Anlotinib in Chinese patients aged ≥70 years with advanced non-squamous non-small cell lung cancer without prior chemotherapy: a multicenter, single-arm pilot trial.

Background: Based on pharmacoeconomics, drug availability and actual treatment, optimal treatment regimens for Chinese non-small-cell lung carcinoma (NSCLC) patients over 70 years old are needed. Methods: This multicenter, single-arm pilot trial enrolled patients with advanced non-squamous NSCLC who refused systemic chemotherapy. Eligible patients received anlotinib (12 mg/day, d1-14, Q3W) until disease progression, intolerant toxicities, or withdrawal from the study. The primary endpoint was progression-free survival (PFS). Results: Forty-nine patients were screened between January 2019 and September 2021, of whom 40 patients were eligible. The median age was 76 years. With a median follow-up period of 16.20 (95% CI: 8.77, 25.10) months, the median PFS was 5.45 months (95% CI: 3.52-9.23) and the median overall survival was 10.32 months (95% CI: 6.44-12.78). Three patients achieved a partial response and 34 had stable disease, with an objective response rate of 7.5% and a disease control rate of 92.5%. Thirty-three (82.5%; 33/40) patients reported treatment-related adverse events (TRAEs) of any grade, and the incidence rate of grade ≥3 TRAEs was 35% (14/40). The most common grade ≥3 TRAEs were hypertension (4/40; 10.0%), hand-foot syndrome (3/40; 7.5%), and proteinuria (2/40; 5.0%). Conclusion: Anlotinib treatment was feasible and safe in Chinese elderly patients with advanced non-squamous NSCLC who did not receive any systemic chemotherapy.

Multi-objective ecological restoration priority in China: Cost-benefit optimization in different ecological performance regimes based on planetary boundaries.

In the context of the "United Nations Decade on Ecosystem Restoration", optimizing spatiotemporal arrangements for ecological restoration is an important approach to enhancing overall socioecological benefits for sustainable development. However, against the background of ecological degradation caused by the human use of most natural resources at levels that have approached or exceeded the safe and sustainable boundaries of ecosystems, it is key to explain how to optimize ecological restoration by classified management and optimal total benefits. In response to these issues, we combined spatial heterogeneity and temporal dynamics at the national scale in China to construct five ecological performance regimes defined by indicators that use planetary boundaries and ecological pressures which served as the basis for prioritizing ecological restoration areas and implementing zoning control. By integrating habitat conservation, biodiversity, water supply, and restoration cost constraints, seven ecological restoration scenarios were simulated to optimize the spatial layout of ecological restoration projects (ERPs). The results indicated that the provinces with unsustainable freshwater use, climate change, and land use accounted for more than 25%, 66.7%, and 25%, respectively, of the total area. Only 30% of the provinces experienced a decrease in environmental pressure. Based on the ecological performance regimes, ERP sites spanning the past 20 years were identified, and more than 50% of the priority areas were clustered in regime areas with increased ecological stress. As the restoration area targets doubled (40%) from the baseline (20%), a multi-objective scenario presents a trade-off between expanded ERPs in areas with highly beneficial effects and minimal restoration costs. In conclusion, a reasonable classification and management regime is the basis for targeted restoration. Coordinating multiple objectives and costs in ecological restoration is the key to maximizing socio-ecological benefits. Our study offered new perspectives on systematic and sustainable planning for ecological restoration.

Promoting sustainable development: Revisiting digital economy agglomeration and inclusive green growth through two-tier stochastic frontier model.

