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.

A high-performance, sensitive, low-cost LIG/PDMS strain sensor for impact damage monitoring and localization in composite structures.

Health monitoring of composite structures in aircraft is critical, as these structures are commonly utilized in weight-sensitive areas and innovative designs that directly impact flight safety and reliability. Traditional monitoring methods have limitations in monitoring area, strain limit, and signal processing. In this paper, a multifunctional sensor has been developed using acid-treated laser-induced graphene (A-LIG) with a multi-layer three-dimensional conductive network. Compared to untreated laser-induced graphene, the sensitivity of A-LIG sensor is increased by 100%. Furthermore, PDMS is used to fill the pores, which improves the fatigue performance of the A-LIG sensor. To obtain clear monitoring results, a data conversion algorithm is provided to convert the electrical signal obtained by the sensor into a strain field contour cloud map. The impact test of the A-LIG/PDMS sensor on the carbon fiber panel of the aircraft wing box segment verifies the effectiveness of its strain sensing. This work introduces a novel approach to fabricating flexible sensors with improved sensitivity, extended strain range, and cost-effectiveness. The sensor exhibits high sensitivity (gauge factor,GF≈ 387), is low hysteresis (∼53 ms), and has a wide working range (up to 47%), and a highly stable and reproducible response over multiple test cycles (>18 000) with good switching response. It presents a promising and innovative direction for utilizing flexible sensors in the field of aircraft structural health monitoring.

Real-world retrospective study of prostate-specific antigen and safety assessment with darolutamide plus androgen deprivation therapy for metastasis hormone-sensitive prostate cancer.

Background: ARASENS has demonstrated the efficacy and safety for darolutamide (DARO) with androgen deprivation therapy (ADT) plus docetaxel in metastasis hormone-sensitive prostate cancer (mHSPC). There is a lack of reports for DARO with ADT in mHSPC though the regimen is used in clinical from time to time. Moreover, recent studies have supported the importance of early and rapid prostate-specific antigen (PSA) reduction, which correlates with reduced disease progression and improved survival in patients with mHSPC. This study aims to evaluate PSA reduction as a primary endpoint for DARO with ADT in the treatment of mHSPC and to evaluate the real-world short-term PSA control of DARO with ADT from two leading medical centers in China. Methods: We retrospectively reviewed the clinical records of patients with mHSPC receiving ADT and DARO (600 mg, b.i.d.). The collection of data spanned from March 1, 2022, to July 31, 2023. The main observation indicators were PSA level and drug-related adverse events (AE) after medication. PSA levels were closely monitored prior to treatment initiation and at 2-week intervals, as well as at 1, 3, and 6 months after the initiation of treatment. We also conducted an analysis to determine the proportion of patients achieving a PSA reduction of 50% or more (PSA50) and 90% or more (PSA90) as well as the percentage of patients with a notable decrease in PSA level to 0.2 ng/mL and PSA nadir of ≤0.02 ng/mL. Results: Fifty-one patients were included in the study, with a median age of 73 years. At diagnosis of HSPC, the majority of patients had a Gleason score ≥8 (n=40, 78.40%) and a median baseline PSA level of 88 ng/mL. Approximately 45.1% (n=23) of patients had a Charlson Comorbidity Index over 1 and were receiving one or more nontumor-related treatments. The median follow-up time was 9.3 months (range, 1.16-15.8 months). The median reductions in PSA levels compared to baseline were 84.37%, 91.48%, 94.67% and 99.81% at 2 weeks, 1 month, 3 months and 6 months after administration of DARO with ADT, respectively. The median time to PSA50, PSA90, significant PSA reduction (PSA <0.2 ng/mL), and PSA nadir (PSA <0.02 ng/mL) was 0.97, 1.27, 1.98, and 2.08 months, respectively. AE mainly included fatigue (two patients) and arm pain (one patient), all of which were grade I or II AE. No grade III or AE were observed. Conclusions: For treating prostate cancer, DARO with ADT has good early efficacy, demonstrating prompt and substantial control of PSA levels, with a favorable safety profile.

