Economic-ecological services and their trade-offs or synergies of agricultural landscapes in Xiangxi, central China.

The scarcity of agricultural ecosystem services (ESs) caused by land use changes has become increasingly prominent, and the negative effects of agricultural production on ecosystems have been a constant concern. In this work, the geographic information system mapping method, the agricultural product supply (AS) model and InVEST model were applied to assess the economic and ecological services of agricultural landscapes. The interlinkages among them in Xiangxi were explored, a mountainous area in central China. The major conclusions drawn were as follows.1) From 2000 to 2020, the economic services (ESs1) of agricultural landscapes in Xiangxi increased by 96.6667%, and those of grain yield per ha (X1), cash crop output value per ha (X2), forestry output value per ha (X3), meat production per capita in rural areas (X4), and fishery output per ha (X5) were 39.0405%, 510.8462%, 297.6807%, 64.5947%, and 194.0348%, respectively. The spatial distribution of X1, X2, X3, X4, and X5 changed considerably, and the major influencing factors were human elements. 2) Ecological services (ESs2) increased by 5.13%, and those of carbon storage (CS, X6), water conservation (WC, X7), and N content in water (X8) were 1.0897%, 13.5808%, and -0.7406%, respectively. The distribution of X6, X7, and X8 was nearly unchanged and primarily influenced by natural factors 3) The relationship between ESs1 and ESs2 was not ideal. The dominant relationships between AS and CS were trade-offs, those between AS and WC were synergies, and those between AS and water purification were trade-offs. 4) The following suggestions are proposed: promote afforestation and vegetation protection policies, implement the best agricultural policies, increase investment in water conservation projects, adjust agricultural scale, and control the usage of agricultural chemicals. For the surrounding areas of more developed regions, strict environmental measures and agricultural policies are necessary. The methods used in this study are novel and can provide methodological references for similar studies. Moreover, it may offer useful suggestions for agricultural resource management and contribute to ecological civilization construction.

Deep Learning Prediction of Ovarian Malignancy at US Compared with O-RADS and Expert Assessment.

Background Deep learning (DL) algorithms could improve the classification of ovarian tumors assessed with multimodal US. Purpose To develop DL algorithms for the automated classification of benign versus malignant ovarian tumors assessed with US and to compare algorithm performance to Ovarian-Adnexal Reporting and Data System (O-RADS) and subjective expert assessment for malignancy. Materials and Methods This retrospective study included consecutive women with ovarian tumors undergoing gray scale and color Doppler US from January 2019 to November 2019. Histopathologic analysis was the reference standard. The data set was divided into training (70%), validation (10%), and test (20%) sets. Algorithms modified from residual network (ResNet) with two fusion strategies (feature fusion [hereafter, DLfeature] or decision fusion [hereafter, DLdecision]) were developed. DL prediction of malignancy was compared with O-RADS risk categorization and expert assessment by area under the receiver operating characteristic curve (AUC) analysis in the test set. Results A total of 422 women (mean age, 46.4 years ± 14.8 [SD]) with 304 benign and 118 malignant tumors were included; there were 337 women in the training and validation data set and 85 women in the test data set. DLfeature had an AUC of 0.93 (95% CI: 0.85, 0.97) for classifying malignant from benign ovarian tumors, comparable with O-RADS (AUC, 0.92; 95% CI: 0.85, 0.97; P = .88) and expert assessment (AUC, 0.97; 95% CI: 0.91, 0.99; P = .07), and similar to DLdecision (AUC, 0.90; 95% CI: 0.82, 0.96; P = .29). DLdecision, DLfeature, O-RADS, and expert assessment achieved sensitivities of 92%, 92%, 92%, and 96%, respectively, and specificities of 80%, 85%, 89%, and 87%, respectively, for malignancy. Conclusion Deep learning algorithms developed by using multimodal US images may distinguish malignant from benign ovarian tumors with diagnostic performance comparable to expert subjective and Ovarian-Adnexal Reporting and Data System assessment. © RSNA, 2022 Online supplemental material is available for this article.