In the global wave of digitization, digital economic agglomeration, as an emerging model, profoundly impacts the economy, environment, and society. Countries worldwide are formulating strategies and policies to promote the development of digital economic agglomeration, yet they also face challenges of widening digital divide and environmental sustainability. Existing research primarily focuses on the positive effects of the digital economy, with limited assessment of the dual effects of digital economic agglomeration on sustainable development. This study utilizes panel data from 282 Chinese cities between 2011 and 2021, employing a two-tier stochastic frontier model. It reexamines the dual impacts and intrinsic mechanisms of digital economic agglomeration, attempting to capture regional and temporal variations in the dual effects to address this research gap. The study shows that: (1) The positive effect of digital economy agglomeration is much more than the negative effect, resulting in a positive net effect that shows an overall increasing trend with significant regional disparities. (2) Digital economic agglomeration has a significant negative spatial spillover effect, promoting local inclusive green growth while inhibiting inclusive green growth in neighboring cities. (3) Regarding the mediating mechanisms, industrial structure, technological innovation and resource allocation efficiency have positive indirect effects on inclusive green growth, while environmental regulation intensity has a negative indirect effect, and it has a nonlinear effect under the threshold constraint of the mediating mechanisms. This study provides policy insights for promoting inclusive green growth, emphasizing the need to consider regional differences in resource distribution, ecological environment, and social demands. It advocates for the organic integration of the digital economy across different regions, reducing polarization effects, and enhancing diffusion effects.

Advancement and the existing landscape of forensic medicine in Africa: A comparison with developed countries.

This article explores the development and challenges of forensic medicine in Africa, comparing it to developed countries. It addresses limited resources, funding, and a shortage of trained professionals. The growth of forensic investigation capabilities and the challenges of funding and technology access are discussed. Training and education have improved, but disparities remain. Partnerships with developed countries and international organizations are crucial to bridge the gap. A comprehensive legal framework is important, but disparities exist among African countries. Harmonizing forensic laws would enhance cooperation. The role of forensic medicine in the criminal justice system is examined, emphasizing the need to build trust in forensic evidence. International collaboration and capacity building are key to advancing forensic medicine in Africa. Investments in infrastructure, funding, training, and legal frameworks are required. By leveraging partnerships, Africa can develop its forensic medicine capabilities for a fair and effective criminal justice system.

High-throughput analytical methodology of monoalkyl phthalate esters and the composite risk assessment with their parent phthalate esters in aquatic organisms and seawater.

A sensitive, robust, and highly efficient analytical methodology involving solid phase extraction coupled to ultra-high performance liquid chromatography tandem mass spectrometry was successfully established to detect 13 monoalkyl phthalate esters (MPAEs) in aquatic organisms and seawater. After the organisms were preprocessed using enzymatic deconjugation with ß-glucuronidase, extraction, purification, and qualitative and quantitative optimization procedures were performed. Under optimal conditions, the limits of detection varied from 0.07 to 0.88 µg/kg (wet weight) and 0.04-1.96 ng/L in organisms and seawater, respectively. Collectively, MPAEs achieved acceptable recovery values (91.0-102.7%) with relative standard deviations less than 10.4% and matrix effects ranging from 0.93 to 1.07 in the above matrix. Furthermore, MPAEs and phthalate esters were detected by the developed methodology and gas chromatography-triple quadrupole tandem mass spectrometer in practical samples, respectively. Mono-n-butyl phthalate and mono-iso-butyl phthalate were the most predominant congeners, accounting for 24.8-35.2% in aquatic organisms and seawater. Comprehensive health and ecological risks were higher after the MPAEs were incorporated than when phthalate esters were considered separately, and greater than their risk threshold. Therefore, the risks caused by substances and their metabolites in multiple media, with analogous structure-activity relationships, should be considered to ensure the safety of aquatic organisms and consumers.

Assessment of ecosystem quality changes based on optimizing key indicators in Nanwenghe National Nature Reserve, Heilongjiang, China.