[Energy-saving and Emission Reduction Path for Road Traffic in Key Coastal Cities of Guangdong, Fujian and Zhejiang].

The rapid development of society and economy has resulted in a substantial increase in energy consumption, consequently exacerbating pollution issues. Current research predominantly focuses on energy-saving and emission reduction in road transportation within individual cities or the three major economic regions of China:the Yangtze River Delta, the Pearl River Delta, and the Beijing-Tianjin-Hebei Region. However, there is a dearth of studies addressing the southeastern coastal economic region. Located at the heart of China's southeastern coastal economic development, the provinces of Guangdong, Fujian, and Zhejiang unavoidably face challenges associated with energy consumption and emissions while pursuing economic growth. To address these challenges, this study employed a LEAP model to construct various scenarios for road transportation in the key coastal cities of Guangdong, Fujian, and Zhejiang from 2015 to 2035. These scenarios included a baseline scenario (BAU), an existing policy scenario (EPS), and an improved policy scenario (MPS). The MPS and EPS encompassed vehicle structure optimization (VSO), improved fuel economy (IFE), and reduced annual average mileage (RDM). By simulating and evaluating these scenarios, the energy-saving and emission reduction potentials of road transportation in the key coastal cities were assessed. The results indicated that, in the primary scenario, the MPS exhibited the most significant improvements in energy-saving, carbon reduction, and pollutant reduction effects. By 2035, the MPS achieved a remarkable 75% energy-saving rate compared to that in the baseline scenario, accompanied by reductions of 68%, 59%, 66%, 70%, and 64% in CO2, CO, NOx, PM2.5, and SO2 emissions, respectively. In the secondary scenario, the improved scenario of enhancing fuel economy achieved a notable 30% reduction in energy consumption. Additionally, the scenarios involving vehicle structure adjustment (yielding reductions of 36%, 30%, 36%, 26%, and 40%) and annual average mileage reduction (resulting in reductions of 37%, 37%, 36%, 37%, and 36%) demonstrated significant reductions in CO2, CO, NOx, PM2.5, and SO2 emissions.

Digital economy and green total factor productivity in China.

The development of information technology has created conducive conditions for the digital economy. The digital economy is regarded as a critical pathway for transforming traditional economic models. Green total factor productivity serves as an indicator for assessing the quality of economic development. During pivotal periods of economic transition, the digital economy and green total factor productivity have emerged as two prominent themes for achieving sustainable economic development. But the impact of digital economy on green total factor productivity is less discussed. Innovation environment refers to a confluence of conditions shaped by factors such as talent, funding, cultural atmosphere and government policies, all of which collectively support innovative activities within a region. The institutional environment encompasses the aggregate of economic, political, social, and legal rules. Currently, there is little discussion on bringing innovation environment and institutional environment into the impact of digital economy on green total factor productivity. To fill the research gap, this paper adopts the Slack based measure-Directional distance function model and Malmquist-Luenberger productivity index to measure green total factor productivity in each region based on the panel data collected from 30 provinces in China from 2004 to 2019. Generalized Method of Moments method is constructed to carry out an empirical study on the impact of digital economy on green total factor productivity. This paper constructs a panel threshold model with innovation environment and institutional environment as threshold variables. In further analysis, this paper employs panel quantile regression for the empirical analysis of the impact of the digital economy on green total factor productivity. Further analysis elucidates the evident disparities in the influence of the digital economy on green total factor productivity at various levels. The research results can provide a guide for discussing the green value of the digital economy and its role in fostering the development of a green economy.

Cost-effectiveness of pembrolizumab versus chemotherapy in patients with platinum-pretreated, recurrent or metastatic nasopharyngeal cancer.