Assessment of respiratory support decision and the outcome of invasive mechanical ventilation in severe COVID-19 with ARDS.

Background: The coronavirus disease 2019 (COVID-19) is an ongoing pandemic. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods: In this retrospective, single-center, case series study, patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8th, 2020, to March 24th, 2020, with the final follow-up date of April 20th, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results: The study included 46 COVID-19-associated ARDS patients who required IMV. The median age of the 46 patients was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR]: 6.0-27.3) days, and the median respiratory support decision score was 11.0 (IQR: 7.8-16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3-17.0] vs. 8.5 (6.0-10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657-0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P < 0.001). Conclusions: For severe COVID-19-associated ARDS with IMV, following the respiratory support decision and assessing completion would improve the progress of ventilation. With a decision score of >11.5, the mortality at 28 days after ICU admission showed an obvious decrease.

Quantitative assessment of postural instability in spinocerebellar ataxia type 3 patients.

OBJECTIVE: Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases, with balance instability as main symptom. Balance quantification is crucial for evaluating the efficacy of therapeutic interventions. However, balance evaluation in SCA3 is often subject to bias. Here, we aimed to quantitatively evaluate postural instability and investigate the relationship between postural instability and clinical characteristics in SCA3 patients. METHODS: Sixty-two SCA3 patients and 62 normal controls were recruited, and their postural balance was measured using a posturographic platform. Principal component analysis was performed as data reduction to identify postural instability factors. Multivariable linear regression was used to investigate potential risk factors for postural instability and to explore whether postural instability predicts the severity and progression of ataxia in SCA3 patients. RESULTS: We found SCA3 patients experience postural instability characterized by significant impairment in static and dynamic stability. The condition without visual feedback was the most sensitive measure in differentiating SCA3 from controls. Regression analyses revealed that ataxia severity predicted both static (P = 0.014) and dynamic stability (P = 0.001). Likewise, along with expanded CAG repeats (P < 0.001), both static (P < 0.001) and dynamic stability (P < 0.001) predicted ataxia severity, but not ataxia progression. INTERPRETATION: Our findings demonstrate the validity of using the Pro-kin system for assessing postural instability in SCA3 patients. This type of quantitative assessment of balance dysfunction can contribute to clinical trials and balance rehabilitation in SCA3 patients.

Potential of Mobile Technology to Relieve the Urgent Mental Health Needs in China: Web-Based Survey.

BACKGROUND: With the rapid development of information technology and mobile devices, an increasing number of mobile medical services and platforms have emerged. However, China's current mental health situation necessitates further discussion and research on how to provide more patient-centered services in the face of many challenges and opportunities. OBJECTIVE: This study aims to explore the attitudes and preferences of mental health service stakeholders regarding mobile mental health services and discuss the challenges and opportunities faced by mobile technology developers in China. METHODS: A web-based survey was conducted by following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist. A total of 586 valid questionnaires were collected. Respondents included 184 patients or their family members, 225 mental health professionals, and 177 people from the general population. Data analysis was completed using SPSS 24.0. RESULTS: Among the various problems perceived regarding the current mental health medical environment, difficulty in finding appropriate psychologists and limited visit times ranked highest. Social media (n=380/586, 64.9%) was the most preferred platform among all participants, whereas professionals showed a higher preference for smartphone apps (n=169/225, 75.1%). Professional instruction, psychological consultation, and mental health education (ranked top 3) were the most commonly identified needs. Mental health professionals generally emphasized more on treatment-related mobile mental health service needs, especially medication reminders (χ22=70.7; P<.001), symptom monitoring (χ22=24.0; P<.001), and access to mental health resources (χ22=38.6; P<.001). However, patients and their family members focused more on convenient web-based prescriptions (χ22=7.7; P=.02), with the general population interested in web-based psychological consultation (χ22=23.1; P<.001) and mental health knowledge (χ22=9.1; P=.01). Almost half of the participants regarded mobile mental health services as highly acceptable or supported their use, but less than 30% of participants thought mobile mental health services might be very helpful. Concerns about mobile mental health mainly focused on information security. Service receivers also suspected the quality and professionalism of content, and mental health professionals were worried about time and energy consumption as well as medical safety. CONCLUSIONS: In terms of service flow, mobile services could be used to expand service time and improve efficiency before and after diagnosis. More individualized mobile mental health service content in more acceptable forms should be developed to meet the various needs of different mental health stakeholders. Multidisciplinary training and communication could be incorporated to facilitate the integration and cooperation of more well-rounded service teams. A standard medical record system and data format would better promote the development of future intelligent medical care. Issues such as ensuring service quality, solving safety risks, and better integrating mobile services with regular medical workflows also need to be addressed.