Net primary productivity (NPP) is an indicator to reflect the production capacity of terrestrial ecosystems, as well as a key indicator for ecological quality. NPP at large scale is difficult to be measured. At present, most of the assessment of ecosystem quality uses NPP products with low resolution, which cannot capture the detailed characteristics of the ecosystem and is not conducive to the assessment of ecosystem quality at small-scale. The establishment of a rapid and efficient assessment method for small-scale ecosystem quality will greatly promote the protection and restoration of ecosystems in China. We focused on the calculation method of ecosystem quality assessment and NPP, and optimized the calculation process of the NPP, and obtained NPP by remote sensing without ground observation data. We established a regression model for remote sensing inversion of leaf area index, and estimated the vegetation coverage by using dimidiate pixel model, developed a set of methods for rapid assessment of ecosystem quality by remote sensing. Taking Nanwenghe National Nature Reserve as an example, we evaluated the change of ecosystem quality from 2001 to 2022. The results showed that from 2001 to 2022, the ecosystem qua-lity of the reserve was good as a whole, and that the area with good and excellent quality accounted for more than 85% in 2022. High vegetation coverage was the backbone of the sustainable good ecosystem quality of the reserve. From 2001 to 2022, ecosystem quality of the reserve showed a trend of first decreasing and then increasing, with the lowest point of ecosystem quality in 2013. This method had achieved good results in the evaluation of ecosystem quality in Nanwenghe National Nature Reserve. The index optimization method proposed in this study could facilitate the rapid and accurate assessment of ecosystem quality in small-scale regions, and thus provides technical reference for the precise improvement of ecosystem quality.

Corporate social responsibility initiatives and their role in firms' reputation and green economic recovery through organizational trust.

Maintaining operations in the face of crises like COVID-19 is difficult. Using the stakeholder theory, this study examines the impact of corporate social responsibility (CSR) programs targeting company employees. Their social position and the likelihood of a green economic rebound (GER) are evaluated. Evidence shows that employee-focused CSR activities implemented by tourism boost organizational GER by fostering a more trusting work environment for their staff. Management and non-management staff at Chinese Tourism were polled using a non-probabilistic convenience sample and a 5-point Likert scale. Structured equation modeling was used to conduct structural analyses. Employee-focused CSR is a significant predictor of a firm reputation in the Chinese tourism industry. In addition, it is found that trust inside the organization acts as a go-between. The evidence also supports the hypothesis that a company's rising profile triggers GER. This research delves deeply into the connection between employees' perceptions of a company's employee-focused CSR initiatives, that company's reputation in the community, and employees' general enthusiasm for their job, a group that has been understudied until now. The findings are helpful for tourism management because they show them how to employ employee-focused CSR activities to strengthen connections with internal stakeholders while also using that reputation to shift to a greener way of doing business.

Resilience assessment of the nitrogen flow system in food production and consumption for sustainable development on the Qinghai-Tibet Plateau.

A robust and resilient nitrogen (N) flow system can effectively ensure consistent food production and consumption activities while preserving environmental quality. In this study, we constructed an indicator system to evaluate N flow system resilience including food production and consumption, at the county scale on the Qinghai-Tibet Plateau (QTP) from 1998 to 2018. The subsystem coupling coordination degree (CCD) and the effect of N losses on N flow system resilience were subsequently explored. The results indicated that despite the overall N flow system resilience remaining low and exhibiting spatiotemporal disparities from 1998 to 2018, over 90 % of the counties experienced improvements. High resilience areas (>0.15) were mainly concentrated in some counties in Sichuan Province, where N losses were positively correlated with system resilience. The level of resilience depended on agricultural and livestock development, and the CCD of subsystems was also high (>0.5) in this region, with the most balanced environmental and socioeconomic development. The low system resilience areas were concentrated in the eastern part of the QTP, where human activities caused substantial disturbances. The fragmentation of the agro-pastoral system coupled with the low system resilience of the food production and driving pressure subsystems led to low CCD between subsystems. In contrast, the western regions, characterized by a stable food production system, high food self-sufficiency, and weak dependence on external systems, showed a higher degree of system resilience and resistance. Our findings provide a reference for N resource management and policy formulation for food production and consumption in the agricultural and pastoral areas of the QTP.

The influence of different levels of physical activity and sports performance on the accuracy of dynamic lower limbs balance assessment among Chinese physical education college students.

