RATING: Medical knowledge-guided rheumatoid arthritis assessment from multimodal ultrasound images via deep learning.

Multimodal ultrasound has demonstrated its power in the clinical assessment of rheumatoid arthritis (RA). However, for radiologists, it requires strong experience. In this paper, we propose a rheumatoid arthritis knowledge guided (RATING) system that automatically scores the RA activity and generates interpretable features to assist radiologists' decision-making based on deep learning. RATING leverages the complementary advantages of multimodal ultrasound images and solves the limited training data problem with self-supervised pretraining. RATING outperforms all of the existing methods, achieving an accuracy of 86.1% on a prospective test dataset and 85.0% on an external test dataset. A reader study demonstrates that the RATING system improves the average accuracy of 10 radiologists from 41.4% to 64.0%. As an assistive tool, not only can RATING indicate the possible lesions and enhance the diagnostic performance with multimodal ultrasound but it can also enlighten the road to human-machine collaboration in healthcare.

The impact of healthcare reform on the dynamic changes in health service utilization and equity: a 10-year follow-up study.

In the past decade, the government of China has implemented healthcare reforms to provide universal access to healthcare by 2020. We aimed to systematically analyse the dynamic changes in health services and equity during the past 10 years to understand the correlation between health services and social-economic status. We performed a longitudinal study in which we extracted aggregated data mainly from a project (2009, 2011, 2012, 2015, 2019). A multi-stage stratified cluster randomized design was used to obtain a representative sample in each county. Concentration indexes were used to analyse the equity of the changes in utilization. We built multivariate random-effects generalized least squares regression models with the panel data to test whether the rate of receiving a medical consultation in the last 2 weeks or the rate of hospital admission or the prevalence of chronic illness was associated with social-economic status including education level and rural disposable income per capita. We found declines in both the rate of not receiving a medical consultation during the last 2 weeks (P < 0.05 intervention group) and the rate of hospital avoidance (P < 0.05) from 2009 to 2019. The equity in residents' health service utilization has improved constantly. We additionally found that rural disposable income per capita is a protective factor for the rate of a receiving a medical consultation during the last 2 weeks and the rate of hospital admission. China's 2009 healthcare reform have positively influenced utilization rates and equity in health service utilization in the past decade, a range of health service-targeted strategies are needed including strengthen the prevention and treatment of chronic diseases, focus attention on the health status of elderly residents and improve social-economic status, especially the level of education.

Cost-effective method of benzene-containing wastewater treatment using floating electro-Fenton system.

Traditional electro-Fenton systems must continuously supply oxygen to the cathode, which leads to extensive volatilisation of benzene in solutions. In this study, we adopted a floating cathode electro-Fenton system without bubbling oxygen into the solution to treat benzene-containing wastewater. The effects of the floating cathode position and main reaction parameters on benzene degradation were analysed, and the degradation cost was estimated. The results indicated that the electro-Fenton system with floating cathode could effectively degrade benzene in solutions. For the cathode, the complete utilisation of air and oxygen released from the anode was crucial. The benzene degradation rate increased with an increase in benzene concentrations. Additionally, pH mainly affected the existing ionic state of iron and production ratio of active substances. The current intensity significantly influenced the reaction activity. Using the floating cathode electro-Fenton method, the benzene removal ratio in the solution could reach 74.80% after 60 min under the optimum reaction conditions. For the floating cathode electro-Fenton system, the cost of treating benzene-containing sewage per cubic metre was $1.2187, which is significantly lower than that for traditional electro-Fenton technology ($1.4000). Hence, the floating cathode electro-Fenton system is an economical and efficient method for benzene degradation in solutions.

Measuring and decomposing the effort regarding the equity of inpatient benefits based on the adjustment of the new cooperative medical scheme in western rural China.

