability analysis, community stability was comparable among shrub removal, pruning, and natural regeneration measures whereas the abandoned field and planting showed lower community stability. We recommended the implementation of in situ conservation measures based on natural regeneration, supplemented by scientific artificial maintenance (shrub removal, pruning, etc.) when necessary, so as to achieve a stable species composition and promote the sustainable development and vegetation landscape restoration at Sanxingdui City Wall.

[Source Analysis and Health Risk Assessment of Heavy Metals in the Groundwater of Shijiazhuang, a Typical City in North China Plain].

Increasing attention has been paid to the heavy metal pollution in groundwater. The source analysis and risk assessment of heavy metals will provide data and method support for the targeted control of heavy metal pollution in groundwater. In this study, 20 sampling sites were selected in Shijiazhuang City. The APCS-MLR model and health risk model were applied to analyze and evaluate the pollution sources and health risks of 10 types of heavy metals in the groundwater of Shijiazhuang. The results showed that ① the mean concentration of heavy metals in groundwater followed the order of Fe>Zn>Mn>Cu>Al>Pb>Cr>As>Cd>Hg, and the mean ρ(Fe) and ρ(Pb) were 260.3 µg·L-1 and 10.01 µg·L-1, respectively. According to the results of the single factor and Nemerow index, Pb, Fe, and Cd primarily contributed to the heavy metal pollution in the groundwater. ② The concentration of heavy metals ranged from 47.30 to 2560 µg·L-1. In terms of spatial distribution, the highest concentration appeared at S3 (2560 µg·L-1), whereas the lowest concentration was at S9 (47.30 µg·L-1). ③ Source analysis results showed that industrial and agricultural activities, transportation emission, and geological background were the major heavy metal sources, among which the contribution of industrial and agricultural activities was the highest (47.83%). ④ The industrial-agricultural activities posed a potential threat to adults (HI>1); however, the non-cancer and the cancer risks of other sources for both adults and children were at an acceptable level (HI<1) and potential threat level, respectively; industrial-agricultural activities were the major source of non-cancer (adults:52.46%, children:52.45%) and cancer risks (adults:65.22%, children:65.69%), among which Cd and As showed high cancer risk. Therefore, to ensure the safety of the groundwater environment, strictly controlling the pollution sources and further strengthening the risk control of heavy metal pollution in groundwater are necessary.

Using a Hybrid Multiattribute Decision-Making Model for Evaluating the Sustainable Development Potential of Characteristic Towns and Exploring Development Planning Strategies.

In recent years, with the development of 'China's new urbanization, the "characteristic town movement" with the development of industrial economy first has brought problems to a large number of rural settlements, such as no cultural planning, no consumption of industry, and no soul. Then, in reality, there are still a large number of rural settlements under the planning of the upper-level local government, with the goal of developing into a characteristic town in the future. Therefore, this study believes that there is an urgent need to build a framework for evaluating the construction potential of rural settlements with sustainable characteristic towns. Not only that but also a decision analysis model should be provided for real-world empirical cases. This model needs to cover the assessment of the sustainable development potential of characteristic towns as the goal and the formulation of improvement strategies. This study combines the data collection of current characteristic town development rating reports, applies data exploration technology to extract core impact elements and obtain hierarchical decision rules, integrates expert domain knowledge with DEMATEL technology, and establishes an impact network relationship diagram between core impact elements. At the same time, the representative characteristic town cases are assessed for their sustainable development potential, and the modified VIKOR technique is applied to clarify the actual problems of the empirical cases, in an attempt to determine whether the development potential and development plan of the characteristic town meet the sustainable development needs from the pre-evaluation mechanism.

A modified melanoma-molGPA scoring model: assessment of survival after and efficacy of different radiotherapy modalities in patients with melanoma brain metastases.

