Predicting nodal metastasis progression of oral tongue cancer using a hidden Markov model in MRI.

Objectives: The presence of occult nodal metastases in patients with oral tongue squamous cell carcinomas (OTSCCs) has implications for treatment. More than 30% of patients will have occult nodal metastases, yet a considerable number of patients undergo unnecessary invasive neck dissection to confirm nodal status. In this work, we propose a probabilistic model for lymphatic metastatic spread that can quantify the risk of microscopic involvement at the lymph node level (LNL) given the location of macroscopic metastases and the tumor stage using the MRI method. Materials and methods: A total of 108 patients of OTSCCs were included in the study. A hidden Markov model (HMM) was used to compute the probabilities of transitions between states over time based on MRI. Learning of the transition probabilities was performed via Markov chain Monte Carlo sampling and was based on a dataset of OTSCC patients for whom involvement of individual LNLs was reported. Results: Our model found that the most common involvement was that of level I and level II, corresponding to a high probability of 𝑝b1 = 0.39 ± 0.05, 𝑝b2 = 0.53 ± 0.09; lymph node level I had metastasis, and the probability of metastasis in lymph node II was high (93.79%); lymph node level II had metastasis, and the probability of metastasis in lymph node III was small (7.88%). Lymph nodes progress faster in the early stage and slower in the late stage. Conclusion: An HMM can produce an algorithm that is able to predict nodal metastasis evolution in patients with OTSCCs by analyzing the macroscopic metastases observed in the upstream levels, and tumor category.

Spatio-temporal evolution of sports tourism industry integration: A empirical analysis of Xinjiang in China.

Since the issuance of the "Guiding Opinions on Vigorously Developing Sports Tourism" in 2016, the integration of sports and tourism has become a strategy in regional economic development. It creates new economic growth points, enhances local images, and promotes cultural communication. In the context of the "Tourism Makes Xinjiang Thrive" strategy, quantitatively investigating the integration of the sports and tourism industries helps people to better understand their interaction which can serve as the valuable input in policy-making for the comprehensive development of a region. This paper uses entropy weight method, stochastic frontier analysis and coupling coordination model to quantitatively analyze the effect of sports tourism industry integration in Xinjiang from the perspective of integration path. Meanwhile, the Dagum Gini coefficient and nuclear density estimation were used to analyze the regional differences and dynamic evolution of industrial integration quality. The result shows that (1) The sports and tourism integration quality in Xinjiang has not reached the optimal goal of complete integration. In the process of mutual industrial promotion, tourism promotes a higher degree of integration with the sports industry. (2) The industrial integration quality shows a phenomenon of "imbalance and inadequacy" among the regions. The regions with high quality of industrial integration were Urumqi, Ili, Kashgar, Altay and Changji, which have rich sports tourism resources. (3) The overall spatial difference in the quality of industrial integration presented a fluctuation downtrend. The difference between the tourism industrial belts was very significant.

Exploring the interwoven relationship: Property rights, financial freedom, government regulation, and stock market fluctuations in emerging economies - A novel system GMM perspective.

This study delves into the impact of formal institutions on stock market volatility within a selection of emerging economies. Specifically, it examines the role that formal institutions play in shaping this volatility. To accomplish our goal, we analyze panel data from 46 emerging nations spanning the years 2000-2019, utilizing system generalized method of moments (GMM), as well as random and fixed effect models for our estimations. The findings of this research validate the existence of a significant association between formal institutions and stock market volatility. Likewise, through dynamic panel estimation, we discover that formal institutions such as property rights, financial freedom, and government regulations have a notable negative effect on stock market volatility. Consequently, this study implies that formal institutions play a crucial role in reducing stock market volatility in emerging economies, fostering their development. The insights gained from this research encourage policymakers to view formal institutions as key influencers of stock market volatility. These results offer valuable guidance for emerging nations.

Exploring the relationship between malnutrition and the systemic immune-inflammation index in older inpatients: a study based on comprehensive geriatric assessment.

