Deep Learning Assessment of Small Renal Masses at Contrast-enhanced Multiphase CT.

Background Accurate characterization of suspicious small renal masses is crucial for optimized management. Deep learning (DL) algorithms may assist with this effort. Purpose To develop and validate a DL algorithm for identifying benign small renal masses at contrast-enhanced multiphase CT. Materials and Methods Surgically resected renal masses measuring 3 cm or less in diameter at contrast-enhanced CT were included. The DL algorithm was developed by using retrospective data from one hospital between 2009 and 2021, with patients randomly allocated in a training and internal test set ratio of 8:2. Between 2013 and 2021, external testing was performed on data from five independent hospitals. A prospective test set was obtained between 2021 and 2022 from one hospital. Algorithm performance was evaluated by using the area under the receiver operating characteristic curve (AUC) and compared with the results of seven clinicians using the DeLong test. Results A total of 1703 patients (mean age, 56 years ± 12 [SD]; 619 female) with a single renal mass per patient were evaluated. The retrospective data set included 1063 lesions (874 in training set, 189 internal test set); the multicenter external test set included 537 lesions (12.3%, 66 benign) with 89 subcentimeter (≤1 cm) lesions (16.6%); and the prospective test set included 103 lesions (13.6%, 14 benign) with 20 (19.4%) subcentimeter lesions. The DL algorithm performance was comparable with that of urological radiologists: for the external test set, AUC was 0.80 (95% CI: 0.75, 0.85) versus 0.84 (95% CI: 0.78, 0.88) (P = .61); for the prospective test set, AUC was 0.87 (95% CI: 0.79, 0.93) versus 0.92 (95% CI: 0.86, 0.96) (P = .70). For subcentimeter lesions in the external test set, the algorithm and urological radiologists had similar AUC of 0.74 (95% CI: 0.63, 0.83) and 0.81 (95% CI: 0.68, 0.92) (P = .78), respectively. Conclusion The multiphase CT-based DL algorithm showed comparable performance with that of radiologists for identifying benign small renal masses, including lesions of 1 cm or less. Published under a CC BY 4.0 license. Supplemental material is available for this article.

Measurement of water resources carrying capacity in Gugang Town of Central China based on human-water-agriculture framework.

More research has revealed that central China is one of the most vulnerable areas to a water crisis because of limited and unequally distributed water resources as well as rising water demands. Also, climate change is expected to reduce water resources dramatically, resulting in increased competition among users and severe water shortages for irrigated agriculture. The township, the most basic level of the Chinese government system, urgently needs to compare water allocation based on different management strategies to define the most optimized water management plan. The concept of a "human-water-agriculture" evaluation system was proposed in this study to couple and coordinate human well-being, sustainable water resource use, and agricultural development in Gugang Town, China. Within this framework, twenty-five indicators were chosen from the criterion layers to assess and optimize the carrying capacity of water resources for historical periods and the future year 2030. The results showed that the WRCC was bearable in previous years, except for 2018 when the percentage of water shortage reached 19.5 % because of a sharp reduction in dynamic surface water availability. The static surface water, represented by the water restored in hilly ponds in village and town areas, was discovered to account for up to 17 % of the total amount for the dry year. The WRCC would be overburdened in 2030, with 61.6 % and 18.1 % water-deficient underwater supply at 90 % and 75 % guarantee rates, respectively. The WRCC states that effective optimization of agricultural water allocation for crops to maximize economic benefits with limited water consumption could significantly improve human and agricultural systems. This study investigated a route for studying WRCC in village and town areas, providing theoretical and practical guidelines for local water-adapted development.

Facile, green and scalable preparation of low-cost PET-PVDF felts for oil absorption and oil/water separation.