PURPOSE: Patients with malignant melanoma brain metastases (MBMs) have poor prognoses. For MBMs, the Melanoma-molGPA is the most widely used predictive score, but its predictive value remains uncertain in patients fully treated with radiotherapy. We identified MBMs prognostic factors and modified the prognostic scoring model. METHODS: We retrospectively analyzed patients diagnosed with MBMs between December 2010 and November 2021 for prognostic factors influencing overall survival (OS) by univariate and multivariate analyses. Nomogram plots were based on Cox regression modeling. We evaluated overall survival (OS) using Kaplan-Meier survival curves and log-rank tests. RESULTS: The median OS (mOS) was 7.9 months. On multivariate analysis, BRAF mutation status (p < 0.001), number of brain metastases (BM) (p < 0.001), presence of liver metastases (p < 0.001), brain metastases with a midline shift (p = 0.003), Karnofsky Performance Score (p = 0.02), and lymphocyte-to-monocyte ratio (p < 0.0001) were independent OS predictors. These were incorporated into a modified risk-stratification model. Overall, whole-brain radiotherapy (WBRT) did not significantly affect mOS (mOS, 6.89 vs. 8.83 months; p = 0.07). After risk stratification using our model, WBRT resulted in no significant survival benefit in the low-risk group (mOS 10.07 vs. 13.1 months; p = 0.71) but significantly worse prognosis in the high-risk group (mOS, 2.37 vs. 6.92 months; p = 0.026). CONCLUSION: We propose a modified model that accurately distinguishes the prognosis of patients with MBMs and guides decision-making for radiotherapy. Based on this novel model, WBRT should be cautiously selected for high-risk patients.

Myopia among children and adolescents: an epidemiological study in Fuzhou City.

Objective: To provide a reference for the prevention and control of myopia by analyzing and discussing the findings of an epidemiological survey of the prevalence of myopia among children and adolescents in Fuzhou City from 2019 to 2021. Methods: Participants for this cross-sectional study were drawn from Gulou District and Minqing County in Fuzhou City using cluster random sampling to account for differences in population density, economic development, and other environmental variables. Results: Myopia was more prevalent in 2020 than in 2019, but by 2021 it had dropped to about the same level as in 2019. Myopia was more prevalent among girls than boys during the course of the study period, with a three-year prevalence of 44.72% for boys and 52.16% for girls. Mild myopia accounted for 24.14% of all cases, followed by moderate myopia at 19.62%, and severe myopia at 4.58%. Students in urban regions had a prevalence of myopia equivalent to that of students in the suburbs, and this prevalence rose with age. Conclusion: Myopia was quite prevalent among children and adolescents in Fuzhou City, and was shown to be steadily rising as students progressed through the school system. This suggests that all levels of government, educational institutions, medical facilities, and concerned parents in Fujian Province should focus on the issue of myopia and collaborate to reduce the risk factors for the development of myopia in school-aged participants.

Evaluation of the accuracy of T-scan system and Cerec Omnicam system used in occlusal contact assessment.

Purpose: The objective of the present study was to determine the accuracy of T-scan system and Cerec Omnicam system with respect to the evaluation of occlusal contact by quantitatively comparing the occlusal contact areas and the overlapping ratios of occlusal contact areas obtained from these systems. Material and methods: The occlusal contact of 20 adolescents with normal occlusion was measured with the T-scan system and the Cerec Omnicam system, respectively. The occlusal contact areas in the intercuspal position were then quantified with Adobe Photoshop CS6 Software. The same procedure was repeated for each subject using with 8 µm articulating paper as the control group. The overlapping ratio of T-scan system and Cerec Omnicam system was calculated respectively, which is defined as the ratio of overlapping areas comparing with those obtained from articulating paper. To examine the accuracy of T-scan system and Cerec Omnicam system, the Paired t-test was applied. The reproducibility of T-scan system was evaluated with Wilcoxon matched-pairs signed-ranks test by comparing the occlusal contact areas between two repeated measurements. In all statistical analysis, the level of significance was set to α = 0.05. Results: Results demonstrated measured occlusal contact areas were significantly different between those obtained between T-scan system and Cerec Omnicam system (P < 0.05). The tooth position of two-dimensional virtual dental arch established by T-scan system based on the width of the central incisor was in disagreement with the actual tooth position. The overlapping ratios obtained from Cerec Omnicam system were higher than those obtained from the T-Scan system (P < 0.05). The sensitivity of T-Scan system in anterior teeth area decreased when sensors are used more than once (P < 0.05). Conclusions: In the intercuspal position, the accuracy of Cerec Omnicam system for occlusal contact assessment is higher than that of T-scan system. The T-scan system demonstrates good reproducibility in the premolar region and the molar region, but poor reproducibility in the anterior teeth region. Clinical implications: In the intercuspal position, Cerec Omnicam system is more accurate than T-scan system, which can quantitatively analyze occlusal relationship in terms of number, position, size and distribution of occlusal contact points. When evaluating occlusal contacts, the accuracy of T-scan system in anterior teeth region is significantly lower than that of premolar and molar regions.

