Recommended 10-Year Follow-Up Strategy for Small Hepatocellular Carcinoma After Radiofrequency Ablation: A Cost-Effectiveness Evaluation.

INTRODUCTION: An optimal follow-up schedule for small (≤3-cm) hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains unclear in clinical guidelines. We aimed to assess the cost-effectiveness of follow-up strategies in patients with small HCC after RFA. METHODS: In total, 11,243 patients were collected from global institutions to calculate recurrence rates. Subsequently, a Markov model covering a 10-year period was developed to compare 25 surveillance strategies involving different surveillance techniques (computed tomography [CT], magnetic resonance imaging or ultrasonography [US], and α-fetoprotein [AFP]) and intervals (3 or 6 months). The study endpoint was incremental cost-effectiveness ratio (ICER), which represented additional cost per incremental quality-adjusted life year. Sensitivity analysis was conducted by varying the values of input parameters to observe the ICER. RESULTS: In a base case analysis, the dominant strategy was CT every 3 months during an initial 2 years, followed by semiannual CT, and then switch to biannual the combination of US screening and AFP testing after 5 years (m3_CT-m6_CT-m6_USAFP), with an ICER of $68,570.92 compared with the "not followed" strategy. One-way sensitivity analysis showed the ICER consistently remained below the willingness-to-pay threshold of $100,000.00. In a probabilistic sensitivity analysis, m3_CT-m6_CT-m6_USAFP was the most cost-effective approach in 95.6% of simulated scenarios at a willingness-to-pay threshold. DISCUSSION: For small HCC after RFA, the recommended follow-up strategy is CT, with scans scheduled every 3 months for the first 2 years, every 6 months thereafter, and transition to biannual the combination of US screening and AFP testing after 5 years.

Monte Carlo study of X-ray grazing incidence microscopy using Geant4.

X-ray grazing incidence microscopy has extensive applications in the fields of laser inertial confinement fusion and synchrotron radiation. Monte Carlo methods can be used to determine the optical performance of X-ray grazing incidence microscopes and predict the experimental results, which is of great significance for studying physical experiments and diagnostics. In this paper, we proposed a Monte Carlo method based on Geant4 for studying X-ray grazing incidence microscopy. We introduced the G4MultilayerReflection class to describe the physical processes of X-ray multilayer mirrors. We designed a dual-energy Kirkpatrick-Baez microscope that can operate at 6.4 and 9.67 keV simultaneously. Monte Carlo simulations of the spatial resolution and throughput efficiency of the microscope were performed using Geant4, which was assembled and characterized. The spatial resolution results obtained by the Geant4 laboratory simulations, the theoretical model, and the experiments were in good agreement. Additionally, we conducted throughput efficiency calibration experiments for the 6.4 keV imaging channel. The difference between the experimental and Geant4-simulated throughput efficiency was evaluated and resulted in root mean square error values of 8.7% and 9.5% along the Y- and Z-axes, respectively.

Lactation Support as a Proxy Measure of Family-Centered Care Quality in Neonates with Life-Limiting Conditions-A Comparative Study.

BACKGROUND: Lactation support is an important measure of Family-Centered Care (FCC) in the Neonatal Intensive Care Unit (NICU). Life-limiting conditions (LLCs) raise complex ethical care issues for providers and parents in the NICU and represent a key and often overlooked population for whom FCC is particularly important. We investigated healthcare disparities in FCC lactation support quality in infants with LLCs. METHODS: A retrospective cohort of inborn infants with or without LLCs admitted to the NICU between 2015-2023 included 395 infants with 219 LLC infants and 176 matched non-LLC infants and were compared on LLC supports. RESULTS: The LLC cohort experienced greater skin-to-skin support, but less lactation specialist visits, breast pumps provided, and human milk oral care use. LLC infants also experienced less maternal visitation, use of donor milk (LLC: 15.5%, non-LLC: 33.5%), and breastfeeds (LLC: 24.2%, non-LLC: 43.2%), with lower mean human milk provision (LLC: 36.6%, non-LLC: 67.1%). LLC infants who survived to discharge had similar human milk use as non-LLC infants (LLC: 49.8%, non-LLC: 50.6%). CONCLUSION: Lactation support was significantly absent for families and infants who presented with LLCs in the NICU, suggesting that policies can be altered to increase lactation support FCC quality for this population.