BACKGROUND: Programmed cell death protein 1 (PD-1) monoclonal antibody, pembrolizumab, is a promising drug for platinum-pretreated, recurrent or metastatic nasopharyngeal cancer (NPC). We aimed to assess the cost-effectiveness of pembrolizumab compared with chemotherapy for Chinese patients in this NPC. METHODS: The cost-effectiveness of pembrolizumab versus chemotherapy was evaluated using a partitioned survival model with a 5-year boundary. Efficacy and toxicity data were derived from the KEYNOTE-122 trials. Economic indicators including life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and lifetime cost were used. One-way analysis and probabilistic sensitivity analysis (PSA) were performed to explore the uncertainties. Additionally, various scenario analyses, including different pembrolizumab price calculations and discount rates were performed. RESULTS: Pembrolizumab or chemotherapy alone respectively yielded 2.82 QALYs (3.96 LYs) and 2.73 QALYs (3.93 LYs) with an ICER of $422,535 per QALYs ($1,232,547 per LYs). This model was primarily influenced by the price of pembrolizumab. Furthermore, PSA indicated that pembrolizumab had none probability of being cost-effective compared with chemotherapy at a willingness-to- pay (WTP) of $38223. Scenario analyses revealed that irrespective of any potential price reduction or adjustments in the discount rate, no discernible impact on the ultimate outcome was observed. CONCLUSION: Pembrolizumab was less cost-effective for patients with platinum-pretreated, recurrent or metastatic NPC compared with chemotherapy in China.

Spatio-temporal evolution characteristics of carbon emissions from road transportation in the mainland of China from 2006 to 2021.

The leaping forward of the economy has promoted the rapid growth of road traffic demand, resulting in the carbon emissions of road traffic increasing significantly. It is well known that a one-size-fits-all emission reduction policy is not feasible. Therefore, conducting an investigation on the carbon emissions of all provincial-level regions within a country can assist the government in formulating carbon emission policies at a macro level tailored to different regions. In this study, the whole provincial-level administrative regions in the mainland of China were selected to quantify the carbon emissions of road traffic, and the carbon emissions from 2006 to 2021 were obtained by employing the top-down model. What's more, spatiotemporal characteristics of road transportation carbon emissions in those regions were explored based on Moran's I spatial autocorrelation method. In addition, the LMDI model was constructed based on five driving factors, namely energy intensity, energy consumption intensity, industrial scale, economic development, and population size, and the decomposition analysis of driving factors is carried out. The results show that carbon emissions from road traffic in all provincial regions showed an overall rising trend in the research period, with an average annual growth rate of 11.83 %. The distribution of road transportation carbon emissions exhibited an east-high, west-low distribution, with significantly higher emissions in the eastern and coastal regions compared to inland areas, additionally, China's seven geographical regions showed an initial rapid increase in carbon emissions followed by a stable growth trend. Secondly, five types of spatial clustering were identified of carbon emissions within provincial regions. Thirdly, the impacts of energy intensity and industrial scale were detrimental to road transportation carbon emissions, whereas economic development, energy consumption intensity, and population size had contrasting effects. Implications according to the above conclusions were put forward, aiming to provide guidance for the sustainable development of road transportation and expediting the achievement of the "carbon peaking and carbon neutrality" objective.

A decision tree model to help treatment decision-making for severe spontaneous intracerebral hemorrhage.

BACKGROUND: Surgical treatment demonstrated a reduction in mortality among patients suffering from severe spontaneous intracerebral hemorrhage (SSICH). However, which SSICH patients could benefit from surgical treatment was unclear. This study aimed to establish and validate a decision tree (DT) model to help determine which SSICH patients could benefit from surgical treatment. MATERIALS AND METHODS: SSICH patients from a prospective, multicenter cohort study were analyzed retrospectively. The primary outcome was the incidence of neurological poor outcome (modified Rankin scale as 4-6) on the 180th day posthemorrhage. Then, surgically-treated SSICH patients were set as the derivation cohort (from a referring hospital) and validation cohort (from multiple hospitals). A DT model to evaluate the risk of 180-day poor outcome was developed within the derivation cohort and validated within the validation cohort. The performance of clinicians in identifying patients with poor outcome before and after the help of the DT model was compared using the area under curve (AUC). RESULTS: One thousand two hundred sixty SSICH patients were included in this study (middle age as 56, and 984 male patients). Surgically-treated patients had a lower incidence of 180-day poor outcome compared to conservatively-treated patients (147/794 vs. 128/466, P <0.001). Based on 794 surgically-treated patients, multivariate logistic analysis revealed the ischemic cerebro-cardiovascular disease history, renal dysfunction, dual antiplatelet therapy, hematoma volume, and Glasgow coma score at admission as poor outcome factors. The DT model, incorporating these above factors, was highly predictive of 180-day poor outcome within the derivation cohort (AUC, 0.94) and validation cohort (AUC, 0.92). Within 794 surgically-treated patients, the DT improved junior clinicians' performance to identify patients at risk for poor outcomes (AUC from 0.81 to 0.89, P <0.001). CONCLUSIONS: This study provided a DT model for predicting the poor outcome of SSICH patients postsurgically, which may serve as a useful tool assisting clinicians in treatment decision-making for SSICH.

