[A cross-sectional survey on the allocation of nursing human resources in burn centers in China].

Objective: To investigate the allocation of nursing human resources in burn centers in China. Methods: A cross-sectional survey was conducted. Using a self-designed questionnaire, a survey was carried out from January to March 2022 to investigate the January to December 2021 status of 39 burn centers in China that met the inclusion criteria based on six strategic regions and other regions, including the hospital grade and the region, the number of nurses and opening beds in the burn centers and burn intensive care units (BICUs), the age, working seniority in burn specialty, educational background, professional title, personnel employment, and turnover of nurses and training of newly recruited nurses in the burn centers. Results: This survey covered 30 provinces, municipalities, and autonomous regions in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan region of China). A total of 39 questionnaires were collected, all of which were valid. The 39 burn centers were located in 38 tertiary A hospitals and 1 tertiary B hospital, with 26 burn centers in strategic areas. The nurse/bed ratio of burn centers in the Greater Bay Area of Guangdong, Hong Kong, and Macao was the highest, while the nurse/bed ratio of burn centers in border ethnic minority area was the lowest. Except for the Chengdu-Chongqing Economic Circle, BICUs had been set up in burn centers in other regions. Among the 39 burn centers, the percentage of nurses aged 25 to 34 years was 51.21% (738/1 441), the percentage of nurses worked in burn specialty for less than 5 years was 31.16% (449/1 441), the percentage of nurses with bachelor's degree was 69.74% (1 005/1 441), and the percentage of nurses with nursing professional title was 44.14% (636/1 441), which were the highest. There were significant differences in the employment of nurses, the percentage of permanent nurses in burn centers in the collaborative development zone of Beijing-Tianjin-Hebei was 82.48% (113/137), while the percentage of permanent nurses in burn centers in important military strategic area was only 9.42% (34/361); the turnover rate of nurses was 9.03% (143/1 584), among which the turnover rate of nurses was 18.14% (80/441) in burn centers in important military strategic area. The training for newly recruited nurses in 39 burn centers was mainly based on the guidance of senior nurses and the pre-job education+specialist training. Conclusions: The burn nursing human resources in strategic areas in China are seriously insufficient and unevenly distributed, with unstable nurse team and lack of standardized specialist training. In particular, the nursing human resources in BICUs need to be equipped and supplemented urgently.

[Summary of tools for assessment of public health emergency response capability].

With the progress of globalization, the public health emergencies represented by major infectious diseases have become a major challenge for the public health management in China. The article briefly describes the emergency response capability assessment tools in China, and introduces two emergency response assessment tools with complete content structure and wide application in the world. Then the advantages and disadvantages of the tools are compared and discussed in order to provide reference for improvement of the assessment tools for public health emergency response capability in China.

[Comparison of Three CNN Models Applied in Bone Age Assessment of Pelvic Radiographs of Adolescents].

ABSTRACT: Objective To compare the performance of three deep-learning models （VGG19, Inception-V3 and Inception-ResNet-V2） in automatic bone age assessment based on pelvic X-ray radiographs. Methods A total of 962 pelvic X ray radiographs taken from adolescents （481 males, 481 females） aged from 11.0 to 21.0 years in five provinces and cities of China were collected, preprocessed and used as objects of study. Eighty percent of these X ray radiographs were divided into training set and validation set with random sampling method and used for model fitting and hyper-parameters adjustment. Twenty percent were used as test sets, to evaluate the ability of model generalization. The performances of the three models were assessed by comparing the root mean square error （RMSE）, mean absolute error （MAE） and Bland-Altman plots between the model estimates and the chronological ages. Results The mean RMSE and MAE between bone age estimates of the VGG19 model and the chronological ages were 1.29 and 1.02 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-V3 model and the chronological ages were 1.17 and 0.82 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-ResNet-V2 model and the chronological ages were 1.11 and 0.84 years, respectively. The Bland-Altman plots showed that the mean value of differences between bone age estimates of Inception-ResNet-V2 model and the chronological ages was the lowest. Conclusion In the automatic bone age assessment of adolescent pelvis, the Inception-ResNet-V2 model performs the best while the Inception-V3 model achieves a similar accuracy as VGG19 model.

Research Progress and Prospect of Machine Learning in Bone Age Assessment.