BACKGROUND: The ultimate objective of rural health reform and development is to establish a mature healthcare service system that adapts to the socialist market economy and the developmental level of the Chinese economy and meets the health demands of the people. Reform of the payment system is one of the key elements. This article explores the effect of the system and the causes of benefit inequity, provides an objective evaluation of policy implementation and offers data support for policy adjustment. METHODS: A two-stage stratified random sampling data collection method comprising a survey in 2009 (the sample size was 3832 families) and a follow-up survey in 2015 (the sample size was 3992 families) was used. Qualitative data are presented as rates or ratios and the χ2 test was used for descriptive statistics. Quantitative data were analysed using a t test. A generalized linear model (GLM) with gamma distribution of the log connection function was adopted to analyse the factors of the compensation benefit inequity. The degree of the compensation benefit inequity contribution was analysed using the concentration index (CI) decomposition method and the Oaxaca decomposition method. RESULTS: Reimbursement refers to the reimbursement expense received by inpatients from the New Cooperative Medical System (NCMS). In the GLM, there were some positive factors for reimbursement in the NCMS, including economic level, level of health facility and deductibles. The CI decomposition analysis results show that the main factors that increased the compensation benefit inequity were economic levels and deductibles over the past 2 y. However, inpatient days (2009) and the actual reimbursement ratio (2015) decreased the inequity. The Oaxaca decomposition analysis results suggest that changes in compensation benefit inequity between 2009 and 2015 were more attributable to changes in economic status and variables related to policy compensation than to demographic variables. Conclusions: This study showed that inequity decreased from 2009 to 2015, which could be the result of adjustment of the compensation policy. However, we should remain vigilant lest the gap between the rich and the poor leads to an increase in inequity.

The greenhouse effect of the agriculture-economic growth-renewable energy nexus: Evidence from G20 countries.

Agriculture is the world's second largest greenhouse gas (GHG) emitter due to the use of fossil fuel-based fertilizers, agricultural machinery, and the burning of biomass. Meanwhile, the Group of Twenty (G20) countries, which include the world's top three agricultural markets, have a significant impact on world agricultural development. This study is the first attempt to examine the effects of the agriculture-economic growth-renewable energy nexus on carbon dioxide (CO2) emissions within the framework of the environmental Kuznets curve (EKC) in a panel of 19 nations of the G20 countries from 1990 to 2014. To do so, panel data unit root tests, cointegration tests, and the panel fully modified ordinary least squares (FMOLS) estimator are used. The main findings are as follows: (1) Panel data unit root and cointegration tests confirm the existence of a long-run relationship among the selected variables, (2) agriculture significantly increases CO2 emissions in the full sample and the developing economies of the G20, while renewable energy consumption reduces the CO2 emissions in the full sample and the developed economies of the G20, (3) the EKC indeed exists in the full sample and developed economies, while economic growth only exerts a positive impact on CO2 emissions for developing economies, indicating that the peak of CO2 emissions for developing economies has not yet been reached, and (4) varied causality links exist among the variables across the different income levels of the G20 countries. Based on the above findings, to suppress the greenhouse effect, the G20 countries' policymakers should not only promote the development of sustainable agriculture, but also stimulate renewable energy consumption, especially in developing economies.

CT two-dimensional reformation versus three-dimensional volume rendering with regard to surgical findings in the preoperative assessment of the ossicular chain in chronic suppurative otitis media.

PURPOSE: To assess the role of three-dimensional volume rendering (3DVR) in the preoperative assessment of the ossicular chain in chronic suppurative otitis media (CSOM). MATERIALS AND METHODS: Sixty-six patients with CSOM were included in this prospective study. Temporal bone was scanned with a 128-channel multidetector row CT and the axial data was transferred to the workstation for multiplanar reformation (MPR) and 3DVR reconstructions. Evaluation of the ossicular chain according to a three-point scoring system on two-dimensional reformation (2D) and 3DVR was performed independently by two radiologists. The evaluation results were compared with surgical findings. RESULTS: 2D showed over 89% accuracy in the assessment of segmental absence of the ossicular chain in CSOM, no matter how small the segmental size was. 3DVR was as accurate as 2D for the assessment of segmental absence. However, 3DVR was found to be more accurate than 2D in the evaluation of partial erosion of segments. CONCLUSION: Both 3DVR and 2D are accurate and reliable for the assessment of the ossicular chain in CSOM. The inclusion of 3DVR images in the imaging protocol improves the accuracy of 2D in detecting ossicular erosion from CSOM.