Use of Blood Lipid Indicators as a Screening Tool of Insulin Resistance among Individuals in Low-Income Country Sides of China: A Multiethnic Region Study.

OBJECTIVE: This study is aimed at evaluating the diagnostic value of blood lipid indicators (BLIs) for insulin resistance (IR) among major ethnic groups in Xinjiang, China, to identify the most valuable indicators and appropriate cut-off points for each ethnic group and to lay the foundation for the early detection, diagnosis, and treatment of metabolic diseases in remote rural areas. METHODS: Overall, 418 Uygurs, 331 Kazakhs, and 220 Hans were randomly included in our study. The homeostasis model assessment was the gold standard for identifying IR. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value, and the nomogram was utilized to analyze the predictive value. The size of the area under the curve (AUC) reflected the accuracy of screening and prediction. RESULTS: Differences in races were observed in terms of IR and BLIs, and the Kazakhs had the highest IR level at 5.27 mmol/L. The correlation between IR and BLIs differed among the three races. For the Kazakhs and Hans, all BLIs, except total cholesterol (TC), were correlated to IR. However, for the Uygurs, only the triglyceride (TG) level, TG/high-density lipoprotein cholesterol (HDL-C) ratio, and TC/HDL-C ratio were associated with IR. After further adjustment of confounding factors, these indicators were still correlated to IR. BLIs that independently correlated to IR in the three nationalities had a certain diagnostic value for IR. In terms of the AUC size, the TG level was the highest in Uygurs, the TG/HDL-C ratio was the highest for Kazakhs and Hans, and the corresponding best cut-off points for IR were 1.515, 1.230, and 1.495 mmol/L, respectively. In addition, for each race, when the indicators with a certain diagnostic value were combined, the diagnostic value for IR was higher. CONCLUSION: BLIs had a certain diagnostic value for IR and could be used as a screening tool for IR among Uygurs, Kazakhs, and Hans in Xinjiang. These findings are extremely important for the prevention and treatment of IR and metabolic diseases in remote rural areas.

Visceral Adiposity and Anthropometric Indicators as Screening Tools of Metabolic Syndrome among Low Income Rural Adults in Xinjiang.

Most previous studies on metabolic syndrome (MetS) examined urban and high income settings. We thus investigated the prevalence of MetS among a multi-ethnic population living in a low income rural area and explored the use of visceral adiposity and anthropometric indicators to identify men and women with MetS. We recruited 10,029 individuals of nomadic Kazakhs, rural Uyghur and Han residents in Xinjiang, China. MetS was defined by the Joint Interim Statement criteria. The receiver operating characteristic curve (ROC) was used to compare the area under the ROC curve (AUC) of each index. The age-adjusted prevalence of MetS was 21.8%. The visceral adiposity index (VAI), lipid accumulation product (LAP), body adiposity index (BAI) and the waist-to-height ratio (WHtR) were significantly associated with MetS, independent of ethnic, age, and other covariates. The AUC of VAI, LAP and WHtR were all greater than 0.7, and the LAP was the index that most accurately identified MetS status in men (AUC = 0.853) and women (AUC = 0.817), with the optimal cut-offs of 34.7 and 27.3, respectively. In conclusion, the prevalence of MetS in low income rural adults of Xinjiang was high and the LAP was an effective indicator for the screening of MetS.