ABSTRACT: Bone age assessment has always been one of the key issues and difficulties in forensic science. With the gradual development of machine learning in many industries, it has been widely introduced to imageology, genomics, oncology, pathology, surgery and other medical research fields in recent years. The reason why the above research fields can be closely combined with machine learning, is because the research subjects of the above branches of medicine belong to the computer vision category. Machine learning provides unique advantages for computer vision research and has made breakthroughs in medical image recognition. Based on the advantages of machine learning in image recognition, it was combined with bone age assessment research, in order to construct a recognition model suitable for forensic skeletal images. This paper reviews the research progress in bone age assessment made by scholars at home and abroad using machine learning technology in recent years.

[A cross-sectional study on economic burden of pulmonary tuberculosis cases from designated tuberculosis hospital].

Objective: To understand the medical expenditure and related household economic burden of pulmonary tuberculosis (TB) patients receiving full course treatment in designated TB hospitals in China and identify the related factors. Method: A cross-sectional study was conducted in 535 consecutive TB patients receiving TB treatment from April 2017 to June 2017 in 5 designated TB hospitals in eastern and western China selected through stratified cluster sampling. A questionnaire was used to collect the information about patients' social economic characteristics and TB diagnosis and treatment expenditure. Results: The average total medical expenditure for TB treatment was 12 635.5 yuan (RMB), in which the direct medical expenditure accounted for 65.3% of the total. Nearly half of the total medical expenditure occurred in pre-treatment period. The expenditure in pre- treatment period was higher in the patients with low education level, newly treated patients, and initial sputum negative patients. The median (quartile) for the ratio of total medical expenditure to annual household income was 22%(10%-57%). Ordinal logistic regression analysis showed that low-level education background, lower household income, hospitalization and suffering from other chronic disease might increase the ratio of medical expenditure to annual household income. Conclusions: Medical expenditure for full course TB treatment is still high in patients in designated TB hospitals. It is suggested to strengthen the capability building of timely found and referral of TB patients in non- designated hospitals and improve fee reduction and exemption policy for some patients.

Assessment of the cryoablation margin using MRI-CT fusion imaging in hepatic malignancies.

AIM: To demonstrate the feasibility of magnetic resonance imaging (MRI)-computed tomography (CT) fusion imaging for the assessment of the ablative margin after cryoablation in hepatic malignancies. MATERIALS AND METHODS: This retrospective study analysed 35 patients with 47 liver tumours treated with CT-guided cryoablation. Fusion images of pre-ablation MRI and intraoperative CT data were created on a workstation. Minimal ablative margin (MAM) assessment was categorised into three groups: (I) MAM <0 mm (tumour protruded through the ablation zone), (II) MAM 0-5 mm, and (III) MAM ≥5 mm. Local tumour progression (LTP) was assessed during follow-up. RESULTS: MRI-CT fusion imaging was successfully achieved in 46 (97.9%) of 47 lesions. LTP was detected in 67.4% (31/46) of cases. Twenty-four (77.4%) of 31 LTPs occurred in the subcapsular region of the liver. Using fusion images, the MAM was classified as groups I, II, and III in 18, 25, and three tumours, respectively. In group I, LTP was found in 15 (83.3%) of 18 lesions, whereas in group II, LTP was detected in 16 (64%) of 25 lesions. The cumulative LTP rate in group II was significantly lower than that in group I (p=0.012). CONCLUSION: Pre-ablation MRI and intraoperative CT fusion imaging is feasible and useful for evaluating the MAM of cryoablation in hepatic malignancies.

[Pollution characteristics and health risk assessment of heavy metals in PM(2.5) in Lanzhou].