[Characteristics and Health Risk Assessment of Volatile Organic Compounds in Different Functional Zones in Baoji in Summer].

The situation of air pollution in Guanzhong Plain has been increasing in recent years; hence, it is very important to study the characteristics of volatile organic compounds (VOCs) and their health risks in urban functional zones. We analyzed 115 VOCs using gas chromatography-mass spectrometry/hydrogen ion flame detector (GC-MS/FID) and high performance liquid chromatography (HPLC) at four sampling sites in the traffic, comprehensive, industrial, and scenic zones of Baoji. We analyzed the main components and key species in the different functional zones. Ozone formation potential (OFP),·OH consumption rate (L·OH), and secondary organic aerosol formation potential (SOAFP) were used to evaluate the environmental impact, and the hazard index (HI) and lifetime cancer risk (LCR) methods were employed. The results revealed that the mean values of φ(TVOCs) in the traffic, comprehensive, industrial, and scenic zones were (59.63±23.85)×10-9, (42.92±11.88)×10-9, (60.27±24.09)×10-9, and (55.54±7.44)×10-9, respectively. The dominant contributors at the traffic zone were alkanes, and those at the other functional zones were OVOCs. Acetaldehyde, acetone, n-butane, and isopentane were abundant at different functional zones. According to the characteristic ratios of VOCs, the average ratio of toluene to benzene (T/B) at the traffic, comprehensive, industrial, and scenic zones were 1.84, 2.39, 1.28, and 1.64, respectively, and the ratio of iso-pentane to n-pentane (i/n) was mainly between 1 and 4. The results indicated that VOCs in Baoji were significantly affected by vehicle emissions and gasoline evaporation, biomass and coal combustion, and industrial coatings and foundry. The ratio of m/p-xylene to ethylbenzene (X/E) was lower than 2 at the four functional zones, and the minimum was 1.79 at the scenic zones; the results revealed that X/E was small, and the aging degree of air masses was high, indicating the influence of regional transport. According to the ratio of formaldehyde to acetaldehyde (C1/C2) and the ratio of acetaldehyde to propanal (C2/C3), it was suggested that there may have been evident anthropogenic emission sources, and the photochemical reaction had an important effect on aldehydes and ketones. Environmental impact assessment results revealed that OVOCs and alkenes contributed significantly to OFP and OFP from large to small was as follows:industrial zone>scenic zone>traffic zone>comprehensive zone. The range of L·OH in each functional zone was 8.77-15.82 s-1, with isoprene contributing the most in the industrial zone and acetaldehyde contributing the most at other functional zones. The SOAFP of each functional zone was as follows:scenic zone>comprehensive zone>traffic zone>industrial zone. Toluene, m/p-xylene, and isoprene were the notable species. According to the health risk assessment of EPA, the HI of toxic VOCs in all functional zones was lower than 1, which was at an acceptable level. However, the number of days with HI>1 in industrial zones accounted for 42.86% of the total sampling days, indicating a high risk. The lifetime carcinogenic risk (LCR) of the traffic, comprehensive, industrial, and scenic zones were 1.83×10-5, 1.21×10-5, 1.85×10-5, and 1.63×10-5, respectively, which were all in grade Ⅲ of the rating system, indicating a high probability of cancer risk. Species with LCR greater than 10-6 were formaldehyde; acetaldehyde; 1,2-dibromoethane; 1,2-dichloroethane; 1,2-dichloropropane; and chloroform.