BACKGROUND: Malnutrition is a prevalent and major challenge among senior citizens, possibly due to the continual low-grade inflammatory state of the body. A novel inflammatory parameter, the systemic immune-inflammation index (SII), is highly valuable in evaluating and predicting the prognosis of a wide range of diseases. This study aims to explore the significance of the SII in assessing malnutrition in older inpatients. METHODS: This retrospective study included 500 senior hospitalized patients who met the inclusion and exclusion criteria from the Comprehensive Geriatric Assessment database of the First Hospital of Jilin University. The Mini-Nutritional Assessment (MNA) questionnaire was used to evaluate the nutritional status of patients. The SII was calculated using complete blood counts, and we performed natural logarithm transformation of the SII [ln(SII)]. Multivariable logistic regression analysis was used to identify the association between ln(SII) and malnutrition. To ensure the stability of the findings, a sensitivity analysis was conducted. RESULTS: The 500 patients had a mean age of 77.29 ± 9.85 years, and 68.6% were male. In accordance with the MNA, 30.4% of the patients were malnourished or at risk of malnutrition, and patients in this group had considerably greater levels of ln(SII) than patients with adequate nutrition (P < 0.001). The optimum ln(SII) cutoff value for patients with malnutrition or at risk of malnutrition was 6.46 (SII = 635.87) with 46.7% sensitivity and 80.2% specificity [95% CI: 0.613-0.721, AUC: 0.667, P < 0.001]. Multivariable logistic regression demonstrated that ln(SII) was an independent risk factor for the risk of malnutrition or malnutrition in older individuals (OR 3.984, 95% CI: 2.426-6.543, P < 0.001). Other metrics from the geriatric comprehensive assessment, including body mass index, calf circumference, fat ratio, activities of daily living and instrumental activities of daily living, and geriatric depression scale scores, were also independently correlated with nutritional status. CONCLUSIONS: According to our research, a high SII is an independent predictor of older inpatient malnutrition, and the SII aids in screening for malnutrition and may be a potential target for intervention. Comprehensive geriatric assessment parameters such as BMI, calf circumference, fat ratio, activities of daily living and depression were also linked to malnutrition.

Adaptability of water resources development and utilization to social-economy system in Hunan province, China.

The interplay of water resources with social-economy spheres involves a reciprocal feedback mechanism. With the acceleration of the construction process of modernized water networks in Hunan Province, investigating the adaptation status of the "Water-Social-Economy " composite system (WSE) is crucial for promoting sustainability. This study clarifies the connotation of the adaptability of WSE, and the quantitative analyses were conducted through coupling coordinative degree, harmonious development capacity, and the evolution of development lag types among the 14 cities of Hunan Province from 2005 to 2020. The results show that: (1) The development index of the water resources subsystem (WRS) showed a "downward-fluctuation-upward" trend, while the development index of the social-economy subsystem (SES) showed signs of great improvement, the former didn't catch up with the latter. (2) The coupling coordination degree of WSE developed well, and reached the coordinative development stage by 2020, but the unbalanced spatial pattern between north to south and east to west still exists and is further intensified. (3) The development ability of WSE improved while the harmony ability reduced, and the development rate of WRS and SES hasn't achieved dynamic synchronization. Finally, the policies and suggestions to improve the adaptability are put forward, which is of instructive significance for the sustainable development of water suitability.

How construction and demolition waste management has addressed sustainable development goals: Exploring academic and industrial trends.

With the rapid growth of the construction industry and urbanization, the construction and demolition waste (CDW) has constituted the most major solid waste flow in the world. The unsustainable management of CDW causes serious societal and environmental issues, as well as leads to resource waste, which directly and indirectly impact on United Nations' Sustainable Development Goals (SDGs). Due to the awareness of the destructive effect by CDW, the academic and industry have devoted to offer a sustainable pathway for CDWM, which characterizes minimizing carbon footprints as well as proposing circular approaches. In this context, CDW can be reused, recycled and recovery as a value resource. Therefore, this study proposed a unique research method that combines qualitative and quantitative approaches in the form of bigdata analysis and machine learning, which aims to explore the CDWM related knowledge and innovation from academic and industrial perspective respectively. Especially, what is different trends in CDWM-related of academia and industry between pre- and post-SDGs declaration era(s)? What aspects of SDGs have been addressed by academia and industry in pre- and post-SDGs declaration era(s)? The study witnessed that a 350% increase in the growth of academic literature and a 278% increase in the growth in industrial patents compared to pre-SDGs declaration period. In the academia, the emerging topics of research has shifted to management, circular economy, life cycle assessment, and ETC. Similarly, patent citation illustrated that the attention of stakeholders on CDWM in the construction industry has shifted from a linear point to a circular view. Moreover, the result showed that SDG6 (Clean Water and Sanitation), SDG12 (Responsible Consumption and Production) and SDG11 (Sustainable Cities and Communities) have noted as most seriously addressed concerns by academia and industry.