Global, regional and national burden of rheumatoid arthritis, and attributable risk factors from 1990 to 2019: update from the Global Burden of Disease 2019 study.

OBJECTIVES: Statistical data on the incidence, disability-adjusted life years (DALYs) and burden of rheumatoid arthritis (RA), and associated risk factors are essential for the development of effective treatment options. The Global Burden of Disease (GBD) study provides a unique opportunity to evaluate the aforementioned parameters. METHODS: The RA incidence rate, age-standardised incidence rate (ASR), DALYs and estimated annual percentage change (EAPC) between 1990 and 2019 were evaluated, using data from 204 territories and countries from the GBD 2019. Risk factors associated with DALYs in patients with RA were estimated using the comparative risk assessment framework of the GBD study. RESULTS: The results of the present study demonstrated that the incidence of RA increased from 567,462.89 to 1,074,390.80 cases, with an ASR of 13/100,000 patients between 1990 and 2019. The number of RA cases and DALYs were increased in all socio-demographic index quintiles during the study period. A significant negative association was found between EAPCs and age-standardised DALYs per 100,000 (ρ= -0.60; p<0.001). Notably, females exhibited an increased ASRs and DALYs than males, at both global and regional levels during the study period. Globally, age-standardised DALYs increased in an age-dependent manner, with the highest rate in the 60-69 years age group. Moreover, smoking was the predominant contributor to RA-associated DALYs for males worldwide, and this trend decreased from 1990 to 2019. CONCLUSIONS: The incidence rate of RA and associated DALYs are increasing worldwide, particularly among female patients. This trend is expected to increase, due an ageing population. Notably, smoking remained the predominant risk factor for RA-associated DALYs in males. Therefore, further investigations into the impact of smoking, and improvements in early diagnosis and treatment strategies for RA are required to reduce the global burden of RA.

Prevalence of mental disorders in the elderly population 5 years after the Lushan earthquake in Ya'an, China.

PURPOSE: This study aimed to explore the prevalence and distribution of mental disorders in the elderly population 5 years after the Lushan earthquake in Ya'an, China. METHODS: A multi-stage, group-matching random sampling method was adopted with 2579 elderly participants (≥ 60 years old) who were interviewed from January to May 2019. Preliminary screening was conducted using the scale by trained psychiatric nurses, followed by a diagnostic interview during the second stage using Chinese Version of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorder by trained psychiatrists. RESULTS: A total of 2561 participants were included in this study with complete data. The weighted lifetime prevalence of all mental disorders in the elderly was 16.2% (95% CI 15.3-17.1), and the weighted 12-month prevalence was 15.2% (95% CI 13.4-17.0). Depressive disorders, anxiety disorders, substance-related and addictive disorders were the most common mental disorders. The 12-month prevalence of all mental disorders were significantly higher in the elderly living alone, with chronic somatic disease, and being poor (P < 0.05). The 12-month prevalence of posttraumatic stress disorder (PTSD) was significantly higher in the elderly in extremely severely earthquake-affected areas (P < 0.001). CONCLUSION: The results of this study show that mental health status of the elderly in Ya'an area differ by socio-economic development, geographical location, and natural disasters. The social and economic development characteristics, the impact of major natural disasters (e.g., earthquakes), and population characteristics should be combined to formulate strategies and interventions to promote the mental health of the elderly.

