An intelligent quantification system for fetal heart rhythm assessment: A multicenter prospective study.

BACKGROUND: The motion relationship and time intervals of the pulsed-wave Doppler (PWD) spectrum are essential for diagnosing fetal arrhythmia. However, few technologies currently are available to automatically calculate fetal cardiac time intervals (CTIs). OBJECTIVE: The purpose of this study was to develop a fetal heart rhythm intelligent quantification system (HR-IQS) for the automatic extraction of CTIs and establish the normal reference range for fetal CTIs. METHODS: A total of 6498 PWD spectrums of 2630 fetuses over the junction between the left ventricular inflow and outflow tracts were recorded across 14 centers. E, A, and V waves were manually labeled by 3 experienced fetal cardiologists, with 17 CTIs extracted. Five-fold cross-validation was performed for training and testing of the deep learning model. Agreement between the manual and HR-IQS-based values was evaluated using the intraclass correlation coefficient and Spearman's rank correlation coefficient. The Jarque-Bera test was applied to evaluate the normality of CTIs' distributions, and the normal reference range of 17 CTIs was established with quantile regression. Arrhythmia subset was compared with the non-arrhythmia subset using the Mann-Whitney U test. RESULTS: Significant positive correlation (P <.001) and moderate-to-excellent consistency (P <.001) between the manual and HR-IQS automated measurements of CTIs was found. The distribution of CTIs was non-normal (P <.001). The normal range (2.5th to 97.5th percentiles) was successfully established for the 17 CTIs. CONCLUSIONS: Using our HR-IQS is feasible for the automated calculation of CTIs in practice and thus could provide a promising tool for the assessment of fetal rhythm and function.

[Fraction Characteristic and Risk Assessment of Heavy Metals in Surface Sediments of the Yellow River Mainstream].

Heavy metals(HMs) are highly toxic and do not easily degrade in the environment. They can accumulate in the human body through the food chain, with serious impacts on the ecological environment and human health. In this study, 14 sampling sites along the mainstream of the Yellow River were investigated, and the total content and chemical fractions of six heavy metals(As, Cd, Cr, Cu, Pb, and Zn) in sediments were analyzed. The geo-accumulation index, potential ecological risk index, and risk assessment coding were used to assess the contamination level and bioavailability of HMs in sediment. Principal component analysis and redundancy analysis were used to identify the main sources of HMs. The results showed that the average content of heavy metals was in the order of Cr>Zn>Cu>Pb>As>Cd. Cd had the highest excess rate relative to the background value of each reach, reaching 85.7%. In the sediments, As, Zn, Pb, and Cu were predominantly in the oxidizable fraction(F3:sulfide and organic matter-bound), Cd was mainly occupied by the acid-soluble(F1:exchangeable and carbonate-bound) and a residual fraction(F4:mineral matrix-bound), and Cr was predominantly in the residual fraction. As, Cr, Cu, Pb, and Zn showed the lowest bioavailability in the upstream, increased in the midstream, and finally decreased in the downstream. The risk assessment showed that Cd, the element with the highest pollution risk level in the Yellow River, was prone to pose a serious threat to the ecological environment and should be prevented and controlled first. The PCA and RDA analyses revealed that fine sediment and total organic matter controlled HMs contamination. Therefore, the prevention and control of soil erosion and sediment migration should be emphasized to control HMs pollution in the Yellow River Basin.

An unexpected contribution of higher education towards the innovations: the moderate role of green technology.

