Digital economy and institutional dynamics: striving for equitable public service in a digitally transformed era.

Background: The rapid emergence of China's digital economy has sparked profound interest in the complex interplay between digitalization and the provision of public services. This study aims to delve deeper into how the development of the digital economy impacts the level of equalization in public service delivery and evaluates whether institutional factors can moderate this transformation. Against the backdrop of pursuing "common prosperity," this research provides valuable guidance for policymaking and strategic planning. It ensures that the ascent of the digital economy not only elevates the standards of public services but also fosters their equitable distribution, thereby advancing the cause of social equity. Methodology: The study utilized the System Generalized Method of Moments (GMM) model along with longitudinal trend data spanning from 2009 to 2018. This approach facilitated an in-depth analysis of the relationship between the digital economy and the level of equalization in public service delivery. The application of this model provided deeper insights into the impact of the digital economy on public service equalization and the identification of underlying mechanisms. Findings: This study reveals a complex paradox that the digital economy is exacerbating regional disparities in the provision of basic public services. Furthermore, the research underscores the pivotal role of institutional environments in mitigating the adverse effects of the digital economy on public service provision. By examining the interplay between digital economy growth and institutional frameworks, the study suggests that adaptable and robust institutions are essential for harnessing the digital economy's benefits while minimizing its potential drawbacks. Conclusion: In conclusion, the findings from this study offer substantial insights into the dual impact of the digital economy on public service provision, enriching the ongoing discourse on digital transformation and social equity. The research underscores the significance of strategic policy reforms and institutional adjustments to harness the transformative power of the digital economy, promoting equitable access to public services and advancing the goal of "common prosperity" in the digital age.

Design and impact assessment of policies to overcome oversupply in China's national carbon market.

China has adopted a national carbon emissions trading market to promote emission reductions, but until now, overallocation of allowances suffer low carbon prices and thus to unfulfilled emission reduction goals. We report a general equilibrium modeling that indicates the flexible compliance and price adjustment mechanism of the carbon market, along with explores the solution to the oversupply of allowances in the China's national carbon market. We find that, under the current policy, the initial loose allowance allocation decreases the overall carbon price, and simultaneously the total amount of banked carbon allowances reaches 4.880 billion tons in 2030, resulting in the level of carbon price cannot achieve NDC (Nationally Determined Contribution) targets. However, by introducing carbon market price adjustment schemes, we observe that the cumulative amount of allowances can effectively reduce, enabling the carbon price rising. Importantly, the amount of the supply of allowances decreases most under the benchmark decrease scenario, which increases the emission reduction pressure of the enterprises from the beginning, leading to the largest economic losses, the price-based adjustment mechanism raises the carbon price to expected level at the minimize economic losses, and the quantity-based adjustment mechanism is more sensitive to policy parameters compared to the price -based adjustment mechanism. These findings offer a promising avenue for selecting cost-effective price adjustment mechanism to improve price mechanism design for national carbon markets.

Carbon price prediction based on decomposition technique and extreme gradient boosting optimized by the grey wolf optimizer algorithm.

It is essential to predict carbon prices precisely in order to reduce CO2 emissions and mitigate global warming. As a solution to the limitations of a single machine learning model that has insufficient forecasting capability in the carbon price prediction problem, a carbon price prediction model (GWO-XGBOOST-CEEMDAN) based on the combination of grey wolf optimizer (GWO), extreme gradient boosting (XGBOOST), and complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN) is put forward in this paper. First, a random forest (RF) method is employed to screen the primary carbon price indicators and determine the main influencing factors. Second, the GWO-XGBOOST model is established, and the GWO algorithm is utilized to optimize the XGBOOST model parameters. Finally, the residual series of the GWO-XGBOOST model are decomposed and corrected using the CEEMDAN method to produce the GWO-XGBOOST-CEEMDAN model. Three carbon emission trading markets, Guangdong, Hubei, and Fujian, were experimentally predicted to verify the model's validity. Based on the experimental results, it has been demonstrated that the proposed hybrid model has enhanced prediction precision compared to the comparison model, providing an effective experimental method for the prediction of future carbon prices.