3D felt materials with pore structures have the advantages of high absorption performance and recyclability in oily wastewater treatment and chemical leakage. However, most of them were fabricated using either toxic organic solvents or complicated procedures. Herein, we report a facile, green, and scalable route for the fabrication of 3D composite felts with large pore structures by sequentially stirring and heating polyethylene terephthalate (PET) fibers and polyvinylidene fluoride (PVDF). The resulting PET-PVDF felt exhibits high oil absorption capacity to a variety of oil and organic solvents with a maximum saturated absorption capacity of 32 g/g. Additionally, it can be used to separate oil/water mixtures with a separation efficiency of 99.9% and separation flux of 89570 L m-2 h-1. Moreover, this felt shows excellent mechanical durability and chemical stability under acid, base, salt solution, and other harsh environments. The current study provides a promising approach for large-scale industrial oily wastewater separation.

Three-dimensional agricultural water scarcity assessment based on water footprint: A study from a humid agricultural area in China.

The comprehensive assessments of quantitative and qualitative water scarcity have been agreed upon in many parts of the world. However, most of the previous studies on water scarcity focus on quantitative water scarcity and arid regions. In this study, based on the water footprint theory, we proposed three-dimensional agricultural water scarcity indexes by simultaneously considering water quantity and water quality, blue water scarcity, green water scarcity, and grey water scarcity. With the help of CROPWAT 8.0, we calculated the three-dimensional agricultural water scarcity index of Liuyang City, a humid region in China, from 2010 to 2019. Meanwhile, the STIRPAT model was used to investigate the effect of human and natural factors on the agricultural water scarcity index. The results show that: (1) During the study period, the agricultural water resources had a shortage of water quantity in Liuyang City, and the blue water scarcity index (WSIblue) exceeded the water shortage threshold in drought years. The green water scarcity index (WSIgreen) exceeded the water shortage threshold from April to July in most years; while the grey water scarcity index (WSIgrey) did not exceed the threshold, which means there was no water qualitative water scarcity during the study period. (2) The natural meteorological conditions have the greatest influence on the three-dimensional scarcity index, among which meteorological factors inhibit the WSIblue and WSIgrey, and promote the WSIgreen. (3) Green water contributes significantly to crop growth, accounting for 42 % of the crop's total water footprint. According to the change law of the green water scarcity index on the monthly scale to guide agricultural production, it plays an important role in regional water resources management. This study is expected to provide scientific suggestions for alleviating regional water resources pressure by considering virtual water use.

Improved Monitoring and Assessment of Meteorological Drought Based on Multi-Source Fused Precipitation Data.

Meteorological drought, one of the most frequent climate-related disasters, causes great danger for human health and socioeconomic development. With an aim to improve the accuracy of meteorological drought monitoring, this study collected multi-source remotely-sensed precipitation products, i.e., the Tropical Rainfall Measuring Mission (TRMM), the Global Precipitation Measurement Mission (GPM), and Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS), and compared their performance over Hubei Province, China. The geographic difference analysis was used to blend the best-fitted product with gauged precipitation data. Based on the fused dataset with verification, the spatio-temporal characteristics of drought were investigated. Results showed that GPM performed the best in precipitation numerical evaluation and event detection with a 5 mm/d threshold. The fused data accurately captured 80% of historical drought events and indicated that extreme annual droughts mainly occurred in the northern and northwestern regions, while slight, moderate, and severe droughts mainly occurred in the central and eastern parts. The short-term drought exhibited the highest frequency of 33% in summer and the lowest frequency of 27% in spring, while the medium-term drought showed a higher frequency in autumn and winter. This could be a preliminary assessment of drought based on multi-source fused precipitation data for precise drought outlook and risk management.

Diabetic foot ulcer risk assessment and prevention in patients with diabetes: a best practice implementation project.