Background: Balance ability is the basis of human actions. Improving the accuracy of dynamic balance assessment can increase the efficiency of sports injury prediction. Objectives: This study aimed to investigate how physical activity and sports performance affect the dynamic balance ability of lower limbs and validate whether the Lower Quarter Y-Balance Test (YBT-LQ) is a reliable predictor of sports injury risk among Chinese physical education college students. Materials and Methods: In total, 169 voluntary participants completed the YBT-LQ at the beginning of a semester and provided some physiological information and an injury report at the end of the semester. The correlation between YBT-LQ performance and selected factors that can affect the dynamic balance control was analyzed based on data statistics. The receiver operating characteristic (ROC) and the area under curve (AUC) of the composite scores of the YBT-LQ were calculated to explore an optimal cutoff value for predicting sports injury risk. Results: The composite scores of the YBT-LQ exhibited strong correlations with both the sports performance level and sports injury, as well as a moderate correlation with physical activity level, age (negative), and metabolic equivalent (MET). In the entire study population, the area under the receiver operating characteristic (ROC) curves for the binary classification of composite YBT-LQ scores of the left and right legs to predict sports injury risk were 0.78 and 0.74, respectively. Stratifying the study participants based on their levels of physical activity and sports performance had an effect on the AUC values of ROC curves. The optimal cutoff scores of the YBT-LQ for predicting sports injury risk were variable, with values more or less than 95%. Specifically, the cutoff scores for participants with the highest level of sports performance were notably higher, reaching up to 106.5% (left) and 107.2% (right). Conclusion: Physical activity and sports performance can influence human dynamic balance control. Composite scores of the YBT-LQ can be used with acceptable efficiency to predict sports injury. Stratifying participants based on their levels of physical activity and sports performance leads to different optimal cutoff values of the YBT-LQ composite scores in predicting sports injury. This approach is preferable to relying solely on a uniform 95% cutoff. It is recommended to analyze individuals with higher levels of sports performance, such as elite athletes, separately from those with lower levels. This is because the former group has a higher optimal cutoff value compared to the latter.

Simultaneous determination and dietary intake risk assessment of 60 herbicide residues in aquatic products.

A sensitive and rugged analytical method was first established to simultaneously determine 60 herbicides in aquatic products with gas chromatography-tandem mass spectroscopy (GC-MS/MS). After extraction with acetonitrile (MeCN), NaCl and anhydrous Na2SO4 were added, concentrated supernatants were directly passed through the Carb/NH2 solid phase extraction column. Then, the cartridge was rinsed with elution solution (MeCN/toluene, 3:1, v/v), followed by GC-MS/MS analysis with multiple reaction monitoring. An excellent linearity (1.0-100.0 µg/L) with R2 value of ≥0.9991 was obtained, and the limits of quantification were 0.018-3.852 µg/kg. Satisfactory recoveries (70.8 %-117.6 %) with RSDs below 11.0 % of herbicide residues were obtained at spiked levels of 0.010-0.050 mg/kg. Furthermore, herbicide residues in actual aquatic products were analyzed, and the acute/chronic risk assessment of dietary exposure was carried out. The wide use of herbicides for controlling weed and removing moss and harmful algae may obviously increase the risk of contamination of the aquaculture environment and fishery products. Therefore, considerable attention and more research are necessary to monitor residue levels for herbicides in aquatic products and ensure the quality of marine products and consumer safety.

Examining racial and ethnic differences in disability among older adults: A polysocial score approach.

OBJECTIVES: Racial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability. STUDY DESIGN: Cohort study. MAIN OUTCOME MEASURES: We included 5833 participants from the Health and Retirement Study, who were aged 65 years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0-19), intermediate (20-30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score. RESULTS: A higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5 % and 24.4 % risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1 % and 12.1 % in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9 % and 8.7 % risk of ADL disability, respectively. CONCLUSIONS: The polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.

Food Nitrogen Footprint Increased by 35% on the Third Pole During 1998-2018.