Utilization of lipidic food waste as low-cost nutrients for enhancing the potentiality of biofuel production from engineered diatom under temperature variations.

The scarcity of natural fossil fuels presents a promising opportunity for the development of renewable microalgae-based biofuels. However, the current microalgae cultivation is unable to effectively address the high costs of the production of biofuels. To tackle this challenge, this study focused on recruiting engineered Phaeodactylum tricornutum (FabG-OE) to enhance biomass accumulation and lipid production by employing food waste hydrolysate under temperature variations. The biomass and lipid accumulations of FabG-OE were improved effectively in mixed culture medium and food waste hydrolysate at a volume ratio (v/v) of 80:20 at 30 °C. It was found that oxidative stress might contribute to the overexpression of lipogenic genes, thereby leading to lipogenesis at 30 °C. Upscaling cultivation of FabG-OE at 30 °C using a semi-continuous strategy and batch strategy was conducted to achieve 0.73 and 0.77 g/L/d of biomass containing 0.35 and 0.38 g/L/d of lipid, respectively. In summary, these findings provide valuable insights for advancing microalgae-based biofuel production.

Layer-by-layer investigation of the black box: A case of assessing the industrial water-related system in China.

The essence of efficiency measurement is to model and estimate the performance of a complex system in a comparable form, and the key to modeling is to make the model as close to reality as possible. Based on data envelopment analysis (DEA) methods, this research proposes a layer-by-layer investigation framework for the black box. To illustrate the rationality of this logical framework, this paper presents a triple-opened dynamic recycling model with a series-parallel structure that allows us to assess the efficiency of the industrial water-related system in China. We obtain and compare the system efficiency under different scenarios for opening the black box. The results show that: (1) China's efforts to improve the performance of the resource use sub-stage through industrial production technology and management have been effective. (2) The performance of China's industrial water-related system strongly relates to the water supply subunit with a positive linear correlation. (3) The water supply subunit is the main foot-dragger in the system, and the government needs to place particular attention on improving the performance of labor in this subunit.

Recent Progress of Surface-Enhanced Raman Spectroscopy for Bacteria Detection.

There are various pathogenic bacteria in the surrounding living environment, which not only pose a great threat to human health but also bring huge losses to economic development. Conventional methods for bacteria detection are usually time-consuming, complicated and labor-intensive, and cannot meet the growing demands for on-site and rapid analyses. Sensitive, rapid and effective methods for pathogenic bacteria detection are necessary for environmental monitoring, food safety and infectious bacteria diagnosis. Recently, benefiting from its advantages of rapidity and high sensitivity, surface-enhanced Raman spectroscopy (SERS) has attracted significant attention in the field of bacteria detection and identification as well as drug susceptibility testing. Here, we comprehensively reviewed the latest advances in SERS technology in the field of bacteria analysis. Firstly, the mechanism of SERS detection and the fabrication of the SERS substrate were briefly introduced. Secondly, the label-free SERS applied for the identification of bacteria species was summarized in detail. Thirdly, various SERS tags for the high-sensitivity detection of bacteria were also discussed. Moreover, we emphasized the application prospects of microfluidic SERS chips in antimicrobial susceptibility testing (AST). In the end, we gave an outlook on the future development and trends of SERS in point-of-care diagnoses of bacterial infections.

Noninvasive assessment of myocardial work during left ventricular isovolumic relaxation in patients with diastolic dysfunction.