Association of Medicaid expansion with 2-year survival and time to treatment initiation in gastrointestinal cancer patients: A National Cancer Database study.

INTRODUCTION: We evaluated whether Medicaid expansion (ME) was associated with improved 2-year survival and time to treatment initiation (TTI) among patients with gastrointestinal (GI) cancer. METHODS: GI cancer patients diagnosed 40-64 years were queried from the National Cancer Database. Those diagnosed from 2010 to 2012 were considered pre-expansion; those diagnosed from 2014 to 2016 were considered post-expansion. Cox models estimated hazard ratios and 95% confidence intervals (CIs) for 2-year overall survival. Generalized estimating equations (GEE) estimated odds ratios (OR) and 95% CI of TTI within 30- and 90 days. Multivariable Difference-in-Difference models were used to compare expansion/nonexpansion cohorts pre-/post-expansion, adjusting for patient, clinical, and hospital factors. RESULTS: 377,063 patients were included. No significant difference in 2-year survival was demonstrated across ME and non-ME states overall or in site-based subgroup analysis. In stage-based subgroup analysis, 2-year survival significantly improved among stage II cancer, with an 8% decreased hazard of death at 2 years (0.92; 0.87-0.97). Those with stage IV had a 4% increased hazard of death at 2 years (1.04; 1.01-1.07). Multivariable GEE models showed increased TTI within 30 days (1.12; 1.09-1.16) and 90 days (1.22; 1.17-1.27). Site-based subgroup analyses indicated increased likelihood of TTI within 30 and 90 days among colon, liver, pancreas, rectum, and stomach cancers, by 30 days for small intestinal cancer, and by 90 days for esophageal cancer. In subgroup analyses, all stages experienced improved odds of TTI within 30 and 90 days. CONCLUSION: ME was not associated with significant improvement in 2-year survival for those with GI cancer. Although TTI increased after ME for both cohorts, the 30- and 90-day odds of TTI was higher for those from ME compared with non-ME states. Our findings add to growing evidence of associations with ME for those diagnosed with GI cancer.

Using HIV Risk Self-Assessment Tools to Increase HIV Testing in Men Who Have Sex With Men in Beijing, China: App-Based Randomized Controlled Trial.

BACKGROUND: Men who have sex with men (MSM) in China hold a low-risk perception of acquiring HIV. This has resulted in an inadequate HIV testing rate. OBJECTIVE: This study aims to investigate whether administering HIV risk self-assessments with tailored feedback on a gay geosocial networking (GSN) app could improve HIV testing rates and reduce sexual risk behaviors in Chinese MSM. METHODS: We recruited MSM from Beijing, China, who used the GSN platform Blued in October 2017 in this 12-month double-blinded randomized controlled trial. From October 2017 to September 2018, eligible participants were randomly assigned to use a self-reported HIV risk assessment tool that provided tailored feedback according to transmission risk (group 1), access to the same HIV risk assessment without feedback (group 2), or government-recommended HIV education materials (control). All interventions were remotely delivered through the mobile phone-based app Blued, and participants were followed up at 1, 3, 6, and 12 months from baseline. The number of HIV tests over the 12-month study was the primary outcome and was assessed using an intention-to-treat analysis with an incident rate ratio (IRR). Unprotected anal intercourse (UAI) over 6 months was assessed by a modified intention-to-treat analysis and was the secondary outcome. All statistical analyses were conducted in SAS 9.3 (SAS Institute, Inc.), and a P value <.05 was considered statistically significant. RESULTS: In total, 9280 MSM were recruited from baseline and were randomly assigned to group 1 (n=3028), group 2 (n=3065), or controls (n=3187). After follow-up, 1034 (34.1%), 993 (32.4%), and 1103 (34.6%) remained in each group, respectively. Over 12 months, group 1 took 391 tests (mean of 2.51 tests per person), group 2 took 352 tests (mean of 2.01 tests per person), and controls took 295 tests (mean of 1.72 tests per person). Group 1 had significantly more HIV testing than the control group (IRR 1.32, 95% CI 1.09-4.58; P=.01), while group 2 did not differ significantly from the controls (IRR 1.06, 95% CI 0.86-1.30; P=.60). The proportion of UAI was not statistically different among different groups, but all 3 groups had UAI, which declined from baseline. CONCLUSIONS: Repeated HIV risk assessments coupled with tailored feedback through GSN apps improved HIV testing. Such interventions should be considered a simple way of improving HIV testing among MSM in China and increasing awareness of HIV status. TRIAL REGISTRATION: ClinicalTrials.gov NCT03320239; https://clinicaltrials.gov/study/NCT03320239.