Technical standardization and total factor productivity in innovation-driven development: Evidence from China.

Innovation drive differs from investment drive and resource drive in that it focuses on knowledge and skills to promote productivity growth. By integrating technical standards within the framework of an innovation-driven development system in this work, theoretical implications for this development strategy may be revealed. Following our theoretical study, we built a PECM utilizing China's inter-provincial panel data from 2007 to 2020 to investigate the long and short-term relationships between standardization, R&D, and innovation-driven development. The following are the key findings: First, both standardization and R&D are the nation's critical engines of innovation-driven development. Second, standardization has the greatest impact on TFP through improving technical efficiency, whereas R&D drives both technical development and technical efficiency improvement. Third, while the influence of technical standard drafters' production scale on scale efficiency was insignificant from 2007 to 2013, it became substantial after 2014 with China's macroeconomic reform of "transforming the mode and changing the structure."

Comparative cost analysis of implanting devices in different cardiac resynchronization therapeutic strategies.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an established treatment option for heart failure patients. However, the implementation of triple-chamber pacemakers can be cost-prohibitive. His-Purkinje system pacing (HPSP) can also enable cardiac resynchronization, and it can be achieved with relatively inexpensive conventional pacemakers. HYPOTHESIS: This article aims to comparatively evaluate the cost of implanting devices in different CRT strategies to provide meaningful guidance for clinical decision-making by electrophysiologists. METHODS: Data was collected on the prices, designed life, and price/designed life of multiple mainstream models of CRT-P, CRT-D, dual-chamber pacemakers, and single-chamber pacemakers that were sold in the Chinese market in 2022. The prices, designed lives, and price/designed life of different pacemaker models were then compared. RESULTS: The costs of CRT-P and CRT-D (13008.44 ± 2752.30 USD and 22043.36 ± 3676.25 USD) were significantly higher than those of conventional pacemakers (dual-chamber: 11142.39 ± 4273.85 USD and single-chamber: 5634.28 ± 2032.80 USD) (p < .05). Additionally, the price/designed life of conventional pacemakers (dual-chamber: 839.63 ± 258.62 US dollar/year and single-chamber: 435.86 ± 125.44 US dollar/year) was significantly better than that of CRT-P and CRT-D (1386.91 ± 266.73 and 2585.53 ± 520.27 US dollar/year, respectively) (p < .05). CONCLUSION: Conduction system pacing (CSP)-based CRT is more cost-effective than BVP-based CRT. Furthermore, CSP-based CRT can achieve cardiac resynchronization with conventional pacemakers and may be a good option for HF patients who do not need defibrillation.

Deep Learning Synthetic Strain: Quantitative Assessment of Regional Myocardial Wall Motion at MRI.

Purpose: To assess the feasibility of a newly developed algorithm, called deep learning synthetic strain (DLSS), to infer myocardial velocity from cine steady-state free precession (SSFP) images and detect wall motion abnormalities in patients with ischemic heart disease. Materials and Methods: In this retrospective study, DLSS was developed by using a data set of 223 cardiac MRI examinations including cine SSFP images and four-dimensional flow velocity data (November 2017 to May 2021). To establish normal ranges, segmental strain was measured in 40 individuals (mean age, 41 years ± 17 [SD]; 30 men) without cardiac disease. Then, DLSS performance in the detection of wall motion abnormalities was assessed in a separate group of patients with coronary artery disease, and these findings were compared with consensus results of four independent cardiothoracic radiologists (ground truth). Algorithm performance was evaluated by using receiver operating characteristic curve analysis. Results: Median peak segmental radial strain in individuals with normal cardiac MRI findings was 38% (IQR: 30%-48%). Among patients with ischemic heart disease (846 segments in 53 patients; mean age, 61 years ± 12; 41 men), the Cohen κ among four cardiothoracic readers for detecting wall motion abnormalities was 0.60-0.78. DLSS achieved an area under the receiver operating characteristic curve of 0.90. Using a fixed 30% threshold for abnormal peak radial strain, the algorithm achieved a sensitivity, specificity, and accuracy of 86%, 85%, and 86%, respectively. Conclusion: The deep learning algorithm had comparable performance with subspecialty radiologists in inferring myocardial velocity from cine SSFP images and identifying myocardial wall motion abnormalities at rest in patients with ischemic heart disease.Keywords: Neural Networks, Cardiac, MR Imaging, Ischemia/Infarction Supplemental material is available for this article. © RSNA, 2023.