Seven-Point Subjective Global Assessment Is More Time Sensitive Than Conventional Subjective Global Assessment in Detecting Nutrition Changes.

BACKGROUND: It is important for nutrition intervention in malnourished patients to be guided by accurate evaluation and detection of small changes in the patient's nutrition status over time. However, the current Subjective Global Assessment (SGA) is not able to detect changes in a short period. The aim of the study was to determine whether the 7-point SGA is more time sensitive to nutrition changes than the conventional SGA. METHODS: In this prospective study, 67 adult inpatients assessed as malnourished using both the 7-point SGA and conventional SGA were recruited. Each patient received nutrition intervention and was followed up after discharge. Patients were reassessed using both tools at 1, 3, and 5 months from baseline assessment. RESULTS: It took significantly shorter time to see a 1-point change using the 7-point SGA compared with the conventional SGA (median: 1 month vs 3 months, P = .002). The likelihood of at least a 1-point change is 6.74 times greater in the 7-point SGA compared with the conventional SGA after controlling for age, sex, and medical specialties (odds ratio, 6.74; 95% confidence interval, 2.88-15.80; P < .001). Fifty-six percent of patients who had no change in SGA score had changes detected using the 7-point SGA. The level of agreement was 100% (κ = 1, P < .001) between the 7-point SGA and 3-point SGA and 83% (κ = 0.726, P < .001) between 2 blinded assessors for the 7-point SGA. CONCLUSION: The 7-point SGA is more time sensitive in its response to nutrition changes than the conventional SGA. It can be used to guide nutrition intervention for patients.

[Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography].

OBJECTIVE: To investigate the clinical value of FibroScan transient elastography for assessing portal hypertension in liver cirrhosis patients by determining the relationship between the liver or spleen stiffness measurement with the imaging parameters of esophageal varices, portal vein width, spleen volume, and splenic vein width. METHODS: A total of 259 patients with liver cirrhosis underwent FibroScan measurement, ultrasound, computed tomography and routine blood analyses. One-hundred-and-one of those patients also underwent endoscopy to diagnose esophageal varices. Receiver operating characteristic (ROC) curves were generated and the areas under the curves (AUCs) were calculated to assess the accuracy of the FibroScan liver and spleen stiffness measurements to predict esophageal varices. Pearson's correlation analysis was used to assess the relationship between clinical features. RESULTS: The median liver and spleen stiffness of the cirrhotic patients were 24.27 kPa and 44.64 kPa, respectively. Liver and spleen stiffness increased in conjunction with increases in Child-Pugh score. Liver stiffness was positively correlated with spleen stiffness (P less than 0.05). Liver and spleen stiffness were positively correlated with esophageal varices, portal vein width, spleen thickness, spleen volume, and splenic vein width. The correlation of spleen stiffness was higher than that of liver stiffness. Spleen stiffness was also negatively correlated with white blood cell count and platelet count. Liver and spleen stiffness also increased in conjunction with increased severity of esophageal varices. The AUC of spleen stiffness was higher than that of liver stiffness for predicting esophageal varices (0.804 vs. 0.737). The optimal cut-off level of spleen stiffness was 44.5 kPa (sensitivity: 88%; specificity: 68%). The estimated prevalence of esophageal varices was 97.87% and the optimized cut-off level of liver stiffness was 18.0 kPa. CONCLUSION: FibroScan appears to be a clinically valuable non-invasive method to assess portal hypertension in cirrhotic patients. Both liver and spleen stiffness measurements correlated with portal hypertension but the spleen stiffness measurement may be of higher clinical value.

Assessment effect of central venous pressure in fluid resuscitation in the patients with shock: a multi-center retrospective research.