The N footprint is considered as an indicator of potential environmental damage from N. Quantitative analysis of N footprint distribution, sources and drivers can help mitigate its negative impacts and promote sustainable N management. In this study, we constructed a city-scale food N footprint (FNF) framework for the Qinghai-Tibet Plateau (QTP) using a N mass balance approach. We quantitatively analyzed the FNF during food production and consumption on the QTP from 1998 to 2018. We used the logarithmic mean Divisa index decomposition method to analyze the driving forces of the FNF, and the decoupling of the FNF. The results showed that the per capita FNF of the QTP increased from 24.92 kg N cap-1 in 1998 to 27.70 kg N cap-1 in 2018, and the total FNF increased by 35.11% from 1998 to 2018. The spatial distribution of the FNF was uneven, with N losses from crop production and animal production being the leading contributing source to the FNF (86%). Economic development and urbanization were the main driving forces behind the FNF increase, while N consumption intensity inhibited the growth of the FNF. With the rapid growth of GDP, the FNF in the eastern part of the QTP grew relatively slowly, indicating a gradual decoupling of the FNF from economic development. To reconcile the relationship between socioeconomic drivers and the FNF, it is necessary to focus on coupling relationships between subsystems within the food production and consumption system to promote N recycling.

Association of dementia comorbidities with caregivers' physical, psychological, social, and financial burden.

BACKGROUND: Informal caregivers of older adults with dementia may experience substantial burdens during their caregiving process, especially when caring for older adults with other comorbid conditions. This study evaluated whether and how comorbidity burden for persons with dementia (PWD) was associated with caregivers' physical, psychological, social, and financial burden as well as caregiving gain. METHODS: Data were from 1,065 community-dwelling older adults living with dementia and their primary caregivers in the National Health and Aging Trends Study and the National Study of Caregiving. PWD's comorbidity burden was measured by the count of chronic conditions and the pattern of comorbidity identified by the latent class analysis (LCA). We considered four domains of caregiving burden-physical, psychological, social, and financial burden. We used linear regressions to identify the unadjusted and adjusted associations between PWD's comorbidity burden and caregiving burden and gain. RESULTS: Of 1,065 PWD, 13.5% had 0-1 and 24.9% had 5 or more number of comorbid chronic conditions, respectively. After multivariable adjustment, an additional chronic condition is associated with an 0.11- and 0.36-point increase in caregivers' physical and psychological burden, respectively. Caregivers of PWD with 5 or more chronic conditions had a 0.64- and 2.22-point higher score of physical and psychological burden, respectively, than those caring for PWD with 0 or 1 comorbid condition. LCA divided PWD into two classes, a high comorbidity class (69.0%) and a low comorbidity class (31.0%). Caregivers of PWD in the high comorbidity burden class had a 0.46-point higher score of physical caregiving burden than those in the low comorbidity burden class. No significant association was found between care recipients' comorbidity burden and their caregivers' social and financial burden or caregiving gain. CONCLUSIONS: The comorbidity burden of PWD was associated with their caregivers' physical and psychological caregiving burden. Relevant interventions to manage the comorbid conditions of people living with dementia and support their caregivers are crucial to improving their physical health and psychological wellbeing.

Projecting Long-Term Care Costs for Home and Community-Based Services in China from 2005 to 2050.

OBJECTIVES: The aim of this study was to estimate and project the trend in long-term care (LTC) costs for home and community-based services as a percentage of gross domestic product in China between 2005 and 2050. DESIGN: Longitudinal. SETTING AND PARTICIPANTS: We used 61,249 observations from 37,702 adults age ≥65 years from waves 2005, 2008, 2011, 2014, and 2018 of the Chinese Longitudinal Healthy Longevity Surveys. METHODS: LTC costs for home and community-based services consisted of the monetary value of time spent on LTC and the direct LTC cost. We used the age-sex-residence-specific weights provided by the Chinese Longitudinal Healthy Longevity Surveys to estimate the LTC costs from 2005 to 2018. We used a component-based model to project LTC costs, in which the 2-part model was used to estimate the average LTC costs and the multi-state Markov model approach was used to project the future population by age, sex, and disability state. RESULTS: The percentage of older adults with disabilities was projected to increase from 6.1% in 2005 to 7.5% in 2020 and 9.6% in 2050. The total LTC cost for home and community-based services were projected to increase from 0.3% of gross domestic product in 2005 to 0.7% in 2020 and to 6.4% in 2050. CONCLUSIONS AND IMPLICATIONS: Policymakers in China should take urgent actions to delay the onset of disabilities among older adults, which would curb the increasing LTC costs and maintain the sustainability of the LTC policies.