INTRODUCTION AND AIM: Diabetic foot ulcer (DFU) is one of the most serious complications in patients with diabetes. Early identification of risk factors can prevent its occurrence and delay its progression. The aim of this project is to conduct an audit of DFU risk assessment protocols at a large tertiary hospital and evaluate the impact of any changes in compliance with the developed evidence-based best practice criteria. METHODS: Preimplementation and postimplementation audits based on JBI's Practical Application of Clinical Evidence System were conducted at the Department of Endocrinology and Metabolism of a tertiary hospital in China. The Getting Research into Practice audit tool was used to analyze the barriers and inadequacies encountered in practice. A total of 12 nurses and 30 patients with diabetes were included in the baseline and follow-up audits. RESULTS: There were 15 baseline audits that indicated deficits in DFU risk assessment by nurses, with 0% compliance for three criteria and 50% compliance or less for seven others. Strategies developed by the project team to address the identified barriers to compliance were adopted, leading to significant improvement in compliance with most criteria at the follow-up audit compared with baseline with 11 criteria achieving at least 90% compliance. CONCLUSION: The project showed that regular audits of foot ulcer risk assessment can help to identify barriers to their implementation. Advising patients of their risk status can support appropriate self-care practices. Further audits are needed to implement evidence-based practices in all aspects of diabetes patient care.

Clinical assessment and screening of stroke patients with aphasia: a best practice implementation project.

INTRODUCTION AND AIMS: As a critical form of stroke damage, aphasia negatively impacts stroke patients' return to society. Speech and language intervention has been found to assist in optimizing poststroke aphasia patient outcomes; consequently, early identification and diagnosis are vital for poststroke aphasia to ensure that patients receive the rehabilitation they require. This project aimed to promote evidence-based practice (EBP) in the assessment and screening of stroke patients with aphasia and to improve the clinical outcomes of patients who suffer from poststroke aphasia in a large tertiary hospital. METHODS: The current evidence implementation project was conducted in the neurology and rehabilitation departments of a tertiary hospital in China. Six audit criteria were developed for the baseline and follow-up audits. The project used the JBI PACES software, as well as JBI's Getting Research into Practice audit and feedback tool, to foster evidence-based healthcare in practice. RESULTS: Although the performance of all evidence-based criteria during the baseline audit was poor, barriers were identified through baseline, and the project team carried out and implemented developed strategies following Getting Research into Practice resources. All the criteria improved from baseline after the follow-up cycle, with four out of six criteria achieving a compliance rate of 100%, and two evidence-based criteria recorded at 73 and 80% compliance, respectively. CONCLUSION: The current project successfully increased EBP for the assessment and screening of stroke patients with aphasia. Further studies are needed to ensure the project's long-term sustainability.

Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension.

A non-dipper pattern of high blood pressure is associated with increased risk of organ damage and cardiovascular disease in patients with hypertension. The aim of the study was to evaluate the left ventricular (LV) remodeling and function and arterial stiffness in a dipper/non-dipper pattern of high blood pressure in patients with hypertension. A total of 183 hypertensive patients with no history of adverse cardiovascular events were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 66 patients with a dipper pattern and 117 patients with non-dipper pattern. Detailed transthoracic echocardiogram was performed and analyzed with advance speckle tracking 3-orthogonal direction strain analysis to assess LV systolic function and tissue Doppler-derived E/E' for LV diastolic function assessment. Cardio ankle vascular index (CAVI) was used to evaluate arterial stiffness. Compared with patients with dipper hypertension, those with non-dipper hypertension had increased LV mass index, higher prevalence of eccentric and concentric LV hypertrophy, more impaired LV diastolic and systolic function and peripheral arterial stiffness. Multivariable analysis revealed that a non-dipper pattern was independently associated with LV systolic dysfunction evaluated by speckle tracking-derived strain analysis. In conclusion, a non-dipper pattern of hypertension is an independent risk factor for LV systolic dysfunction. Treatment that could reverse this non-dipper pattern may reduce cardiac damage in these patients.

Reproducibility analysis on shear wave elastography (SWE)-based quantitative assessment for skin elasticity.