Impact of hypromellose acetate succinate and Soluplus® on the performance of ß-carotene solid dispersions with the aid of sorbitan monolaurate: In vitro-in vivo comparative assessment.

Solid dispersions (SDs) possess the potential to enhance the bioavailability of insoluble active pharmaceutical ingredients (APIs) by effectively converting them into amorphous state. However, SDs have a tendency to recrystallize unless appropriate excipients are employed. The objective of this study was to evaluate the ability of hypromellose acetate succinate HF (HPMCAS-HF) and Soluplus® to inhibit the recrystallization of ß-carotene and improve its in vivo bioavailability through the fabrication of ternary ß-carotene solid dispersions (SDs) with the aid of specific surfactant. Due to rapid micellization, the dissolution profiles of ß-carotene SDs based on HPMCAS-HF/Span 20 (5:5, w/w) or Soluplus®/Span 20 (6:4, w/w) combinations exhibited significant improvement, which were almost 7-10 times higher than ß-carotene bulk powder. DSC and PXRD analysis indicated a notable reduction in the crystallinity degree of ß-carotene within the SDs. The stability study demonstrated a half-life of ß-carotene in the SDs exceeding 30 days. Additionally, the in vivo pharmacokinetics analysis confirmed that the cellulose derivatives/surfactant combinations significantly enhanced the bioavailability of ß-carotene by 1.37-fold and 2.3-fold, respectively. Notably, the HPMCAS-HF/Span 20 combination exhibited superior performance. Consequently, the HPMCAS-HF/Span 20 combination held potential for the advancement of an effective drug delivery system for ß-carotene.

Values of different biochemical indices and clinical scoring systems for the assessment of acute biliary pancreatitis in a Chinese population.

OBJECTIVE: To investigate values of biochemical indices and clinical scoring systems for the assessment of acute biliary pancreatitis (ABP). METHODS: Clinical characteristics, laboratory values including procalcitonin (PCT), and radiologic examinations of all ABP patients with mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), or severe acute pancreatitis (SAP) were recorded within 48 hours after the onset of acute pancreatitis. Scores of the Accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Bedside Index of Severity in Acute Pancreatitis (BISAP), Computed Tomography Severity Index (CTSI), Ranson, Japanese Severity Score (JSS), Pancreatitis Outcome Prediction (POP) Score and Systemic Inflammatory Response Syndrome (SIRS) score were then calculated. The area under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve was used to analyze the predictive values of biochemical indexes and scoring systems for ABP severity and organ failure. RESULTS: The percentage of patients over 60 in the SAP group was higher than in the MAP and MSAP groups. PCT had the highest value for predicting SAP (AUC = 0.84, P < 0.001) and organ failure (AUC = 0.87, P < 0.001). The AUCs of APACHE II, BISAP, JSS and SIRS for predicting severity were 0.87, 0.83, 0.82, and 0.81, respectively (all P < 0.001). As for organ failure, the AUCs were 0.87, 0.85, 0.84, and 0.82, respectively (all P < 0.001). CONCLUSIONS: PCT has a high value for predicting ABP severity and organ failure. Among the clinical scoring systems, BISAP and SIRS are more suitable for early assessment of AP; while APACHE II and JSS are more suitable for monitoring disease progression after thorough examination.

Learning Performance of Weighted Distributed Learning With Support Vector Machines.

The divide-and-conquer strategy is a very effective method of dealing with big data. Noisy samples in big data usually have a great impact on algorithmic performance. In this article, we introduce Markov sampling and different weights for distributed learning with the classical support vector machine (cSVM). We first estimate the generalization error of weighted distributed cSVM algorithm with uniformly ergodic Markov chain (u.e.M.c.) samples and obtain its optimal convergence rate. As applications, we obtain the generalization bounds of weighted distributed cSVM with strong mixing observations and independent and identically distributed (i.i.d.) samples, respectively. We also propose a novel weighted distributed cSVM based on Markov sampling (DM-cSVM). The numerical studies of benchmark datasets show that the DM-cSVM algorithm not only has better performance but also has less total time of sampling and training compared to other distributed algorithms.