Trends and status in resources security, ecological stability, and sustainable development research: a systematic analysis.

Resources are essential for human survival and development, and resource security occupies an important position in national security. With the increasing resource shortage problem, ecological stability is facing severe challenges. All countries are actively seeking new sustainable development ways to deal with various issues and shocks caused by the shortage of resources. This study aims to systematically and comprehensively evaluate the knowledge structure, research hotspots, and resource security evolution trends. Based on the number of 6391 articles retrieved from the Web of Science database from 1990 to 2021, this article carried out a visual analysis of global resource security research from the perspectives of scientific output characteristics, keywords, and highly cited literature scientific collaboration networks and hotspot emergence analysis. The research results show that after humans have experienced new public safety incidents, their understanding of resource security and sustainable development has risen to a new height. The number of relevant documents is increasing rapidly. At present, the research on resource security is still dominated by developed countries in Europe and America. This study finds that "food supply chain," "water availability," and "soil resources suitability" are the frontiers and hotspots in the field of resource security. Besides, "biodiversity," "mineral resource security," "medical and health resources" are important topics and directions of current research. This study provides a theoretical basis for scholars to explore the future research direction and practice of resource security, to achieve ecological stability and sustainable development.

Comprehensive risk assessment of marine radioactivity in the Beibu Gulf of Guangxi.

In this paper, a marine environmental sensitivity index system was constructed based on three factors: the marine biological species sensitivity, the marine ecological value sensitivity and the social and economic sensitivity. Combined with numerical simulations of 137Cs in the Beibu Gulf under the condition of a level-7 nuclear accident, a comprehensive risk assessment of marine radioactivity under the simulated accident in the Beibu Gulf was carried out. The results show that the areas at high risk and medium-to-high risk to marine radioactivity are mainly concentrated within 30 km of the Fangchenggang Nuclear Power Plant. The medium-risk areas are mainly distributed in sea areas within 30-50 km of the nuclear power plant, and the other sea areas are low-risk areas. The distribution of the risk sources and the characteristics of the regional tidal currents are the main factors affecting the magnitude and distribution of the comprehensive risk of regional marine radioactivity.

The Chinese Government's Response to the Pandemic: Measures, Dynamic Changes, and Main Patterns.

(1) Background: The governance measures that governments deploy vary substantially across countries and even within countries; there is, however, limited knowledge of the responses of local governments or from different areas in the same country. (2) Methods: By using grounded theory and an automatic text processing method, this study analyses the pandemic governance measures, the pandemic governance pattern, and possible factors across 28 provinces in mainland China based on the text of 28 official provincial government Sina microblogs dating from 20 January to 1 July 2020. (3) Results and discussion: The provincial pandemic governance patterns in China are divided into a pathogen-control pattern, a diagnosis and treatment consolidation pattern, a balanced promotion pattern, a quick-adjustment response pattern, and a recovery-oriented pattern. The pandemic severity, economic development, public health service, and population structure may all have an impact on pandemic governance measures. (4) Conclusions: The conclusions of this study may help us to reconstruct governance systems related to global public health emergencies from the perspective of normalisation, as well as providing important clarification for management and a reference for countries seeking to curb the global spread of a pandemic.

Patterns of use and perceived value of social media for population health among population health stakeholders: a cross-sectional web-based survey.