BACKGROUND: This study aims to investigate the value of myocardial work (MW) parameters during the isovolumic relaxation (IVR) period in patients with left ventricular diastolic dysfunction (LVDD). METHODS: This study prospectively recruited 448 patients with risks for LVDD and 95 healthy subjects. An additional 42 patients with invasive measurements of left ventricular (LV) diastolic function were prospectively included. The MW parameters during IVR were noninvasively measured using EchoPAC. RESULTS: The total myocardial work during IVR (MWIVR), myocardial constructive work during IVR (MCWIVR), myocardial wasted work during IVR (MWWIVR), and myocardial work efficiency during IVR (MWEIVR) of these patients were 122.5 ± 60.1 mmHg%, 85.7 ± 47.8 mmHg%, 36.7 ± 30.6 mmHg%, and 69.4 ± 17.8%, respectively. The MW during IVR was significantly different between patients and healthy subjects. For patients, MWEIVR and MCWIVR were significantly correlated with the LV E/e' ratio and left atrial volume index, MWEIVR exhibited a significant correlation with the maximal rate of decrease in LV pressure (dp/dt per min) and tau, and the MWEIVR corrected by IVRT also exhibited a significant correlation with tau. CONCLUSIONS: MW during IVR significantly changes in patients with risks for LVDD, and is correlated to LV conventional diastolic indices, including dp/dt min and tau. Noninvasive MW during IVR may be a promising tool to evaluate the LV diastolic function.

Source Apportionment and Health Risk Assessment of Heavy Metals in Soils of Old Industrial Areas-A Case Study of Shanghai, China.

Heavy metals in the soil of industrial areas pose severe health risks to humans after land-use properties are transformed into residential land. The public exposure time and frequency will soar significantly under residential land. However, much uncertainty still exists about the relationship between soil heavy metal pollution and-human health risks in an old industrial zone in Shanghai, China. Principal component analysis-(PCA) was used to explore the main sources of these heavy metals. Kriging interpolation was u-sed to identify their spatial distribution and high-risk areas, and the Human Health risk model was used to measure health risk. The results illustrate that the pollution levels of Cd, Hg, and Pb in industrial land are more serious than those in irrigation cropland. Meanwhile, the results of PCA showed that there were two main pollution sources under irrigated cropland, a natural source and a traffic source, accounting for 44.1% and 31.0%, respectively, and there were three main pollution sources under industrial land, with natural sources accounting for 28.5%, traffic sources accounting for 25.7%, and industrial sources accounting for 13.1%. In addition, the health risk assessment results indicated that the priority control pollutants of non-carcinogenic risk and carcinogenic risk were Zn and Cr, respectively. The high-risk area was mainly located in the middle of the study area. These results indicate that eliminating heavy metal pollution in the soil of the industrial area is so important to decrease health risks. The results of this study provide theoretical contributions to early warning of health risks related to heavy metal pollution in industrial area soil and serve as a practical reference for speeding up the formulation of industrial land pollution management policies.

Patient Access to Orphan Drugs Covered by Medical Insurance in China: Real-World Evidence From Patient Survey.

BACKGROUND: After the inclusion of more high-cost orphan drugs in China's National Reimbursement Drugs List, this study investigated issues relating to patient access to the 7 medicines for 4 rare diseases after listing. METHODS: This study collected data from a national survey conducted in China. Three aspects associated with the accessibility of medicines, namely, approachability, availability, and affordability, were analyzed using descriptive statistics. In addition, multilevel logistic regression models were used to investigate the associations between patient characteristics and the accessibility of surveyed orphan drugs. RESULTS: Of the 999 completed responses included in the study, 15% of the patients (n = 150) did not use the medicines because of non-medicine-related issues. Among the 849 patients using the surveyed medications, 64.4% (n = 547) encountered the problem of unavailability, whereas 51.2% (n = 435) reported affordability as an issue, and 49.6% (n = 320) had health expenditure beyond the catastrophic threshold. The data also indicated that Commercial Medical Insurance helped patients to relieve the cost burden on orphan drugs, but the payout of Commercial Medical Insurance failed to influence patients' decisions to continue the treatments. CONCLUSION: Accessibility of orphan drugs has improved in China after their inclusion in the National Reimbursement Drugs List. Nevertheless, the availability and affordability of medicines remained the barriers for patients to access the desired treatments. It is recommended that further policy refinement in conjunction with the collaboration among healthcare stakeholders is required to deliver better care for patients with rare disease.

Graft Patency Assessment with CCTA Using a Comprehensive Singlebranch Bridging Score.