Construction and validation of NSMC-ASIL, a predictive model for risk assessment of malignant hepatic nodules.

Most malignant hepatic nodules (MHNs) eventually progress to hepatocellular carcinoma (HCC). However, assessment of the risk of malignancy in high-risk groups of patients with hepatic nodules remains a challenge. This study aimed to develop and validate a simple scoring system to predict the risk of development of MHNs. 1144 patients with primary nodular lesions of hepatic were divided into training cohort and validation cohort. The nomogram model for predicting the risk of MHNs was established according to age, sex, nodule size, prothrombin time (PT), alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVKA-II), γ-glutamine acyltransferase isoenzyme (γ-GT), alanine aminotransferase (ALT), total bile acid (TBA), and total bilirubin (TBIL) in training cohort by logistic regression and validated in validation cohort. The area under receiver operating characteristic curve (AUC) of the predictive model for diagnosing MHNs in training cohort was 0.969 (95% CI: 0.959-0.979), with sensitivity 93.38% and specificity 90.75%, and the AUC in the validation cohort was 0.986 (95% CI: 0.975-0.996), with sensitivity 90.81% and specificity 94.26%. The AUC, sensitivity, and specificity of this model for the diagnosis of early-stage HCC were 0.942, 88.64% and 87.35% in training cohort, and 0.956, 87.04% and 91.85% in validation cohort, respectively. We established a nomogram model that used intuitive data for reliably predicting the risk of MHNs, and this model also showed good diagnostic accuracy in predicting early-stage HCC.

Relationship, Discourse and Construction: The Power Process and Environmental Impact of the Honghe Hani Rice Terraces as a World Heritage Site.

The coexistence of conservation and degradation is a challenge for protected areas, and unequal political and social power is the mechanism underlying this conservation paradox. The World Heritage site of the Honghe Hani Rice Terraces (HHRT) has important natural and cultural value, but despite the enormous investment in protecting the site, the rice terraces continue to degrade, and much of the degradation has been unexpected. This study attempts to reveal the mechanism of these unintended protection outputs from the perspective of power relations. After reviewing the literature on the political ecology of protected areas, this study further considers the conceptual framework of power in view of the ambiguity of the concept and integrates the themes from research on protected areas into the power analysis framework of political ecology. Three aspects of the power process and environmental impact of heritage sites are analyzed: the actor network, conservation discourse and natural reconstruction. The results reveal that power among actors in the HHRT has changed over the course of continuous interaction, power has been produced and re-established in different relational networks, and the exercise of power has changed and reshaped the natural environment of the heritage site through a series of spatial planning decisions. Conservation discourse related to heritage is an important way for actors to establish and exercise power. However, due to spatial differences in the allocation of power, local development opportunities are unbalanced. In this unbalanced relationship, in order to maintain or strive for development opportunities and achieve economic development, residents of the HHRT have reshaped the natural environment by changing their farming methods and traditional planting methods, posing a potential threat to the sustainable development of the heritage site.

SMANet: multi-region ensemble of convolutional neural network model for skeletal maturity assessment.

Background: Bone age assessment (BAA) is a crucial research topic in pediatric radiology. Interest in the development of automated methods for BAA is increasing. The current BAA algorithms based on deep learning have displayed the following deficiencies: (I) most methods involve end-to-end prediction, lacking integration with clinically interpretable methods; (II) BAA methods exhibit racial and geographical differences. Methods: A novel, automatic skeletal maturity assessment (SMA) method with clinically interpretable methods was proposed based on a multi-region ensemble of convolutional neural networks (CNNs). This method predicted skeletal maturity scores and thus assessed bone age by utilizing left-hand radiographs and key regional patches of clinical concern. Results: Experiments included 4,861 left-hand radiographs from the database of Beijing Jishuitan Hospital and revealed that the mean absolute error (MAE) was 31.4±0.19 points (skeletal maturity scores) and 0.45±0.13 years (bone age) for the carpal bones-series and 29.9±0.21 points and 0.43±0.17 years, respectively, for the radius, ulna, and short (RUS) bones series based on the Tanner-Whitehouse 3 (TW3) method. Conclusions: The proposed automatic SMA method, which was without racial and geographical influence, is a novel, automatic method for assessing childhood bone development by utilizing skeletal maturity. Furthermore, it provides a comparable performance to endocrinologists, with greater stability and efficiency.