Assessment of Autologous Blood marker localIzation and intraoperative coLonoscopy localIzation in laparoscopic colorecTal cancer surgery (ABILITY): a randomized controlled trial.

BACKGROUND: Laparoscopic colorectal surgery has been proved to have similar oncological outcomes with open surgery. Due to the lack of tactile perception, surgeons may have misjudgments in laparoscopic colorectal surgery. Therefore, the accurate localization of a tumor before surgery is important, especially in the early stages of cancer. Autologous blood was thought a feasible and safe tattooing agent for preoperative endoscopic localization but its benefits remain controversial. We therefore proposed this randomized trial to the accuracy and safety of autogenous blood localization in small, serosa-negative lesion which will be resected by laparoscopic colectomy. METHODS: The current study is a single-center, open-label, non-inferiority, randomized controlled trial. Eligible participants would be aged 18-80 years and diagnosed with large lateral spreading tumors that could not be treated endoscopically, malignant polyps treated endoscopically that required additional colorectal resection, and serosa-negative malignant colorectal tumors (≤ cT3). A total of 220 patients would be randomly assigned (1:1) to autologous blood group or intraoperative colonoscopy group. The primary outcome is the localization accuracy. The secondary endpoint is adverse events related to endoscopic tattooing. DISCUSSION: This trial will investigate whether autologous blood marker achieves similar localization accuracy and safety in laparoscopic colorectal surgery compared to intraoperative colonoscopy. If our research hypothesis is statistically proved, the rational introduction of autologous blood tattooing in preoperative colonoscopy can help improve identification of the location of tumors for laparoscopic colorectal cancer surgery, performing an optimal resection, and minimizing unnecessary resections of normal tissues, thereby improving the patient's quality of life. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, NCT05597384. Registered 28 October 2022.

Prospective assessment of pancreatic ductal adenocarcinoma diagnosis from endoscopic ultrasonography images with the assistance of deep learning.

BACKGROUND: Endosonographers are highly dependent on the diagnosis of pancreatic ductal adenocarcinoma (PDAC). The objectives of this study were to develop a deep-learning radiomics (DLR) model based on endoscopic ultrasonography (EUS) images for identifying PDAC and to explore its true clinical benefit. METHODS: A retrospective data set of EUS images that included PDAC and benign lesions was used as a training cohort (N = 368 patients) to develop the DLR model, and a prospective data set was used as a test cohort (N = 123 patients) to validate the effectiveness of the DLR model. In addition, seven endosonographers performed two rounds of reader studies on the test cohort with or without DLR assistance to further assess the clinical applicability and true benefits of the DLR model. RESULTS: In the prospective test cohort, DLR exhibited an area under the receiver operating characteristic curves of 0.936 (95% confidence interval [CI], 0.889-0.976) with a sensitivity of 0.831 (95% CI, 0.746-0.913) and 0.904 (95% CI, 0.820-0.980), respectively. With DLR assistance, the overall diagnostic performance of the seven endosonographers improved: one endosonographer achieved a significant expansion of specificity (p = .035,) and another achieved a significant increase in sensitivity (p = .038). In the junior endosonographer group, the diagnostic performance with the help of the DLR was higher than or comparable to that of the senior endosonographer group without DLR assistance. CONCLUSIONS: A prospective test cohort validated that the DLR model based on EUS images effectively identified PDAC. With the assistance of this model, the gap between endosonographers at different levels of experience narrowed, and the accuracy of endosonographers expanded.