AIMS: This study aims to assess the prognostic value of graft patency with coronary computed tomography angiography (CCTA) using a comprehensive single-branch targeted atherosclerotic risk score (CSBS) in patients before coronary artery bypass grafting (CABG). METHODS: This retrospective study contains a total of 88 patients who underwent clinical CCTA before off-pump CABG surgery between 2015 and 2018. Graft failure was defined as patients with missing multi-slice CCTA or coronary angiography. The predictive value of CSBS (ranging from 0-70 and divided into 2 groups: < 20 and ≥20) was analyzed using Kaplan-Meier analysis and Cox regression models. RESULTS: Patients' mean age was 61.2 ± 10.5 years, with a mean follow-up of 20.4 ± 15.2 months. A total of 203 grafts (21.5% arterial grafts) were analyzed and 30 of the vessels were occluded (14.8%). There was no significant difference in graft occlusion among the three targeted vessel groups. The Cox proportional hazard analysis showed that CSBS < 20 was a significant predictor of graft failure. CONCLUSION: Lower comprehensive single-branch targeted atherosclerotic risk score evaluated by CCTA is an independent prognostic factor for graft failure in patients before CABG surgery.

Differentiation of benign and malignant spinal schwannoma using guided attention inference networks on multi-source MRI: comparison with radiomics method and radiologist-based clinical assessment.

BACKGROUND: Differentiating diagnosis between the benign schwannoma and the malignant counterparts merely by neuroimaging is not always clear and remains still confounding in many cases because of atypical imaging presentation encountered in clinic and the lack of specific diagnostic markers. PURPOSE: To construct and validate a novel deep learning model based on multi-source magnetic resonance imaging (MRI) in automatically differentiating malignant spinal schwannoma from benign. MATERIAL AND METHODS: We retrospectively reviewed MRI imaging data from 119 patients with the initial diagnosis of benign or malignant spinal schwannoma confirmed by postoperative pathology. A novel convolutional neural network (CNN)-based deep learning model named GAIN-CP (Guided Attention Inference Network with Clinical Priors) was constructed. An ablation study for the fivefold cross-validation and cross-source experiments were conducted to validate the novel model. The diagnosis performance among our GAIN-CP model, the conventional radiomics model, and the radiologist-based clinical assessment were compared using the area under the receiver operating characteristic curve (AUC) and balanced accuracy (BAC). RESULTS: The AUC score of the proposed GAIN method is 0.83, which outperforms the radiomics method (0.65) and the evaluations from the radiologists (0.67). By incorporating both the image data and the clinical prior features, our GAIN-CP achieves an AUC score of 0.95. The GAIN-CP also achieves the best performance on fivefold cross-validation and cross-source experiments. CONCLUSION: The novel GAIN-CP method can successfully classify malignant spinal schwannoma from benign cases using the provided multi-source MR images exhibiting good prospect in clinical diagnosis.

Oil-based drilling cuttings pyrolysis residues at a typical shale gas drilling field in Chongqing: pollution characteristics and environmental risk assessment.

With the rapid development of unconventional natural gas such as shale gas, many oil-based drilling cuttings and their pyrolysis residues are produced, which are defined as hazardous wastes. In this paper, the pollution status of petroleum hydrocarbons and the leaching toxicity of eight heavy metals (Pb, Cr, Zn, Mn, Cu, Cd, Ni, and Hg) in the pyrolysis residues were studied. The ecological risk and human health risk were evaluated in the scenario where pyrolytic residues were used for paving as building materials. The results showed that the content of petroleum hydrocarbons in the pyrolysis residues was 7643.16 ± 169.67 mg/kg. Zn in the pyrolysis residues was extremely polluted, Pb was moderately polluted, Cr, Cu, As were slightly polluted, and the leaching toxicity was far below the standard value. In the ecological risk assessment, the comprehensive potential ecological risk of multiple heavy metals in the pyrolysis residues was low. On the other hand, the pyrolysis residues had no non-carcinogenic risk to adults under the condition of paving, but there was an obvious non-carcinogenic risk to children, and the carcinogenic risk of adults and children was within an acceptable range. In addition, aiming at reducing the health risk of the population, suggestions were put forward to reduce the exposure risk of the population and the content of heavy metals in the pyrolysis residue, which provided a scientific reference for the standardized management of the pyrolysis residue of oil-based drilling cuttings and the research on the corresponding treatment process.