Objective: To understand the pollution characteristics and assess the pollution health risks of heavy metals in atmospheric PM(2.5) in Lanzhou. Methods: According to the regional characteristics of air pollution and industrial distribution characteristics in Lanzhou, atmospheric PM(2.5) was sampled monthly in Chengguan and Xigu Districts from January, 2015 to December, 2016. Detected the concentration of PM(2.5) and 12 kinds of elements (Sb, Al, As, Be, Cd, Cr, Hg, Pb, Mn, Ni, Se and Tl) by weighing method and inductively coupled plasma mass spectrometry. Enrichment factor and geo-accumulation index were used to describe the pollution characteristics, while health risk assessment was conducted using the recommended United States Environmental Protection Agency (USA EPA) model. The health risks of non-carcinogens were evaluated by non-cancer hazard quotient (HQ), the non-carcinogenic risk was considered to be negligible when HQ<1, HQ>1 meant a health risk. With a single contaminant cancer Risk value to evaluate the health risks of carcinogens, when the Risk value between 10(-6) to10(-4) as an acceptable level. Results: The daily average concentrations of PM(2.5) was 83.0 µg/m(3), 77.0 µg/m(3) in Chengguan and Xigu Districts, respectively, during the sampling periods, and the concentration of PM(2.5) in winter/spring was higher than summer/fall in both districts. The concentration of Al in PM(2.5) was the highest and other elements in descending order: Pb, Mn, As, Sb/Cd, Tl in both districts. Enrichment factor results showed that Al and Mn were mainly affected by natural factors, the rest of five elements were all typical man-made pollution elements and according to geo-accumulation index pollution level of Cd was the strongest in the winter. The results of health risk assessment showed that Mn had the highest non-cancer risks (HQ>1) and affected the health of the children seriously. HQ reached up to 2.44 and 1.79 in Chengguan and Xigu Districts, respectively. Pb, As, Sb, Cd had slight health impact (HQ<1), could be negligible. The cancer risks range of As, Cr were 6.33×10(-6) to 6.46×10(-5) between the acceptable level of risk (10(-6) to 10(-4)), which indicated that As and Cd had potential cancer-risks. Conclusions: The pollution level of atmospheric PM(2.5) and the heavy metals in it was still grim;the non-cancer risks caused by multiple metals on children deserved attention. Although the cancer risks of As and Cd were between the acceptable level of risk, the potential cancer risk still shall not be ignored.

[Automated Assessment for Bone Age of Left Wrist Joint in Uyghur Teenagers by Deep Learning].

OBJECTIVES: To realize the automated bone age assessment by applying deep learning to digital radiography （DR） image recognition of left wrist joint in Uyghur teenagers, and explore its practical application value in forensic medicine bone age assessment. METHODS: The X-ray films of left wrist joint after pretreatment, which were taken from 245 male and 227 female Uyghur nationality teenagers in Uygur Autonomous Region aged from 13.0 to 19.0 years old, were chosen as subjects. And AlexNet was as a regression model of image recognition. From the total samples above, 60％ of male and female DR images of left wrist joint were selected as net train set, and 10％ of samples were selected as validation set. As test set, the rest 30％ were used to obtain the image recognition accuracy with an error range in ±1.0 and ±0.7 age respectively, compared to the real age. RESULTS: The modelling results of deep learning algorithm showed that when the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the net train set was 81.4% and 75.6% in male, and 80.5% and 74.8% in female, respectively. When the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the test set was 79.5% and 71.2% in male, and 79.4% and 66.2% in female, respectively. CONCLUSIONS: The combination of bone age research on teenagers' left wrist joint and deep learning, which has high accuracy and good feasibility, can be the research basis of bone age automatic assessment system for the rest joints of body.

[Advantages and Application Prospects of Deep Learning in Image Recognition and Bone Age Assessment].

Deep learning and neural network models have been new research directions and hot issues in the fields of machine learning and artificial intelligence in recent years. Deep learning has made a breakthrough in the applications of image and speech recognitions, and also has been extensively used in the fields of face recognition and information retrieval because of its special superiority. Bone X-ray images express different variations in black-white-gray gradations, which have image features of black and white contrasts and level differences. Based on these advantages of deep learning in image recognition, we combine it with the research of bone age assessment to provide basic datum for constructing a forensic automatic system of bone age assessment. This paper reviews the basic concept and network architectures of deep learning, and describes its recent research progress on image recognition in different research fields at home and abroad, and explores its advantages and application prospects in bone age assessment.

A health risk assessment of reclaimed municipal wastewater for industrial and miscellaneous use.

The study evaluated the safety of reclaimed water using health risk assessment and biotoxicity tests. The reclaimed water was produced from reverse osmosis and used in industrial and miscellaneous purposes. The health risk assessment was conducted based on the concentrations of detectable pollutants in reclaimed water in a hypothetical scenario. The estimated carcinogenic and non-carcinogenic risks are lower than the generally accepted level. Biotoxicity evaluation included three genotoxicity tests, a chronic toxicity test using medaka fishes, and a subchronic toxicity test using mice. The reclaimed water is not genetically toxic, and does not cause significant chronic effects on these model organisms. These results confirm the safety of using reclaimed water from municipal wastewater treatment plants.

Assessment of donor fatty livers for liver transplantation.