Understanding how environmental restrictions affect the relationship between economic stability and unbalanced technical innovation is crucial for optimizing environmental and financial policy frameworks in developing nations to achieve sustainable development goals (SDGs). Understanding the driving effect of green funding on green development is vital for promoting economic transformation and achieving long-term green growth. Green growth is one of the most exciting new strategies for sustained economic expansion. Despite environmental technology's significance, further study is required to ascertain whether and how environmental technologies affect green development. Therefore, the purpose of this study is to examine how environmental technology may promote green growth in the G7 by reducing reliance on renewable and non-renewable energy sources. Investing in higher education is the most powerful thing a society can do intellectually if it is serious about attaining sustainability by applying skills, providing consulting, delivering training, and disseminating knowledge. Thus, the paper analyzes how the G7 countries' pursuit of green economic development is affected by economic policy uncertainty, investments in renewable energy, human capital, and health expenditure. The G7 economies' panel data from 2005 to 2021 was used to verify the assertions using the GMM estimate. Additional generalized method of moment (GMM) tests, including a one-step test and a two-step test with a robust check, are used to estimate the variables in this study. The research shows that economic policy uncertainty and health expenditure have negative effects on green economic growth, whereas investments in renewable energy, green finance, human capital, and an ageing population have favorable effects. The research findings direct the formulation of policy implications that would maintain the role of green financing as a growth engine in the Chinese economy.

Diagnostic value of Kaiser score combined with breast vascular assessment from breast MRI for the characterization of breast lesions.

Objectives: The Kaiser scoring system for breast magnetic resonance imaging is a clinical decision-making tool for diagnosing breast lesions. However, the Kaiser score (KS) did not include the evaluation of breast vascularity. Therefore, this study aimed to use KS combined with breast vascular assessment, defined as KS*, and investigate the effectiveness of KS* in differentiating benign from malignant breast lesions. Methods: This retrospective study included 223 patients with suspicious breast lesions and pathologically verified results. The histopathological diagnostic criteria were according to the fifth edition of the WHO classification of breast tumors. The KS* was obtained after a joint evaluation combining the original KS and breast vasculature assessment. The receiver operating characteristic (ROC) curve was used for comparing differences in the diagnostic performance between KS* and KS, and the area under the receiver operating characteristic (AUC) was compared. Results: There were 119 (53.4%) benign and 104 (46.6%) malignant lesions in total. The overall sensitivity, specificity, and accuracy of increased ipsilateral breast vascularity were 69.2%, 76.5%, and 73.1%, respectively. The overall sensitivity, specificity, and accuracy of AVS were 82.7%, 76.5%, and 79.4%, respectively. For all lesions included the AUC of KS* was greater than that of KS (0.877 vs. 0.858, P = 0.016). The largest difference in AUC was observed in the non-mass subgroup (0.793 vs. 0.725, P = 0.029). Conclusion: Ipsilaterally increased breast vascularity and a positive AVS sign were significantly associated with malignancy. KS combined with breast vascular assessment can effectively improve the diagnostic ability of KS for breast lesions, especially for non-mass lesions.

Assessment and management of radiation-induced trismus in patients with nasopharyngeal carcinoma: a best practice implementation project.

INTRODUCTION AND AIMS: Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis, and trismus. Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously affects the quality of life for patients with NPC. However, the current clinical assessment and management of trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC. METHODS: This evidence-based audit and feedback project was implemented using a three-phase approach at a third-class hospital in China, following JBI's Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria derived from the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit to assess the results of the interventions implemented to improve practice. RESULTS: After evidence application, the compliance rate for audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate for audit criterion 2 increased from 0% to 100%. The compliance rate for audit criterion 3 increased from 22 to 62%. The compliance rate for audit criterion 4 increased from 88 to 100%. The compliance rate for audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate for audit criterion 6 increased from 0 to 55%. CONCLUSION: Implementation of the best evidence for the assessment and management of trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.

[Assessment of the Efficacy and Influencing Factors of Treating Facial and Neck Port-Wine Stains with 595 nm Pulsed Dye Laser].