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Under the background of the carbon peaking and carbon neutrality goals, the evolution of the spatiotemporal pattern of carbon storage has recently emerged as a research hotspot. The change in land use and land cover (LULC) is the primary driver of carbon storage changes. Understanding the spatiotemporal variations of LULC and carbon storage at the small scale of district and county level and proposing strategies to improve carbon sink, will contribute to the ecological conservation, restoration and sustainable development of districts or counties. With Yanqing District in Beijing as an example, we calculated carbon storage from 1990 to 2020 based on the InVEST model and used the PLUS model to predict LULC type changes under three scenarios (natural growth, ecological conservation and economic development) from 2020 to 2050. We further predicted the carbon storage and proposed mea-sures to improve carbon sink. The results showed that the key LULC change in Yanqing between 1990 and 2020 were the conversion of 88.9% of grassland to forest, 50.1% of farmland to forest, and 39.5% of cropland to impervious surface. The total carbon storage showed an upward trend, with an increase of 3.34×106 Mg. The spatial distribution of carbon storage presented "high in the northeast, low in the southwest, and high in the mountainous areas, low in the riverine areas." The increase in forest and the decrease in grassland were the main reasons for the increase and decrease in carbon storage, respectively. Between 2020 and 2050, the ecological restoration efforts under the ecological protection scenario increased, and the probability of other LULCs transforming into forest increased, resulting in a 5.8% increase in carbon storage, which had the highest increase and carbon storage under the three scenarios. High-value carbon storage areas were concentrated in the northeast, northwest, and south of Yanqing District, basically corresponding to the mountainous regions of Yanqing with high forest coverage, and the low-value areas generally corresponded to the plains with high development intensity and low forest coverage. We could implement comprehensive ecological protection and restoration measures, including forest and grassland ecosystem protection, water environment ecological restoration, farmland ecological restoration, to promote sustainable development in Yanqing District and to achieve the "dual carbon" goal.

Wide-field swept-source OCTA in the assessment of retinal microvasculature in early-stage diabetic retinopathy.

BACKGROUND: To perform a quantitative analysis of retinal microvasculature in patients with early-stage diabetic retinopathy (DR) using wide-field swept-source optical coherence tomography angiography (SS-OCTA).  METHODS: One hundred nineteen eyes of 119 patents (67 eyes with no DR and 52 eyes with mild-moderate nonproliferative diabetic retinopathy (NPDR)) were enrolled in this observational and cross-sectional cohort study, and an age-matched group consisting of 39 eyes of 39 non-diabetic subjects were set as the control. Each participant underwent a full ophthalmic examination, including wide-field SS-OCTA imaging. On OCTA scans (12 mm * 12 mm), the mean perfusion area (PA) and vessel density (VD) were independently measured in all 16 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors. Linear regression analyses were conducted to evaluate the influences of PA. RESULTS: In the central ring, there were no significant differences in the average PA and VD among the groups. In the 3 mm radius, the PA and VD of the no DR and mild-moderate NPDR were significantly decreased compared with the control group in superior and inferior quadrants. In the wide-field scans (9 and 12 mm radius), there was no significant difference in average PA and VD between the groups in each sectors (p > 0.05). Regression analysis found that the effect of VD on PA was statistically different (b = 1.311, p < 0.001). CONCLUSION: Wide-field OCTA imaging is useful for evaluating peripheral capillary perfusion in eyes with early-stage DR. Decrease in PA and VD was greater in the S3 and I3 sectors, and reductions in PA and VD were uneven in wide-filed sectors (9 and 12 mm radius).

The value of myocardial work in assessment of ventricular function in patients with non-obstructive hypertrophic cardiomyopathy.