BACKGROUND: Central venous pressure (CVP) and intrathoracic blood volume index (ITBVI) were used to assess the fluid status. It has previously been shown that CVP is not as accurate as ITBVI for all the shock patients. We therefore hypothesized that the change of CVP has the ability to predict fluid responsiveness in some clinical cases of shock. METHODS: From September 1st 2009 to September 1st 2011, sixty-three patients with shock from different Intensive Care Unit (ICU) were collected into this retrospective study. All the patients received fluid challenge strategy (infusing 300 ml hydroxyethyl starch in 20 minutes), were monitored with CVP and pulse-indicated continuous cardiac output (PICCO). The correlation between changes in cardiac index (ΔCI), CVP (ΔCVP) and ITBVI (ΔITBVI) were analyzed. Fluid responsiveness was defined as an increase in CI ≥ 10%. Receiver operating characteristic (ROC) curves were generated for ΔCVP and ΔITBVI. RESULTS: For all the patients, there was no correlation between ΔCI and ΔCVP (P = 0.073), but in the subgroup analysis, the correlation between ΔCI and ΔCVP was significant in those younger than 60 years old (P = 0.018) and those with hypovolemic shock (P = 0.001). The difference of areas under the ROC curves of ΔCVP and ΔITBVI were not statistically significant in the group younger than 60 years old or hypovolemic shock group (P > 0.05, respectively). However, no similar results can be found in the group older than 60 years old and the other two shock type groups from ROC curves of ΔCVP and ΔITBVI. CONCLUSIONS: ΔCVP is not suitable for evaluating the volume status of the shock patients with fluid resuscitation regardless of their condition. However, in some ways, ΔCVP have the ability to predict fluid responsiveness in the younger shock patients or in the hypovolemic shock patients.

[Resistance realized heritability and risk assessment of Panonychus citri to avermectin and fenpropathrin].

On the basis of resistance breeding and selection in laboratory, and by using the threshold trait analysis in quantitative genetics, this paper studied the realized resistance heritability of Panonychus citri (McGregor) collected from Beibei of Chongqing to avermectin and fenpropathrin, and predicted the resistance risk of P. citri to these two acaricides. After 11- and 16-generations of selection with avermectin and fenpropathrin, the resistance of P. citri to the two acaricides increased by 3.8- and 29.9-fold, and the realized resistance heritability was 0.0475 and 0.1544, respectively. Under laboratory condition, to develop a 10-fold increase of resistance required 12-26 generations of selection for avermectin, and 7-16 generations of selection for fenpropathrin under the selection pressure of 50%-90% mortality for each generation. Under field condition, it would require more generations to develop the same resistance level. Comparing with bioacaricide avermectin, pyrethroid fenpropathrin had obviously higher resistance risk to P. citri. The results provided references for the resistance management of P. citri to acaricides.

Population forecasting model of Nilaparvata lugens and Sogatella furcifera (Homoptera: Delphacidae) based on Markov chain theory.

Nilaparvata lugens (Stål) and Sogatella furcifera (Horváth) are the two most important long-distance migratory insect pests that cause great yield losses to rice in China. Accurate long-term population forecast is needed to implement effective management strategies for these two rice pests. In this paper, a transition probability matrix of 5-yr steps of Markov chain theory was constructed based on 31-yr light-trapping data of the two pests from 1977 to 2007 in Jiangkou County, Guizhou, China. The weight of each step for the transition probability matrix was calculated according to its prediction accuracy. Insect occurrence levels in the sixth year were predicted based on the occurrences of the previous 5 yr. Nonparametric Wilcoxon paired sample tests showed that there were no significant differences between the actual and predicted occurrences for both N. lugens and S. furcifera. In addition, the models accurately forecasted field occurrence in 2008 in Jinangkou County for both species. The results showed that the Markov models developed in this study offer an effective method for long-term population forecasting of N. lugens and S. furcifera and thus provide plant protection agencies and organizations with valuable information in implementing appropriate management strategies for these two devastating rice pests in Jiangkou and neighboring areas.