OBJECTIVE: To assess the efficacy of 595 nm pulsed dye laser (PDL) in the treatment of facial and neck port-wine stains (PWSs), and to explore the main factors affecting the efficacy. METHODS: A total of 259 PWS cases who were treated with 595 nm PDL were retrospectively enrolled and their clinical information was analyzed in the study. Before- and after-treatment comparison of individual patient was done by comparing patient photographs taken before and after PDL treatment of the PWSs in order to assess the treatment efficacy, using mild purpura as the endpoint of the PDL treatment. A total of 82 male and 177 female cases were included, with patient age ranging between 1 month and 63 years. Univariate analysis was done to select factors influencing the treatment efficacy. Then, ordered multivariate logistic regression analysis was performed to evaluate the main factors affecting the efficacy. Statistics of adverse reaction of patients were also collected. RESULTS: Of the 259 patients covered in the study, 57 (22%) had achieved complete clearing of PWS, 106 (40.9%) showed significant improvement, and 68 (26.3%) showed moderate improvement, amounting to a total of 231 effective treatment cases, indicating a 89.2% overall rate of effective treatment. There were 28 ineffective treatment cases (10.8%). Ordered multivariate logistic regression analysis showed that the color of PWS, the area of PWS, anatomical sites of PWS and the number of treatment sessions were the main factors affecting the therapeutic efficacy, while proliferation did not affect the therapeutic efficacy. Red-type PWS had better treatment efficacy than that of the purple-type PWS (odds ratio [ OR]=2.748, P<0.05). Patients with PWS≤10 cm 2 showed better treatment efficacy than those with PWS>10 cm 2 ( OR=2.094, P<0.05). Treatment efficacy of PWS located in the central section of the face was not as good as those located on the neck ( OR=0.190, P<0.05), and the treatment efficacy of PWS located in the central and lateral section of the face was not as good as those located on the neck ( OR=0.243, P<0.05). Patients who had more than 3 treatment sessions showed better efficacy than those who had 1-3 sessions of treatment ( OR=0.508, P<0.05). No patients incurred any serious adverse reactions. CONCLUSION: Patients with PWS located on the neck, red-type PWS and area ≤10 cm 2 are suitable for treatment with 595 nm PDL and there should be more than three sessions of treatment. Patient sex, age, or proliferation do not affect the treatment effect.

Surgery-free video-oculography in mouse models: enabling quantitative and short-interval longitudinal assessment of vestibular function.

Vestibulo-ocular reflex (VOR) responding to acceleration stimuli is originated from the vestibular apparatuses and thus widely used as an in vivo indicator of the vestibular function. We have developed a vestibular function testing (VFT) system that allows to evaluate VOR response with improved efficiency. The previously required surgical procedure has been avoided by using a newly designed animal-immobility setup. The efficacy of our VFT system was demonstrated on the mice with vestibular abnormalities caused by either genetic mutations (Lhfpl5-/- or Cdh23-/-) or applied vestibulotoxicant (3,3'-iminodipropionitrile, IDPN). Daily longitudinal inspection of the VOR response in the IDPN-administered mice gives the first VOR-based daily-progression profile of the vestibular impairment. The capability of VOR in quantifying the severity of toxicant-induced vestibular deficits has been also demonstrated. The acquired VOR-measurement results were validated against the corresponding behavioral-test results. Further validation against immunofluorescence microscopy was applied to the VOR data obtained from the IDPN-administered mice. We conclude that the improved efficiency of our surgery-free VFT system, firstly, enables the characterization of VOR temporal dynamics and quantification of vestibular-impairment severity that may reveal useful information in toxicological and/or pharmaceutical studies; and, secondly, confers our system promising potential to serve as a high-throughput screener for identifying genes and drugs that affect vestibular function.

Fractional Flow Assessment for the Evaluation of Intracranial Atherosclerosis: A Feasibility Study.

PURPOSE: Current studies on endovascular intervention for intracranial atherosclerosis select patients based on luminal stenosis. Coronary studies demonstrated that fractional flow measurements assess ischemia better than anatomical stenosis and can guide patient selection for intervention. We similarly postulated that fractional flow can be used to assess ischemic stroke risk. METHODS: This was a feasibility study to assess the technical use and safety of applying a pressure guidewire to measure fractional flow across intracranial stenoses. Twenty patients with severe intracranial stenosis were recruited. The percentage of luminal stenosis, distal to proximal pressure ratios (fractional flow) and the fractional flow gradients across the stenosis were measured. Procedural success rate and safety outcomes were documented. RESULTS: All 20 patients had successful crossing of stenosis by the pressure guidewire. Ten patients underwent angioplasty, and 5 had stenting performed. There was one perforator stroke, but not related to the use of the pressure wire. For the 13 patients with complete pre- and postintervention data, the mean preintervention stenosis, fractional flow and translesional pressure gradient were 76.2%, 0.66 and 29.9 mm Hg, whilst the corresponding postintervention measurements were 24.7%, 0.88 and 10.9 mm Hg, respectively. Fractional flow (r = -0.530, p = 0.001) and the translesional pressure gradient (r = 0.501, p = 0.002) only had a modest correlation with the luminal stenosis. CONCLUSION: Fractional flow measurement by floating a pressure guidewire across the intracranial stenosis was technically feasible and safe in this study. Further studies are needed to validate its use for ischemic stroke risk assessment.