KBrO3-Promoted Cross-Dehydrogenative Coupling Reaction: An Odorless Regioselective Sulfenylation of Imidazoheterocycles in Water.

A regioselective metal-free sulfenylation of imidazoheterocycles with heterocyclic thiols or thiones has been achieved using a cross-dehydrogenative coupling method in water. In addition, the procedure has several advantages including green solvents, free of foul-smelling sulfur sources, and mild conditions, thus providing considerable application potential in the pharmaceutical industry.

Peri-therapeutic multi-modal hemodynamic assessment and detection of predictors for symptomatic in-stent restenosis after percutaneous transluminal angioplasty and stenting.

Backgrounds: This study performed multi-modal hemodynamic analysis including quantitative color-coded digital subtraction angiography (QDSA) and computational fluid dynamics (CFD) to delineate peri-therapeutic hemodynamic changes and explore the risk factors for in-stent restenosis (ISR) and symptomatic ISR (sISR). Methods: Forty patients were retrospectively reviewed. Time to peak (TTP), full width at half maximum (FWHM), cerebral circulation time (CCT), angiographic mean transit time (aMTT), arterial stenosis index (ASI), wash-in gradient (WI), wash-out gradient (WO) and stasis index were calculated with QDSA and translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified from CFD analysis. These hemodynamic parameters were compared between before and after stent deployment and multivariate logistic regression model was established to detect predictors for ISR and sISR at follow-up. Results: It was found that stenting generally reduced TTP, stasis index, CCT, aMTT and translesional WSSR while significantly increased translesional PR. ASI decreased after stenting, and during the mean follow-up time of 6.48 ± 2.86 months, lower ASI (<0.636) as well as larger stasis index were corroborated to be independently associated with sISR. aMTT showed a linear correlation with CCT before and after stenting. Conclusion: PTAS not only improved cerebral circulation and blood flow perfusion but also changed local hemodynamics significantly. ASI and stasis index derived from QDSA were proved to play a prominent role in risk stratification for sISR. Multi-modal hemodynamic analysis could facilitate intraoperative real-time hemodynamic monitoring and help the determination of the end point of intervention.

An Automated Skill Assessment Framework Based on Visual Motion Signals and a Deep Neural Network in Robot-Assisted Minimally Invasive Surgery.

Surgical skill assessment can quantify the quality of the surgical operation via the motion state of the surgical instrument tip (SIT), which is considered one of the effective primary means by which to improve the accuracy of surgical operation. Traditional methods have displayed promising results in skill assessment. However, this success is predicated on the SIT sensors, making these approaches impractical when employing the minimally invasive surgical robot with such a tiny end size. To address the assessment issue regarding the operation quality of robot-assisted minimally invasive surgery (RAMIS), this paper proposes a new automatic framework for assessing surgical skills based on visual motion tracking and deep learning. The new method innovatively combines vision and kinematics. The kernel correlation filter (KCF) is introduced in order to obtain the key motion signals of the SIT and classify them by using the residual neural network (ResNet), realizing automated skill assessment in RAMIS. To verify its effectiveness and accuracy, the proposed method is applied to the public minimally invasive surgical robot dataset, the JIGSAWS. The results show that the method based on visual motion tracking technology and a deep neural network model can effectively and accurately assess the skill of robot-assisted surgery in near real-time. In a fairly short computational processing time of 3 to 5 s, the average accuracy of the assessment method is 92.04% and 84.80% in distinguishing two and three skill levels. This study makes an important contribution to the safe and high-quality development of RAMIS.

Application of Quantitative Computed Tomographic Perfusion in the Prognostic Assessment of Patients with Aneurysmal Subarachnoid Hemorrhage Coexistent Intracranial Atherosclerotic Stenosis.