Scenarios and sustainability of the economy-nitrogen-resource-environment system using a system dynamic model on the Qinghai-Tibet Plateau.

Nitrogen (N) plays a vital role in the development of crop production and animal husbandry in agricultural and pastoral areas. However, the irrational utilization of N resources and subsequent environmental issues with rapid economic development has attracted wide public attention. Coordinating the economy-N-resource-environment (ENRE) system is of great importance for regional sustainable development. In this study, the dynamics of the ENRE system of a typical agricultural and pastoral area on the Qinghai-Tibet Plateau (QTP) were simulated using the VENSIM software from 1998 to 2018. Four typical scenarios (current development scenario, economic development scenario, environment protection scenario and resource optimization scenario) are established to assess the sustainability level and the coupling coordination degrees (CCDs) of the three subsystems, i.e., the economy, N-resource and environment subsystems from 2019 to 2030. Our study indicates that the N flow-based system dynamics (SD) model connects the different subsystems of the ENRE system together well and allows different scenario simulations. From 2019 to 2030, the ENRE system is at a weak sustainability level during the simulation period, and the three subsystems are at slightly unbalanced stages of development in terms of CCD level. The sustainability and CCD levels of the four examined scenarios are as follows: resource optimization scenario > economic development scenario > environment protection scenario >current development scenario, with average values of 0.45, 0.37; 0.42, 0.36; 0.41, 0.35; and 0.39, 0.34, respectively. Under the resource optimization scenario, reducing N inputs to food production and consumption and reducing the planting area of cash crops can effectively improve the N use efficiency of the food chain in the N-resource subsystem (15.34% from 2019 to 2030 on average). Our results provide a reference for promoting sustainable development and formulating policies in agricultural and pastoral regions.

Assessment of cerebral glucose metabolism in patients with heart failure by 18F-FDG PET/CT imaging.

BACKGROUND: To evaluate the cerebral metabolism in patients with heart failure (HF). METHODS: One hundred and two HF patients were prospectively enrolled, who underwent gated 99mTc-sestamibi single photon emission computed tomography (SPECT)/CT, cardiac and cerebral 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Fifteen healthy volunteers served as controls. Patients were stratified by extent of hibernating myocardium (HM) and left ventricular ejection fraction (LVEF) into 4 groups where Group1: HM < 10% (n = 33); Group2: HM ≥ 10%, LVEF < 25% (n = 34); Group3: HM ≥ 10%, 25% ≤ LVEF ≤ 40% (n = 16) and Group 4: LVEF > 40% (n = 19). The standardized uptake value (SUV) in the whole brain (SUVwhole-brain) and the SUV ratios (SUVR) in 24 cognition-related brain regions were determined. SUVwhole-brain and SUVRs were compared between the 4 patient groups and the healthy controls. RESULTS: SUVwhole-brain (r = 0.245, P = 0.013) and SUVRs in frontal areas, hippocampus, and para-hippocampus (r: 0.213 to 0.308, all P < 0.05) were correlated with HM. SUVwhole-brain differed between four patient groups and the healthy volunteers (P = 0.016) and SUVwhole-brain in Group 1 was lower than that in healthy volunteers (P < 0.05). SUVRs of Group 3 in frontal areas were the highest among four patient subgroups (P < 0.05). CONCLUSIONS: Cerebral metabolism in the whole brain was reduced but maintained in cognition-related frontal areas in HF patients with HM and moderately impaired global left ventricular function.

Cost-effectiveness analysis of different screening strategies for colorectal cancer in Guangzhou, southern China: a Markov simulation analysis based on natural community screening results.

OBJECTIVES: To evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model. METHODS: Treeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty. RESULTS: All strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was ¥435 762/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was ¥435 762/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively. CONCLUSIONS: All screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.