Shear Wave Elastography (SWE) is an objective and non-invasive method widely used to quantify the tissue solidity. However, there are concerns about the accuracy of the skin SWE results due to the low signal-to-noise ratio (SNR) caused by subcutaneous fat, muscle and bone. This article analyzed the reproducibility of the result for skin SWE and therefore evaluated the availability of SME for skin elasticity involved diseases. Thirty volunteers (mean age: 37 ±â€Š12 years) were selected. SWE were taken on the skin of abdomen and the middle tibia in order to assess the impact of fat, muscle and bone on SWE results. Skin in the area of anterior and lateral tibia marked with seven parallel lines, and each line indicated an identical thickness of the subcutaneous fat from 1-7 mm. Intra-class correlation coefficients (ICC) were used to evaluate the intra-observer and inter-observer reproducibility. The solidity of abdominal skin showed soft and small individual differences (12.4 ±â€Š2.7 kPa), whereas high shear moduli (25-48 kPa) were observed in the skin above tibia and tibialis anterior muscle. When the subcutaneous fat was thicker than 3 mm (≥3), we obtained excellent intra-observer reproducibility (ICC range 0.78-0.98) and inter-observer reproducibility (ICC range 0.75-0.98). The thickness of subcutaneous fat could affect the reproducibility of skin SWE. The further study on skin SWE standardization should be taken.

[Effects of temperature and photoperiod on body mass, energy budget and digestive tract morphology in Pycnonotus sinensis.] / æ¸©åº¦ä¸Žå ‰å‘¨æœŸå¯¹ç™½å¤´é¹Žä½“è´¨é‡ã€èƒ½é‡æ”¶æ”¯å’Œæ¶ˆåŒ–é“å½¢æ€çš„å½±å“.

Temperature and photoperiod are proximate environmental factors that have an important influence on the morphological, physiological and behavioral adjustments animals performance du-ring seasonal acclimatization. In this study, the effects of temperature and photoperiod on phenotypic flexibility in body mass, energy budget and digestive tract morphology in the Chinese bulbul (Pycnonotus sinensis) were examined, and the relationship between energy budget and digestive tract morphology was analyzed. Twelve male and sixteen female Chinese bulbuls were randomly assigned into 4 experimental groups so that each group was comprised of three males and four females. The groups were: 1) a warm and long photoperiod (30 ℃, 16 light: 8 dark) group, 2) a warm and short photoperiod (30 ℃, 8 light: 16 dark) group, 3) a cold and long photoperiod (10 ℃, 16 light:8 dark) group, and 4) a cold and short photoperiod (10 ℃, 8 light: 16 dark) group. Each group was acclimated to its respective temperature and photoperiod for 4 weeks. Birds in the cold temperature and short photoperiod group underwent a significant increase in body mass, gross energy intake (GEI) and digestible energy intake (DEI) compared to the other three groups, and there was a significant interaction between temperature and photoperiod on gross energy intake and diges-tible energy intake. The mass of the stomach, small intestine, rectum, and total digestive tract, all increased significantly in cold temperature treatment groups compared to those acclimated to a relatively warm temperature. There was a significant, positive correlation between GEI and DEI resi-duals and those of the length and dry mass of the small intestine and total digestive tract. These results suggested that the Chinese bulbul met the increased energy demands of winter (colder tempe-ratures and reduced foraging time due to shorter day-length) by increasing its body mass, digestible energy intake and digestive tract size.

[Assessment of regional left ventricular systolic function by VSI in children with Kawasaki disease].