The comorbidity of aneurysmal subarachnoid hemorrhage (aSAH) with intracranial atherosclerotic stenosis (ICAS) has been suggested to increase the risk of postoperative ischemic stroke. Logistic regression models were established to explore the association between computed tomography perfusion (CTP) parameters and 3-month neurological outcomes and delayed cerebral ischemia (DCI). Prognostic-related perfusion parameters were added to the existing prognostic prediction models to evaluate model performance improvement. Tmax > 4.0 s volume > 0 mL was significantly associated with 3-month unfavorable neurological outcomes after adjusting for potential confounders (OR 3.90, 95% CI 1.11-13.73), whereas the stenosis degree of ICAS was not. Although the cross-validated area under the curve (AUC) was similar after the addition of the Tmax > 4.0 s volume > 0 mL (SAHIT: p = 0.591; TAPS: p = 0.379), the continuous net reclassification index (cNRI) and integrated discrimination index (IDI) showed that the perfusion parameters significantly improved the performance of the two models (p < 0.001 for all comparisons). Patients with coexistent aSAH and ICAS, Tmax > 4.0 s volume > 0 mL is an independent factor of 3-month neurological outcomes. A quantitative assessment of cerebral perfusion may help accurately screen patients with poor outcomes due to the coexistence of aSAH and ICAS.

Dynamic evolution characteristics and driving factors of carbon emissions in prefecture-level cities in the Yellow River Basin of China.

This paper focuses on the spatiotemporal evolution characteristics, as well as the driving factors, of carbon emissions in the prefecture-level cities in the Yellow River Basin (YB). The paper's findings will aid in promoting ecological conservation and high-quality development in the region. The initiatives undertaken in the YB are a significant national strategy towards achieving carbon peaking and carbon neutrality. To fully investigate the spatiotemporal evolution process, as well as the typical characteristics of their carbon emissions, conventional, and spatial Markov transition probability matrices were developed utilizing YB's panel data for 55 prefecture-level cities from 2003 to 2019. The generalized Divisia index decomposition method (GDIM) cleverly uses this data to conduct a complete analysis of the dynamics and driving processes influencing the change in carbon emissions in these cities. However, the evolution of carbon emissions in prefecture-level cities has reached a point of stability that maintains the original state, making it challenging to make meaningful short-term progress. The data indicates that prefecture-level cities in the YB are emitting more carbon dioxide on average. Neighborhood types in these cities significantly influence the transformation of carbon emissions. Low-emission areas can encourage a reduction in carbon emissions, whereas high-emission areas can encourage an increase. The spatial organisation of carbon emissions exhibits a "high-high convergence, low-low convergence, high-pulling low, low-inhibiting high" club convergence phenomenon. Carbon emissions rise with per capita carbon emissions, energy consumed, technology, and output scale, whereas it falls with carbon technology intensity and output carbon intensity. Hence, instead of enhancing the role of increase-oriented variables, prefecture-level cities in the YB should actively engage these reduction-oriented forces. The YB's key pathways for lowering carbon emissions include boosting research and development, promoting and applying carbon emission reduction technologies, lowering output carbon intensity and energy intensity, and improving energy use effectiveness.

A Low-Cost Synthetic Route of FAPbI3 Quantum Dots in Air at Atmospheric Pressure: The Role of Zinc Iodide Additives.

Perovskite quantum dots (PQDs) have shown great promise in optoelectronic device applications. Typically, a traditional hot-injection method with heating and high vacuum pressure is used to synthesize these colloidal nanoparticles. In this article, we report a low-cost synthetic method for FAPbI3 PQDs in air at atmospheric pressure with the assistance of ZnI2. Compared with the FAPbI3 PQDs synthesized under vacuum/N2 condition, the air-synthesized Zn:FAPbI3 PQDs exhibit the same crystalline structure with a similar preferential crystallographic orientation but demonstrate higher colloidal stability and higher production yield. Furthermore, we examine the influence of ZnI2 during the synthesis process on morphologies and optoelectronic properties. The results show that the mean size of the obtained FAPbI3 PQDs is decreased by increasing the amount of added ZnI2. More importantly, introducing an optimal amount of ZnI2 into the Pb source precursor enables increasing the carrier lifetime of FAPbI3 PQDs, showing the potential beneficial effect on device performance.