Spatiotemporal Differentiation of the Coupling and Coordination of Production-Living-Ecology Functions in Hubei Province Based on the Global Entropy Value Method.

Rapid urbanization and industrialization have brought about regional prosperity and pressure on the ecological environment, and the disorder of development has led to competition among the production-living-ecology functions. How to build livable cities, optimize the spatial layout of land, and promote the coordinated development of the production-living-ecology functions in various regions has become an important issue in the sustainable development and utilization of land space. In order to study the spatiotemporal conflict and coordination of the production-living-ecology functions with respect to the dramatic developments associated with the 21st century, this study took Hubei Province, which is the top-ranking economic region in China in recent years, as the study area and adopted the global entropy value method, triangle model, and coupled evaluation model to delineate an index system to measure the degree of conflict and coordination of the production-living-ecology functions in Hubei Province from 2000 to 2020, and also delineate zoning management based on statistical yearbook data. The results showed the following: (1) With respect to the time scale, the indices of the production-living-ecology functions in Hubei Province increased year by year, and the degree of coordination also increased yearly, from the stage of disorder with certain conflict to the stage of coordination with a high level of coupling. (2) On the spatial scale, the development of production-living-ecology functions in Hubei Province was unbalanced, which may be related to the overall development strategy of "two circles and one belt" in Hubei Province, with the eastern part of the province having a higher degree of coordination of the production-living-ecology functions and the western part having a lower degree of coordination. (3) Among the production-living-ecology functions, the ecological function of Hubei Province as a whole exhibited minimal change and maintained stable development, while the living and production functions underwent considerable development, indicating that Hubei Province has protected the orderly development of the ecological environment in the process of urbanization and new industrialization. (4) According to the development and coordination of the production-living-ecology functions in each region of Hubei Province, four development management zones were created: high-quality development zone, secondary development zone, balanced development zone, and development potential zone. Finally, policy suggestions are given for each zone.

Spatiotemporal Characteristics, Decoupling Effect and Driving Factors of Carbon Emission from Cultivated Land Utilization in Hubei Province.

The carbon emission level and spatiotemporal characteristics in Hubei Province were estimated and studied using the Intergovernmental Panel on Climate Change (IPCC) carbon emission coefficient technique based on county data from Hubei Province from 2000 to 2020. The relationship between carbon emissions from cultivated land utilization and agricultural economic growth was examined using the Tapio decoupling index, and the factors influencing carbon emissions in Hubei Province were further examined using the Logarithmic Mean Divisia Index (LMDI model). The results demonstrate that: (1) Spatiotemporal variations in carbon emissions are evident. In terms of time, the volume of carbon emissions in Hubei Province is still substantial, and the transition to low-carbon land use is quite gradual. Geographically, the high-value region of the middle east coexists with the low-value zone of the west, with apparent regional contrasts. (2) The decoupling between carbon emissions and agricultural economic growth is becoming more and more obvious in Hubei Province. The number of counties and cities in a negative decoupling state has significantly decreased, and the majority of counties are now in a strong decoupling condition. (3) Agricultural production efficiency is the most significant driving factor for restricting carbon emission, according to the decomposition results of carbon emission driving factors based on the LMDI model. In addition, the results of sample decomposition based on topographic characteristics indicate that agricultural production efficiency is primarily responsible for the suppression of carbon emissions in flat regions. The increase in carbon emissions in hilly regions is primarily influenced by agricultural productivity. The increase in carbon emissions in mountainous regions is mostly influenced by agricultural labor intensity. This study's finding has enlightening implications for the high-quality growth of agriculture.

Spatiotemporal Differentiation and Balance Pattern of Ecosystem Service Supply and Demand in the Yangtze River Economic Belt.