OBJECTIVE: To assess the regional left ventricular systolic function of children with Kawasaki disease before and after treatment by vector myocardial strain and strain rate imaging (VSI) technology. METHODS: The regional left ventricular systolic function was assessed using VSI technology in 32 children with Kawasaki disease before treatment and one month after treatment and in 30 age-matched normal children. RESULTS: Nine segments of the left ventricular in the Kawasaki disease group before treatment had decreased longitudinal peak systolic strain rate (LSRs) compared with the normal control group. After treatment, the LSRs in 9 segments in the Kawasaki disease group increased, but 6 segments had decreased LSRs compared with the normal control group. The radial peak systolic strain rate (RSRs) of 8 segments in the Kawasaki disease group before treatment was lower than that in the control group. After treatment, only one segment had decreased RSRs compared with the control normal group and 5 segments had increased RSRs compared with that before treatment. The circumferential peak systolic velocity (CVs) of 6 segments in the Kawasaki disease group before treatment group was lower than that in the control normal group. After treatment, only one segment had decreased CVs in the Kawasaki disease group compared with the control normal group and 3 segments had increased CVs compared with that before treatment. CONCLUSIONS: The regional left ventricular systolic function in children with Kawasaki disease before and after treatment can be accurately assessed using VSI technology, which shows the clinical significance of this technology in assessment of treatment outcome in children with Kawasaki disease.

Outcomes of simultaneous placement of an inflatable penile prosthesis and a male urethral sling through a single perineal incision.

INTRODUCTION: Synchronous implantation of an inflatable penile prosthesis (IPP) and a bulbourethral sling single via a single perineal is a unique approach in managing erectile dysfunction and stress urinary incontinence. AIM: This article describes our surgical approach and reviews the operative time, length of hospital stay (LOS), estimated blood loss (EBL), and cost of synchronous dual prosthetic implantation compared with the implants performed individually. Additionally, we review the short-term outcomes in patients with dual sling and penile prosthesis synchronous implants. METHODS: Fifty-eight patients with IPP, 53 slings, and eight simultaneous dual implantations between January 2000 and July 2008 were retrospectively reviewed. Operative times, EBL, length of stay, cost, and complications were compared in three groups (group 1, IPP; group 2, slings; group 3, dual implants). Additionally, we reviewed pre- and postoperative Sexual Health Inventory for Men (SHIM) scores and pad use in group 3. MAIN OUTCOME MEASURES: Review of operative times, EBL, LOS, cost, and complications. RESULTS: Dual implantation had similar operative times compared with the total time for the individual procedures (98 +/- 24 minutes for IPP; 86 +/- 24 minutes for sling; 177 +/- 17 minutes for dual implant, P > 0.05). EBL was reduced (57 +/- 30 mL for IPP; 48 +/- 59 mL for sling; 49 +/- 5 mL for group 3). LOS was also reduced (1.2 +/- 0.45 days for IPP, 0.7 +/- 0.48 days for sling; and 1.1 +/- 0.50 days for dual implant). Dual implantation was associated with approximately $9,000 in savings. With a mean follow-up of 13.6 months, group 3 reported SHIM increase from 1.3 +/- 0.5 to 23.5 +/- 0.6 and a decrease in pad use from three pads per day (range 2-6) down to a mean of one pad per day (range 0-2). One sling erosion and one sling infection occurred in group 2. One patient in group 3 had acute urinary retention resolved with 5 days of catheter drainage. CONCLUSION: Dual penile prosthesis and bulbourethral sling implantation through a single perineal incision is safe, efficient, and cost-effective.

[Emergy analysis of agro-ecolomic system in Shanxi Province].

By the methods of emergy, this paper studied the input and output, working efficiency, and environmental loading of the agro-ecolomic system in Shanxi Province in 2005. The results showed that in 2005, the agro-ecolomic system in Shanxi still stayed in the period of traditional agriculture, which mainly depended on manpower and environmental resources. The emergy investment ratio (EIR) was 1.07, emergy yield ratio (EYR) was 0.99, and environmental loading ratio (ELR) was 6.55. In the structural adjustment of agriculture, stockbreeding had made great strides forward, but grain crops other than rice and wheat, vegetables, and fruits still had smaller emergy yield and were far from becoming dominant industry. The efficiency of the agro-ecolomic system was lower, and its environmental loading press was bigger. For the future, the surplus labors in agriculture in Shanxi should be shifted continually to other industries, and the high quality emergy such as agricultural science and technology should be increased to improve the use efficiency of environmental resources and the input and output of the system emergy.