AIM: The effect of fatty liver on graft survival, especially with reference to macrovesicular and microvesicular steatosis, is still uncertain. This preliminarily study was designed to create a noninvasive method for the quantification of the hepatic fat content in vivo and to establish provisional criteria for the assessment of fatty donor livers before liver transplantation among transplant surgeons, radiologists, and pathologists. METHODS AND MATERIALS: Different degrees of rat fatty liver model were established by feeding rats a diet deficient in choline and methionine for different periods of time. Computed tomography (CT) with test tubes containing variable percentages of fat equivalent substance were used to assess the severity of fatty change of the rat liver. This was then correlated with the histological classification, level of hepatic enzymes, and graft survival. RESULTS: Linear correlation between the fat volume fraction added to the test tubes and CT density were found. The process of producing a fatty liver via diet alteration peaked at week 3. At this time hepatic enzymes, radiological fat content, and posttransplantation survival were worse (P=0.013), compared with other time points. Radiological assessment of fatty liver correlated well with survival and serum glutamic oxaloacetic transaminase and glutamic pyruvate transaminase levels. CONCLUSION: Severe microvesicular steatosis does not influence recipient survival, however, macrovesicular steatosis affects graft survival. Caliber CT is a practical and simple method that allows an accurate noninvasive quantitative assessment of hepatic fatty infiltration. It has potential to be a useful parameter for the assessment of donor livers for clinical liver transplantation.

[Relationship between method of payment and eyedrop usage in patients after cataract surgery].

UNLABELLED: To assess the relationship between pay methods and eyedrop usage, we compared the duration of usage of 4% Sulfisomeazole (Sinomin, 10ml/bottle, Shionogi, Taiwan), 0.1% Fluorometholon (Flumetholon, 5ml/bottle, Santen, Japan), and 0.1% Dexamethasone (Maxidex, 5 ml/bottle, Alcon, Belgium) in patients after cataract surgery. The study subjects included 108 insured patients (mean age 64.73 years) and 49 uninsured patients (mean age 67.30 years). The results were as follows. The duration of eyedrop usage in the uninsured (4% Sinomin: 19.18 +/- 1.92 day/bottle, 0.1% Flumetholon: 16.95 +/- 1.41 day/bottle, and 0.1% Maxidex: 14.53 +/- 1.54 day/bottle) was significantly longer than in the insured (4% Sinomin: 13.15 +/- 0.71 day/bottle, 0.1% Flumetholon 12.52 +/- 0.63 day/bottle, and 0.1% Maxidex 9.59 +/- 0.45 day/bottle; each P < 0.01). There was no significant difference in the duration of eyedrop usage among the patients with different types of insurance. IN CONCLUSION: our results indicated a close relationship between method of payment and eyedrop usage.

[Trial manufacture and application of soft uterine probe with reading scales (Type III) for the detection of IUD position].

PIP: The position of the IUD in the uterus is important to its contraceptive effectiveness. Pelvic x-ray examination is often imprecise and can not reveal whether the IUD is lodged in the muscles or outside of the uterus. Ultrasonic examination requires expensive equipment and is a complicated procedure. Examination of the position of an IUD inside the uterus with a flexible probe may solve the problem of uterine perforation which occurs with the use of a metal probe and may also reduce the incidence of unnecessary extraction and allow an appropriate correction of the IUD position. In August 1985, the soft silicone rubber uterine probe with a reading scale was developed and manufactured by the No. 3 Hospital of China's Medical University. The probe is inserted into the uterus together with the IUD. After the insertion procedure, clients walk about 500 meters, and a side-ways x-ray or radiography examination of the position of the IUD and the probe shows whether the IUD is properly placed or descended. A clinical study was conducted with 1000 IUD users, including 222 cases of IUD insertion after abortion and 162 cases of uterine bleeding it IUD in situ. A comparison of the post-abortion group, the irregular bleeding group and the normal group shows that a larger proportion of the former 2 groups had experienced an IUD descending. The results suggests that the large size of a post-abortion uterus makes it hard for an IUD to stay in place. Improper positioning of the IUD may be the cause of the irregular bleeding. The soft probe may also be used for uterine examinations. In cases of malformation of the uterus or of pelvic tumor, the use f the soft probe under ultrasonic examination may confirm the position of the uterus or tumor. The soft probe can also be used to clarify the association of irregular bleeding with the IUD.^ieng