Analyzing the supply and demand of ecosystem services and the regional balance pattern is an important basis for improving the ecological management level. Taking the Yangtze River economic belt as the study area, the spatiotemporal characteristics and balance pattern of ecosystem service supply and demand are quantitatively revealed based on equivalent factors, supply and demand balance modeling and quantile regression. The results show that: (1) the ecosystem services value in the research area experienced a change process of "increase-decrease-increase" from 2000 to 2020. The ecological service value of cultivated land and grassland presented a continuous decline, with decreases of 20.446 billion and 4.53 billion yuan, respectively, in the past 20 years, with reduction rates of -4.82% and -3.98%, respectively. (2) The demand for ecosystem services showed an unbalanced and phased growth trend. The total demand for ecosystem services showed heterogeneity and agglomeration effects in space. High demand and higher demand areas are mainly distributed in the regions with relatively developed population and economy, including Yangtze River Delta urban agglomeration, "Changsha-Zhuzhou-Xiangtan" urban agglomeration, Poyang Lake Plain, Jianghan Plain and Chengdu Plain. (3) The overall pattern of the supply-demand balance of ecosystem services has changed little; however, there have also been significant changes in certain areas in individual years.

Quantitative Risk Assessment of Vibrio parahaemolyticus in Shellfish from Retail to Consumption in Coastal Cities of Eastern China.

ABSTRACT: Vibrio parahaemolyticus is the main foodborne pathogen worldwide that causes acute gastroenteritis. A quantitative microbiological risk assessment (QMRA) was conducted to evaluate the health risk associated with V. parahaemolyticus in shellfish in the coastal cities in the eastern part of the People's Republic of China. The QMRA framework was established from shellfish at retail to cooking at home to consumption. The prevalence and level of V. parahaemolyticus in shellfish, cooking methods, storage temperature, time after purchase, shellfish consumption frequency, and consumption amount were analyzed in the exposure assessment. The results of the exposure assessment were introduced into the beta-Poisson dose-response model, and Monte Carlo analysis was used to calculate the risk of gastroenteritis from shellfish consumption. The probability of illness caused by V. parahaemolyticus from shellfish consumption per person per year (Pill,yr) was 3.49E-05. Seasonal differences were noted in the Pill/meal; the maximum was 4.81E-06 in summer and the minimum was 2.27E-07 in winter. The sensitivity analysis revealed that the level of V. parahaemolyticus in shellfish and the amount of shellfish consumed per meal were main factors contributing to illness. This QMRA provided valuable information such as the probability of illness associated with the consumption of shellfish and reference points for prevention strategies and control standards of V. parahaemolyticus in shellfish.

Damage Diagnosis of Single-Layer Latticed Shell Based on Temperature-Induced Strain under Bayesian Framework.

Under the framework of Bayesian theory, a probabilistic method for damage diagnosis of latticed shell structures based on temperature-induced strain is proposed. First, a new damage diagnosis index is proposed based on the correlation between temperature-induced strain and structural parameters. Then, Markov Chain Monte Carlo is adopted to analyze the newly proposed diagnosis index, based on which the frequency distribution histogram for the posterior probability of the diagnosis index is obtained. Finally, the confidence interval of the damage diagnosis is determined by the posterior distribution of the initial state (baseline condition). The damage probability of the unknown state is also calculated. The proposed method was validated by applying it to a latticed shell structure with finite element developed, where the rod damage and bearing failure were diagnosed based on importance analysis and temperature sensitivity analysis of the rod. The analysis results show that the proposed method can successfully consider uncertainties in the strain response monitoring process and effectively diagnose the failure of important rods in radial and annular directions, as well as horizontal (x- and y-direction) bearings of the latticed shell structure.

Comprehensive Risk Assessment of High Temperature Disaster to Kiwifruit in Shaanxi Province, China.

In recent years, the main kiwifruit producing region, central-south Shaanxi Province, has often suffered from the threat of extreme high temperatures. Assessing the risk of high-temperature disasters in the region is essential for the rational planning of agricultural production and the development of resilience measures. In this study, a database was established to assess the risk of a high-temperature disaster to kiwifruit. Then, four aspects, hazard, vulnerability, exposure and disaster prevention and mitigation capacity, were taken into account and 19 indexes were selected to make an assessment of the risk of a high-temperature disaster. At the same time, 16 indexes were selected for the assessment of the climatic suitability of kiwifruit in terms of light, heat, water, soil and topography, and were used as one of the indexes for exposure assessment. The analytic hierarchy process and the entropy weighting method were combined to solve the weights for each index. The results reveal that: (1) The Guanzhong Plain has a high climatic suitability for kiwifruit, accounting for 15.14% of the study area. (2) The central part of the study area and southern Shaanxi are at high risk, accounting for 22.7% of the study area. The major kiwifruit producing areas in Shaanxi Province (e.g., Baoji) are at a low risk level, which is conducive to the development of the kiwifruit industry. Our study is the first to provide a comprehensive assessment of the risk of a high-temperature disaster to the economic fruit kiwifruit, providing a reference for disaster resilience and mitigation.