Assessment of cardiac preload status by pulse pressure variation in patients after anesthesia induction: comparison with central venous pressure and initial distribution volume of glucose.

PURPOSE: Recognition of intraoperative hypovolemia is important for fluid management. Previous studies demonstrated functional preload parameter pulse pressure variation (PPV) could predict volume changes in response to fluid loading and loss. In this study, we examined the correlation between PPV and other two cardiac preload indicators, central venous pressure (CVP) or initial distribution volume of glucose (IDVG), in patients after anesthesia induction. METHODS: In 30 patients undergoing scheduled craniotomy surgery, we compared measurement of PPV (%) using the Ohmeda monitor method to simultaneously measure CVP and IDVG after anesthesia induction through correlation analysis and receiver operating characteristic (ROC) curves. RESULTS: Pulse pressure variation has negative linear correlation with IDVG (r = -0.65, P < 0.01). IDVG values (n = 13) when PPV ≥ 11% showed a significant difference compared with those (n = 17) when PPV < 11% (P < 0.001). The ROC curve showed the best cutoff value of IDVG is 122 ml/kg, equivalent to the threshold of PPV (11%) for predicting fluid responsiveness. However, there is no significant correlation between CVP in normal ranges (4-9 mmHg) and PPV (r = -0.12, P > 0.05). CONCLUSION: As an indicator of cardiac preload, PPV has a negative linear correlation with IDVG in patients after anesthesia induction. It does not correlate well with CVP in the normal range. Our results imply that an individual PPV, not CVP, is equivalent to IDVG in assessing volume status after induction.

Embryonic stem cell grafting in normal and infarcted myocardium: serial assessment with MR imaging and PET dual detection.

PURPOSE: To use magnetic resonance (MR) imaging and positron emission tomography (PET) dual detection of cardiac-grafted embryonic stem cells (ESCs) to examine (a) survival and proliferation of ESCs in normal and infarcted myocardium, (b) host macrophage versus grafted ESC contribution to serial MR imaging signal over time, and (c) cardiac function associated with the formation of grafts and whether improvement in cardiac function is related to cardiac differentiation of ESCs. MATERIALS AND METHODS: All animal procedures were approved by the institutional animal care and use committee. Murine ESCs were stably transfected with a mutant version of herpes simplex virus type 1 thymidine kinase, HSV1-sr39tk, and also were labeled with superparamagnetic iron oxide (SPIO) particles. Cells were injected directly in the border zone of the infarcted heart or in corresponding regions of normal hearts in athymic rats. PET and MR imaging were performed longitudinally for 4 weeks in the same animals. RESULTS: ESCs survived and underwent proliferation in the infarcted and normal hearts, as demonstrated by serial increases in 9-(4-[(18)F]fluoro-3-hydroxymethylbutyl) guanine PET signals. In parallel, the hypointense areas on MR images at the injection sites decreased over time. Double staining for host macrophages and SPIO particles revealed that the majority of SPIO-containing cells were macrophages at week 4 after injection. Left ventricular ejection fraction increased in the ESC-treated rats but decreased in culture media-treated rats, and border-zone function was preserved in ESC-treated animals; however, cardiac differentiation of ESCs was less than 0.5%. CONCLUSION: Dual-modality imaging permits complementary information in regard to cell survival and proliferation, graft formation, and effects on cardiac function. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/250/3/821/DC1.