BACKGROUND: Although existing studies have described patterns of social media use in healthcare, most are focused on health professionals in one discipline. Population health requires a multi-disciplinary approach to ensure diversity and to include diverse stakeholders. To date, what is known about using social media in population health is focused on its potential as a communication tool. This study aims to investigate patterns of use and perceived value of social media usage among stakeholders in population health practice, policy, or research. METHODS: We conducted a web-based survey of delegates attending the Singapore Population Health Conversations and Workshop. We designed a 24-item questionnaire to assess 1) social media use in terms of type of platform and frequency of use; 2) perceptions of social media relevance and impact on population health; and 3) top three areas in population health that would benefit from social media. We used descriptive and logistic regression analyses to assess the relationships between variables. RESULTS: Of the 308 survey respondents, 97.7% reported that they use social media in some form. Messaging (96.8%) was the most dominant activity when using social media. Challenges in implementing social media for population health were time investment by health care professionals (56.2%) and patient adoption (52.9%). The top three population health areas that would benefit most from using social media were the promotion of healthy behaviors (60.7%), community engagement (47.7%), and preventive care (40.6%). Older respondents (> = 40 years) were less likely to view social media as useful for the promotion of healthy behaviors (OR = 0.34; 95% CI: 0.19-0.60). Non-social/healthcare professionals were more likely to consider social media to be useful for community engagement (OR = 1.74; 95% CI: 1.10-2.76). For preventive care, older respondents (OR = 0.51; 95% CI: 0.32-0.82) and non-social/healthcare professionals were less likely to view social media as useful (OR = 0.61; 95% CI: 0.38-0.97). CONCLUSIONS: Our findings suggest that it may be important to select the specific care areas that would benefit most from using social media. The time investment needed by population health professionals should be fully addressed in planning to maximize the application and potential value of social media.

Mercury, microcystins and Omega-3 polyunsaturated fatty acids in farmed fish in eutrophic reservoir: Risk and benefit assessment.

Fish is an important source of nutritional omega-3 (n-3) polyunsaturated fatty acids, but it also readily accumulates toxic mercury (Hg) and microcystins (MC) in eutrophic aquatic systems. In China, farmed fish was widely consumed, and aquaculture has caused pervasive eutrophication of freshwater lakes, resulting in the increasing accumulation of MC in fish tissue. To assess the risk-benefit of consuming farmed fish, 205 fish samples of 10 primary species were collected from the eutrophic Wujiangdu (WJD) Reservoir, SW China. The contents of Hg, microcystin-RR (MC-RR), microcystin-LR (MC-LR), and polyunsaturated fatty acids (PUFA) in fish were analyzed. The results showed that THg and MeHg concentrations in all fish sampls were well below the safety limit (500 ng/g w.w) established by the Standardization Administration of China, with average values of 22.9 ± 22.8 and 6.0 ± 6.6 ng/g wet weight (w.w.), respectively. Average concentrations of MC-RR and MC-LR were 40 ± 80 and 50 ± 80 ng/g w.w., respectively. MC-RR and MC-LR concentrations in fish were significantly higher in silver carp and black carp than in perch and catfish (p < 0.05). In nutritional terms, average concentrations of n-3 PUFA and the eicosapentaenoic (EPA) + docosahexaenoic acids (DHA) of fish were 2.0 ± 2.5 and 1.4 ± 0.5 mg/g w.w., respectively. The risk-benefit assessment suggests that the n-3 PUFA benefits from consuming all farmed fish species in the WJD Reservoir outweigh the adverse effects of MeHg. However, except for perch, most fish species still pose a high MC-LR exposure risk that created a requirement for fish consumption advisories and monitoring. Consequently, more attention should be paid on the health risk of combined exposure to pollutants by aquatic product consumption.

Health care reform in China from the perspective of physicians.