Influenza colloidal gold method and blood routine tests combination for rapid diagnosis of influenza: a decision tree-based analysis.

Rapid influenza diagnosis can facilitate targeted treatment and reduce antibiotic misuse. However, diagnosis efficacy remains unclear. This study examined the efficacy of a colloidal gold rapid test for rapid influenza diagnosis. Clinical characteristics of 520 patients with influenza-like illness presenting at a fever outpatient clinic during two influenza seasons (2017-2018; 2018-2019) were evaluated. The clinical manifestations and results of routine blood, colloidal gold, and nucleic acid tests were used to construct a decision tree with three layers, nine nodes, and five terminal nodes. The combined positive predictive value of a positive colloidal gold test result and monocyte level within 10.95-12.55% was 88.2%. The combined negative predictive value of a negative colloidal gold test result and white blood cell count > 9.075 × 109/L was 84.9%. The decision-tree model showed the satisfactory accuracy of an early influenza diagnosis based on colloidal gold and routine blood test results.

Preliminary Quantitative Risk Assessment of Norovirus in Shellfish in the Yellow Sea and Bohai Sea of China.

Norovirus (NoV) is a main foodborne pathogen of acute gastroenteritis in the world. A preliminary quantitative risk assessment (QRA) was conducted to evaluate the health risk caused by this virus in shellfish in the Yellow Sea and Bohai Sea of China. The QRA framework was established from the process of shellfish at retail through cooking at home to consumer consumption. The prevalence and quantity of NoVs in shellfish, cooking methods, internal temperature and time of shellfish in different cooking conditions, shellfish consumption frequency, and consumption amount were analyzed in the exposure assessment. The results of exposure assessment were introduced into the beta-Poisson dose-response model, and Monte Carlo analysis was used to calculate the risk of gastroenteritis caused by shellfish consumption in the cities around the Yellow Sea and Bohai Sea of China. The results showed that the probability of illness caused by NoVs due to shellfish consumption per year (Pill,yr) was 1.86 × 10-5. It was estimated that the annual number of patients with gastroenteritis per 1,000,000 general population (Nexp,mil) was 0.10, 1.23, 16.90, and 0.38 for population aged 0-4, 5-18, 19-64, and >65 years, respectively. This assessment provides valuable information such as the probability of illness associated with the consumption of shellfish and it also provides a reference for further in-depth QRA of NoVs in shellfish or other foods.

Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China.

BACKGROUND: The distribution of health-care resources is foundational to achieving fairness and having access to health service. China and its local Shanghai's government have implemented measures to allocate health-care resources with the equity as one of the major goals since 2009-health-care reform. The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years. METHODS: The study was conducted using 2010-2016 data to analyze health-resource allocation on institutions, beds, and workforce in Shanghai, China. The annual growth rate (AGR) was used to evaluate the time trends of health-care resource from 2010 to 2016, and Theil index was calculated to measure inequality of five indicators of health-care resource allocation during this study period. RESULTS: All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator. The Theil of the indicators, except for doctors in hospitals, all exhibited downward time trends. CONCLUSIONS: Regional difference between urban and rural areas and inequality between institution and workforce, especially for doctors, still existed. Some targeted measures including but not limited to income raising, facilitation of transportation conditions, investment of more fiscal funds, enhancement of health-care service provision for rural residents should be fully considered to narrow resource distribution gap between urban and rural districts and mitigate the inequality of health-care resource allocation.

[Remote Sensing Classification of Urban Black-odor Water Based on Decision Tree].