An artificial intelligence-driven image quality assessment system for whole-body [18F]FDG PET/CT.

PURPOSE: Image quality control is a prerequisite for applying PET/CT. This study aimed to develop an artificial intelligence-driven real-time and accurate whole-body [18F]FDG PET/CT image quality assessment system. METHODS: This study included 173 patients (age, 59 ± 12 years; 66.3% males) with whole-body [18F]FDG PET/CT imaging. Images of ten patients were used as an educational set. Images of the rest 163 patients were reconstructed to 952 images by simulating several scanning times and randomly split into training (60%, 98 patients, 578 images), validation (20%, 33 patients, 192 images), and test (20%, 32 patients,182 images) sets. Two experienced physicians (R1 and R2) independently assessed the image quality of thorax, abdomen, and pelvis region twice (R1a and b; R2a and b), 1 month apart, using a 5-point Likert scale. Objective image quality metrics were extracted from the mediastinal blood pool, three liver levels, and the bilateral gluteus maximus. The developed convolutional neural networks for image quality assessment (IQA-CNNs) generated the subjective quality scores and objective image metrics. The IQA-CNNs and physicians' performances were compared for localization accuracy, score agreement, and process time. RESULTS: The physicians demonstrated good inter- and intra-rater subjective assessment agreement, with kappa coefficients (R1a vs. R2a, R1a vs. R1b, R2a vs. R2b, and R1a vs. R2b) of 0.78, 0.77, 0.76, and 0.80. The IQA-CNNs and R1 or R2 agreed in the subjective assessments, with kappa coefficients of 0.79 and 0.78. IQA-CNNs and R1 or R2 also agreed in their objective image quality assessment (ICC > 0.60). The IQA-CNNs evaluation speed was 200 times faster than the manual assessment. CONCLUSION: An automated system for rapid assessment of [18F]FDG PET/CT image quality was developed, showing comparable performance to senior physicians. The system generates a comprehensive and detailed image quality assessment report, including subjective visual scores and objective image metrics for various anatomical regions.

Cost-effectiveness of rezvilutamide versus bicalutamide and androgen-deprivation therapy in patients with highvolume, metastatic, hormone-sensitive prostate cancer.

Background: Rezvilutamide, a novel androgen-receptor inhibitor with limited blood-brain barrier penetration, exhibits significant antitumour activity against highvolume, metastatic, hormone-sensitive prostate cancer (mHSPC). In this study, we aimed to compare the cost-effectiveness of rezvilutamide and bicalutamide as first-line treatments for untreated prostate cancer among Chinese patients, in order to evaluate the efficacy of rezvilutamide. Methods: In this study, we utilized partition survival model to assess the cost-effectiveness of rezvilutamide and bicalutamide treatments for highvolume mHSPC. The model was developed using TreeAge Pro 2022 software and relied on clinical data obtained from the CHART trial. Transition probabilities were estimated from the reported survival probabilities in trials using parametric survival modeling. From the perspective of the Chinese healthcare system, we calculated quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and lifetime cost. A lifetime horizon and an annual discount rate of 5% were employed. To address modeling uncertainties, we conducted one-way sensitivity analysis and probabilistic sensitivity analysis. Results: The cost of rezvilutamide versus bicalutamide were $62700 and $13200. Rezvilutamide had an ICER of $41900 per additional QALYs gained compared with bicalutamide. Research indicated that rezvilutamide achieved at least an 28.20% probability of cost-effectiveness at the threshold of $38223.34/QALY. One-way sensitivity analysis revealed that the results were sensitive to utility of PD. Scenario analysis showed that rezvilutamide was cost-effectiveness if its price was reduced by more than 10%. Conclusion: Based on the analysis at the current price, rezvilutamide was found to be less cost-effective for patients with highvolume mHSPC compared to bicalutamide in China.