BACKGROUND: To evaluate myocardial work using speckle tracking echocardiography in patients with non-obstructive hypertrophic cardiomyopathy (HCM). METHODS: Fifty patients with HCM and 50 normal controls were included. Left ventricular ejection fraction (LVEF) was quantified using the bi-plane Simpson's method. Myocardial work parameters, which included global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE), were derived from the 2D strain-pressure loop. RESULTS: The patient group was older (49.19 ± 14.69 vs. 37.16 ± 7.49 years old) and had a higher body mass index (24.93 ± 3.67 vs. 23.26 ± 3.32 kg/m2) and systolic blood pressure (121.81 ± 16.50 vs. 115.30 ± 11.01 mmHg) (P < 0.05). The mean LVEF in patients was 51%, with 54% of patients had LVEF ≤ 50%. Compared to controls, GWI (946.42 ± 360.64 vs. 1639.72 ± 204.56 mmHg%), GCW (1176.94 ± 373.23 vs. 1960.16 ± 255.72 mmHg%), and GWE (83.96 ± 7.68 vs. 95.26 ± 1.98%) were significantly decreased, while GWW (158.17 ± 82.47 vs. 79.12 ± 40.26 mmHg%) was significantly increased (P < 0.05) in the patient group. In patients, GWE showed a trend of positive correlation with LVEF (r = 0.276, P = 0.06), while GWW had a trend of negative correlation with LVEF (r = - 0.241, P = 0.09). No correlation between myocardial work and LV diastolic function or QRS duration was observed. Maximal wall thickness significantly correlated with all the myocardial work parameters. CONCLUSIONS: Assessing myocardial work adds useful information of LV function in patients with non-obstructive HCM.

Multi-Scenario Simulation Analysis of Grain Production and Demand in China during the Peak Population Period.

The transformation of dietary structure brought about by economic development in populous countries is expected to trigger an increase in grain demand, which will put enormous pressure on the grain supply in these nations and even globally. We simulated nine demand scenarios for 2020-2050 based on China's dataset for 15 kinds of grains from 1961-2018. The results show that the maximum difference between the predicted grain demand is 323.8 Mt, equal to the total grain consumption of approximately 600 million Chinese people in one year. To capture which demand scenarios will be met when grain productivity gradually improves within reasonable ranges, we present three projections from the production side. In particular, Projection 1 (P1), which maintains productivity at the current level, only fulfills the projected demand for Scenarios 1-LL, 2-LM, 4-ML, and 7-HL and falls short of the maximum value (Scenario 9-HH) by 117 Mt, which requires an additional 250,000 ha of arable land resources to fill the gap. After raising the preset value of grain yield, the productivity of Projection 2 in turn satisfies the demand scenario 5-MM. When both set variables (grain yields and arable area) increase simultaneously, the output of Projection 3 increases by 15.3% over P1. However, it still lags behind the demand of 68 million tons in Scenario 9-HH, thus implying uncertainty in China's vision of meeting the goal of 95% grain self-sufficiency. Rather than pursuing a single outcome, we discuss multiple possibilities for China's future grain balance and emphasize the adjusting and compensating role of grain trade and storage in the whole system. Ultimately, this paper calls for a better understanding of the supply-demand gap therein and its future trends to support national grain security as well as global sustainable food policies.

Characterization, risk assessment and resource potential of sediments in the black-odor water in Hunan, China.

The black-odor water in urban water bodies is increasingly found, resulting in serious atrophy of water bodies and degradation of water ecosystems. At present, the pollution status of the sediments as an internal source still remains much unknown. In order to assess the pollution status of black-odor water sediments, the content of total nitrogen, total phosphorus, organic matter and heavy metals in the sediments were determined by taking the black-odor water sediments in urban areas of Hunan Province as the research object. Geoaccumulation and potential ecological risks index methods were used to evaluate heavy metal pollution in the sediments, and comprehensive pollution index method was used to evaluate nitrogen and phosphorus nutrient pollution in the sediments so as to provide pertinent information for urban black-odor water treatment. Finally, resource recovery potentials of sediments in black-odor water were revealed. The results could be beneficial for evaluation of sediments in black-odor water bodies.

Towards a global One Health index: a potential assessment tool for One Health performance.