Health care reform is a worldwide problem. To address the problems of costs, access, quality, efficiency, and equity, China initiated healthcare reform in 2009. The progress of China's healthcare reform has been internationally recognized as the reform has expanded insurance coverage and improved access to and reduced the costs of care over the ten-year period from 2008 to 2018. To achieve sustainable goals, attention must be focused on whether and how the reform encourages physicians. This paper highlights the role of physicians, the challenges that need to be addressed, and the direction in which to advance health reform in China from the perspective of physicians. The slow-growing and aging physician population cannot meet the ever-increasing medical demand. Physicians have a heavy workload, work long hours, have unsatisfactory income, and have a fraught relationship with patients. The situation calls for rethinking the value of physicians and rebuilding trust between physicians and patients. Further healthcare reform is needed to equitably allocate physicians with adequate training, time, and resources to deliver evidence-based practices and patient-centered care.

A basic understanding of mucopolysaccharidosis: Incidence, clinical features, diagnosis, and management.

Mucopolysaccharidoses (MPS) are a group of rare lysosomal storage diseases (LSD) with multi-organic and severe symptoms. MPS occur worldwide in various forms though have relative a low incidence. The prevalent type of MPS varies among different continents, indicating that it may be associated with region and ethnic background. Undegraded glycosaminoglycans (GAGs) induced by deficiency of enzymes are the primary cause of MPS. Clinical features differ depending on the specific enzyme deficiency including coarse facial features, cognitive retardation, hepatosplenomegaly, hernias, kyphoscoliosis, corneal clouding, etc. Symptoms of different types are usually similar especially MPS I and II, but may have distinguishable features such as severe neurological problems in MPS III and hydrops fetails in MPS VII. These clinical features contribute to diagnosis, but early and precisely diagnosis in the asymptomatic stage is imperative for better outcomes. Novel approaches including urinary and blood GAG test, enzyme assay and gene test help to diagnose MPS and to determine its subtype. Hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT) are conventional treatment for MPS, but are not effective at treating all MPS. Newer threatments, such as advanced ERT, gene therapy and substrate reduction therapy (SRT), improve therpeutic efficacy. In this review, we update information on the clinical manifestations, diagnosis, and treatment of the different forms of this disease in the hopes of stimulating further interest in MPS.

Nutritional assessment and prognosis of oral cancer patients: a large-scale prospective study.

BACKGROUND: To evaluate and compare the prognostic performance of four nutritional indicators body mass index (BMI), serum albumin (ALB), prognostic nutritional index (PNI) and nutritional risk index (NRI) in oral cancer patients, and to predict the response to chemotherapy in patients with different nutritional status. METHODS: This prospective study which involved 1395 oral cancer patients was conducted in Fujian, China from September 2007 to November 2018. The BMI, PNI and NRI were calculated according to the following formulas: BMI = weight / height2 (kg/m2), PNI = albumin (g/l) + 0.005 × lymphocyte (count/µl) and NRI = (1.519 × albumin, g/l) + (41.7× present/ideal body weight), respectively. The univariate and multivariate Cox proportional hazards models were used to compare the prognostic value of BMI, ALB, PNI and NRI in overall survival (OS) in oral cancer. RESULTS: Patients with BMI < 18.5 kg/m2 (VS 18.5 kg/m2 ≤ BMI < 24 kg/m2) had a poor survival outcome (HR = 1.585; 95% CI: 1.207-2.082 ). ALB, PNI, NRI were inversely correlated with OS of oral cancer (HR = 0.716; 95% CI: 0.575-0.891; HR = 0.793; 95% CI: 0.633-0.992; HR = 0.588; 95% CI: 0.469-0.738, respectively). In addition, the prognostic predictive performance of NRI was superior to BMI or ALB or PNI. Interestingly, compared with patients with better nutritional status, chemotherapy was significantly associated with poorer OS in malnourished oral cancer patients. CONCLUSIONS: BMI, ALB, PNI and NRI are of prognostic value in patients with oral cancer and the prognostic performance of NRI was superior to BMI or ALB or PNI. Malnutrition (BMI < 18.5 kg/m2 or ALB< 40 g/l or PNI < 49.3 or NRI < 97.5) could predict an unfavorable response to chemotherapy in oral cancer patients.