Spatially Enhanced Differential RNA Methylation Analysis from Affinity-Based Sequencing Data with Hidden Markov Model.

With the development of new sequencing technology, the entire N6-methyl-adenosine (m(6)A) RNA methylome can now be unbiased profiled with methylated RNA immune-precipitation sequencing technique (MeRIP-Seq), making it possible to detect differential methylation states of RNA between two conditions, for example, between normal and cancerous tissue. However, as an affinity-based method, MeRIP-Seq has yet provided base-pair resolution; that is, a single methylation site determined from MeRIP-Seq data can in practice contain multiple RNA methylation residuals, some of which can be regulated by different enzymes and thus differentially methylated between two conditions. Since existing peak-based methods could not effectively differentiate multiple methylation residuals located within a single methylation site, we propose a hidden Markov model (HMM) based approach to address this issue. Specifically, the detected RNA methylation site is further divided into multiple adjacent small bins and then scanned with higher resolution using a hidden Markov model to model the dependency between spatially adjacent bins for improved accuracy. We tested the proposed algorithm on both simulated data and real data. Result suggests that the proposed algorithm clearly outperforms existing peak-based approach on simulated systems and detects differential methylation regions with higher statistical significance on real dataset.

Assessment of association between the dopamine D2 receptor (DRD2) polymorphism and neurodevelopment of children exposed to lead.

The mechanism of lead (Pb) neurotoxicity has not been illustrated over the years. People pay more attention to dopaminergic neurotransmission, specifically dopamine receptor-2 (DRD2) Taq IA polymorphism, but no consensus has been reached. A total of 258 three-year-old children in Guiyu (exposed group) and Nanao (reference group), China were examined and their concentrations of blood lead (BPb) were determined. Cognitive and language scores of children were assessed using the Bayley Scales of Infant Development, third edition (BSID-III). Genotyping for the DRD2 polymorphism was carried out using a polymerase chain reaction (PCR) re-sequencing platform. The logistic stepwise regression analysis and stepwise regression analysis was used to explore associations among lead, neurodevelopment of children, and DRD2 Taq IA categories. Median values of Pb in Guiyu was higher than that of the reference group (11.30 ± 5.38 µg/dL vs. 5.77 ± 2.51 µg/dL, P < 0.001). Compared with the reference group, children from e-waste exposed area have lower cognitive scale scores (100 ± 25 vs 120 ± 20, P < 0.001) and lower language scale scores (99.87 ± 7.52 vs 111.39 ± 7.02, P < 0.001). The three kinds of genotype, A1/A1, A1/A2, and A2/A2, had no significant influences on BPb, cognitive scores and language scores (P > 0.05). Exposure of inhabitants, especially children to Pb from informal e-waste recycling activities might have contributed to higher levels of BPb and reduced cognitive and language scores observed in local children, however, the result obtained showed no significant association between DRD2 polymorphism and neurodevelopment of children exposed to lead.

Investigation of carbon dioxide emission in China by primary component analysis.