BACKGROUND: A One Health approach has been increasingly mainstreamed by the international community, as it provides for holistic thinking in recognizing the close links and inter-dependence of the health of humans, animals and the environment. However, the dearth of real-world evidence has hampered application of a One Health approach in shaping policies and practice. This study proposes the development of a potential evaluation tool for One Health performance, in order to contribute to the scientific measurement of One Health approach and the identification of gaps where One Health capacity building is most urgently needed. METHODS: We describe five steps towards a global One Health index (GOHI), including (i) framework formulation; (ii) indicator selection; (iii) database building; (iv) weight determination; and (v) GOHI scores calculation. A cell-like framework for GOHI is proposed, which comprises an external drivers index (EDI), an intrinsic drivers index (IDI) and a core drivers index (CDI). We construct the indicator scheme for GOHI based on this framework after multiple rounds of panel discussions with our expert advisory committee. A fuzzy analytical hierarchy process is adopted to determine the weights for each of the indicators. RESULTS: The weighted indicator scheme of GOHI comprises three first-level indicators, 13 second-level indicators, and 57 third-level indicators. According to the pilot analysis based on the data from more than 200 countries/territories the GOHI scores overall are far from ideal (the highest score of 65.0 out of a maximum score of 100), and we found considerable variations among different countries/territories (31.8-65.0). The results from the pilot analysis are consistent with the results from a literature review, which suggests that a GOHI as a potential tool for the assessment of One Health performance might be feasible. CONCLUSIONS: GOHI-subject to rigorous validation-would represent the world's first evaluation tool that constructs the conceptual framework from a holistic perspective of One Health. Future application of GOHI might promote a common understanding of a strong One Health approach and provide reference for promoting effective measures to strengthen One Health capacity building. With further adaptations under various scenarios, GOHI, along with its technical protocols and databases, will be updated regularly to address current technical limitations, and capture new knowledge.

Assessment of the prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in perihilar cholangiocarcinoma patients following curative resection: A multicenter study of 333 patients.

Background & Aims: Tumor-associated chronic inflammation has been determined to play a crucial role in tumor progression, angiogenesis and immunosuppression. The objective of this study was to assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in perihilar cholangiocarcinoma (pCCA) patients following curative resection. Methods: Consecutive pCCA patients following curative resection at 3 Chinese hospitals between 2014 and 2018 were included. The NLR was defined as the ratio of neutrophil count to lymphocyte count. PLR was defined as the ratio of platelet count to lymphocyte count. The optimal cutoff values of preoperative NLR and PLR were determined according to receiver operating characteristic (ROC) curves for the prediction of 1-year overall survival (OS), and all patients were divided into high- and low-risk groups. Kaplan-Meier curves and Cox regression models were used to investigate the relationship between values of NLR and PLR and values of OS and recurrence-free survival (RFS) in pCCA patients. The usefulness of NLR and PLR in predicting OS and RFS was evaluated by time-dependent ROC curves. Results: A total of 333 patients were included. According to the ROC curve for the prediction of 1-year OS, the optimal cutoff values of preoperative NLR and PLR were 1.68 and 113.1, respectively, and all patients were divided into high- and low-risk groups. The 5-year survival rates in the low-NLR (<1.68) and low-PLR groups (<113.1) were 30.1% and 29.4%, respectively, which were significantly higher than the rates of 14.9% and 3.3% in the high-NLR group (≥1.68) and high-PLR group (≥113.1), respectively. In multivariate analysis, high NLR and high PLR were independently associated with poor OS and RFS for pCCA patients. The time-dependent ROC curve revealed that both NLR and PLR were ideally useful in predicting OS and RFS for pCCA patients. Conclusions: This study found that both NLR and PLR could be used to effectively predict long-term survival in patients with pCCA who underwent curative resection.

Unresected small lymph node assessment predicts prognosis for patients with pT3N0M0 thoracic esophageal squamous cell carcinoma.

BACKGROUND: The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients. METHODS: Between January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan-Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence. RESULTS: Eighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR, P<0.001; LR, P<0.001). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.001). CONCLUSIONS: Unresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.