Remote sensing monitoring of black-odor water is an important method for understanding the current status of urban water quality, and comprehensively evaluating the effect of urban water environment treatment. A total of 171 samples were collected in Nanjing, Changzhou, Wuxi, and Yangzhou cities and water quality parameters and optical parameters were measured simultaneously. Based on the analysis of the water color and optical characteristics of the black-odor water and non-black-odor water (denoted as general water), a decision tree was constructed to identify the severe, mild black-odor water, and general water as green and yellow water. The results found that:①According to the water color, the water bodies can be divided into six types. Among them, type 1 to 4 water bodies are black-odor water, which are gray black, dark gray, gray, and light gray water, respectively, and type 5 and 6 water bodies are general water, which are green and yellow water, respectively; ②Type 1 water body contains high contents of non-pigmented particulate matter and colored dissolved organic matter(CDOM), however, the absorption of pigmented particulate matter is not dominant. Type 2 and 5 water bodies are dominated by pigmented particulate matter. Type 3, 4, and 6 water bodies are dominated by non-pigmented particulate matter; ③After water color classification, and according to the differences of the reflection spectrums of the six types of water bodies, the difference of black-odorous water index (DBWI), green-red-nir area water index (G-R-NIR AWI), the green band reflectance and the normalized difference black-odorous water index (NDBWI) were used to construct a decision tree to identify the severe, mild black-odor water, and general water; ④The decision tree was applied to the PlanetScope satellite image of Yangzhou City on April 9, 2019, and 10 synchronous sampling points were used for verification. The overall recognition accuracy reached 80.00%, and the K value reached 0.67. The urban water classification model, after water color classification, can be applied to other similar water bodies, and provides a technical method for the supervision of black-odor water bodies.

SVM-Boosting based on Markov resampling: Theory and algorithm.

In this article we introduce the idea of Markov resampling for Boosting methods. We first prove that Boosting algorithm with general convex loss function based on uniformly ergodic Markov chain (u.e.M.c.) examples is consistent and establish its fast convergence rate. We apply Boosting algorithm based on Markov resampling to Support Vector Machine (SVM), and introduce two new resampling-based Boosting algorithms: SVM-Boosting based on Markov resampling (SVM-BM) and improved SVM-Boosting based on Markov resampling (ISVM-BM). In contrast with SVM-BM, ISVM-BM uses the support vectors to calculate the weights of base classifiers. The numerical studies based on benchmark datasets show that the proposed two resampling-based SVM Boosting algorithms for linear base classifiers have smaller misclassification rates, less total time of sampling and training compared to three classical AdaBoost algorithms: Gentle AdaBoost, Real AdaBoost, Modest AdaBoost. In addition, we compare the proposed SVM-BM algorithm with the widely used and efficient gradient Boosting algorithm-XGBoost (eXtreme Gradient Boosting), SVM-AdaBoost and present some useful discussions on the technical parameters.

Usefulness of three-dimensional printing of superior mesenteric vessels in right hemicolon cancer surgery.

The anatomy of the superior mesenteric vessels is complex, yet important, for right-sided colorectal surgery. The usefulness of three-dimensional (3D) printing of these vessels in right hemicolon cancer surgery has rarely been reported. In this prospective clinical study, 61 patients who received laparoscopic surgery for right hemicolon cancer were preoperatively randomized into 3 groups: 3D-printing (20 patients), 3D-image (19 patients), and control (22 patients) groups. Surgery duration, bleeding volume, and number of lymph node dissections were designed to be the primary end points, whereas postoperative complications, post-operative flatus recovery time, duration of hospitalization, patient satisfaction, and medical expenses were designed to be secondary end points. To reduce the influence of including different surgeons in the study, the surgical team was divided into 2 groups based on surgical experience. The duration of surgery for the 3D-printing and 3D-image groups was significantly reduced (138.4 ± 19.5 and 154.7 ± 25.9 min vs. 177.6 ± 24.4 min, P = 0.000 and P = 0.006), while the number of lymph node dissections for the these 2 groups was significantly increased (19.1 ± 3.8 and 17.6 ± 3.9 vs. 15.8 ± 3.0, P = 0.001 and P = 0.024) compared to the control group. Meanwhile, the bleeding volume for the 3D-printing group was significantly reduced compared to the control group (75.8 ± 30.4 mL vs. 120.9 ± 39.1 mL, P = 0.000). Moreover, patients in the 3D-printing group reported increased satisfaction in terms of effective communication compared to those in the 3D-image and control groups. Medical expenses decreased by 6.74% after the use of 3D-printing technology. Our results show that 3D-printing technology could reduce the duration of surgery and total bleeding volume and increase the number of lymph node dissections. 3D-printing technology may be more helpful for novice surgeons.Trial registration: Chinese Clinical Trial Registry, ChiCTR1800017161. Registered on 15 July 2018.