Principal component analysis (PCA) is employed to investigate the relationship between CO2 emissions (COEs) stemming from fossil fuel burning and cement manufacturing and their affecting factors. Eight affecting factors, namely, Population (P), Urban Population (UP); the Output Values of Primary Industry (PIOV), Secondary Industry (SIOV), and Tertiary Industry (TIOV); and the Proportions of Primary Industry's Output Value (PPIOV), Secondary Industry's Output Value (PSIOV), and Tertiary Industry's Output Value (PTIOV), are chosen. PCA is employed to eliminate the multicollinearity of the affecting factors. Two principal components, which can explain 92.86% of the variance of the eight affecting factors, are chosen as variables in the regression analysis. Ordinary least square regression is used to estimate multiple linear regression models, in which COEs and the principal components serve as dependent and independent variables, respectively. The results are given in the following. (1) Theoretically, the carbon intensities of PIOV, SIOV, and TIOV are 2573.4693, 552.7036, and 606.0791 kt per one billion $, respectively. The incomplete statistical data, the different statistical standards, and the ideology of self sufficiency and peasantry appear to show that the carbon intensity of PIOV is higher than those of SIOV and TIOV in China. (2) PPIOV, PSIOV, and PTIOV influence the fluctuations of COE. The parameters of PPIOV, PSIOV, and PTIOV are -2706946.7564, 2557300.5450, and 3924767.9807 kt, respectively. As the economic structure of China is strongly tied to technology level, the period when PIOV plays the leading position is characterized by lagging technology and economic developing. Thus, the influence of PPIOV has a negative value. As the increase of PSIOV and PTIOV is always followed by technological innovation and economic development, PSIOV and PTIOV have the opposite influence. (3) The carbon intensities of P and UP are 1.1029 and 1.7862 kt per thousand people, respectively. The carbon intensity of the rural population can be inferred to be lower than 1.1029 kt per thousand people. The characteristics of poverty and the use of bio-energy in rural areas result in a carbon intensity of the rural population that is lower than that of P.

Requests for health education from Chinese cancer patients during their recovery period: a cross-sectional study.

To determine the prevalence of posttreatment patient requests for health information from Chinese cancer patients during their recovery period, a cross-sectional, descriptive study using a mailed survey was conducted among 374 patients selected randomly. The survey addressed what types of information patients actually wanted but did not receive from their care providers. Questionnaires from 360 patients were received and analyzed. Approximately 76.0% of the patients did not receive health information and expressed the need for the information. The information about how to reduce emotional distress (90.1%), rehabilitation (76.2%), disease symptoms (59.3%), and nutritional support (56.8%) were paramount among patients' concerns. Only 12.8% hoped to acquire information on sexual health. Health information for cancer patients at the recovery stage in China is poor. A tripartite involvement of the hospital-family-community and the combined intervention related to physical sequelae and psychosocial factors are needed at the recovery stage.

[Study on the use of benzodiazepine among middle school students in Wuhan City].

OBJECTIVE: In order to understand the status of benzodiazepine (BZD) use in middleschool students from Wuhan city. METHODS: In the Wuhan city zone, twenty-eight middle-schools were chosen randomly to the even numbers, with students from grade 8 to 12 had been studied. Altogether, 258 classes were investigated with 12 345 questionnaires were filled in by the subjects anonymously. SPSS 10.0 was used for data analysis. RESULTS: Rate of BZD use in Wuhan middle school students was 4.0% with the rate of dependence as 4.1per thousand. There were differences in gender and grade: male students tend to be higher than females (P< 0.01), and senior higher than junior's (P < 0.01). More commonly used drugs would include Diazepam (59%) and Surazepam (29.7%). Among students who used drugs, 43.3% used for 1-7 day and 8.2% of them used 6 tablets or more. 57.6% used 1 tablet once a day (46.2%) before bed time (40.8%). The major reason for using drug was insomnia (43%), followed by pressure from school. The reasons for BZD abuse were: relief of anxiety (14.1%), curiosity (13.3%), peer pressure (10.8%), and fun seeking (9.85%), etc. The source of drugs was from their families (29%). By Multinomial logistic regression, the risk factors of abuse BZD were: ignorance of drug prescription, sex, regular alcohol intake, knowing that BZD use can bring amusement regular, smoking cigarettes, relationship with parents, mother's way of providing education, schooling of fathers, relationship between parents. CONCLUSION: Difference was seen in the use of BZD between gender and age of the students. Multiple factors showed that: personal, family and social factors were related to the use of BZD.