Treatment plan prescreening for patient-specific quality assurance measurements using independent Monte Carlo dose calculations.

Purpose: This study proposes a method to identify plans that failed patient-specific quality assurance (QA) and attempts to establish a criterion to prescreen treatment plans for patient-specific QA measurements with independent Monte Carlo dose calculations. Materials and methods: Patient-specific QA results measured with an ArcCHECK diode array of 207 patients (head and neck: 25; thorax: 61; abdomen: 121) were retrospectively analyzed. All patients were treated with the volumetric modulated arc therapy (VMAT) technique and plans were optimized with a Pinnacle v16.2 treatment planning system using an analytical algorithm-based dose engine. Afterwards, phantom verification plans were designed and recalculated by an independent GPU-accelerated Monte Carlo (MC) dose engine, ArcherQA. Moreover, sensitivity and specificity analyzes of gamma passing rates between measurements and MC calculations were carried out to show the ability of MC to monitor failing plans (ArcCHECK 3%/3 mm,<90%), and attempt to determine the appropriate threshold and gamma passing rate criterion utilized by ArcherQA to prescreen treatment plans for ArcCHECK measurements. The receiver operator characteristic (ROC) curve was also utilized to characterize the performance of different gamma passing rate criterion used by ArcherQA. Results: The thresholds for 100% sensitivity to detect plans that failed patient-specific QA by independent calculation were 97.0%, 95.4%, and 91.0% for criterion 3%/3 mm, 3%/2 mm, and 2%/2 mm, respectively, which corresponded to specificities of 0.720, 0.528, and 0.585, respectively. It was shown that the 3%/3 mm criterion with 97% threshold for ArcherQA demonstrated perfect sensitivity and the highest specificity compared with other criteria, which may be suitable for prescreening treatment plans treated with the investigated machine to implement measurement-based patient-specific QA of patient plans. In addition, the area under the curve (AUC) calculated from ROC analysis for criterion 3%/3 mm, 3%/2 mm, and 2%/2 mm used by ArcherQA were 0.948, 0.924, and 0.929, respectively. Conclusions: Independent dose calculation with the MC-based program ArcherQA has potential as a prescreen treatment for measurement-based patient-specific QA. AUC values (>0.9) showed excellent classification accuracy for monitoring failing plans with independent MC calculations.

Assessment of Adaptation Status of Reintroduced Equus Przewalskii Based on Comparative Analysis of Fecal Bacteria with Those of Captive E. Przewalskii, Domestic Horse and Mongolian Wild Ass.

Intestinal microbiota play an important role in the survival of the host. However, no study to date has elucidated the adjustment of intestinal microbiota of the host during rewilding. Thus, this study aims to describe the intestinal bacterial community of reintroduced Przewalski's horse (RPH) after being released into their original habitat for approximately 20 years in comparison with that of captive Przewalski's horse (CPH), sympatric domestic horse (DH) and Mongolian wild ass (MWA) by sequencing the 16S rRNA gene. The results showed that the prevalent bacterial communities were different among CPHs, RPHs, DHs and MWAs at the family level. NMDS and ANOSIM analysis showed that the pattern of bacterial community composition in captive equines was distinct from that in the wild groups. It is shown that some bacteria had significant differences among different taxa (p < 0.001), such as Firmicutes, Bacteroidetes, Armatimonadetes, Clostrida, Bacteroidia, Clostridiales, Bacteroidales, Rikenellaceae and Bacteroidales_UCG-001. These bacteria were associated with the transition from in captive to in the wild (CPH and RPH), which reflected the change of environmental conditions. Meanwhile, Proteobacteria, Clostridia, Bacilli, Negativicutes, Gammaproteobacteria, Clostridiales, Bacillales, Selenomonadales, Pseudomonadales and Planococcaceae were the changed groups among RPHs, MWAs and DHs, which are related to feeding habits and diseases. Our results clearly showed the differences between intestinal microbiota in reintroduced animals and wild animals and led us to understand the survival state of reintroduced animals in the wild.

Analysis and Prediction of Corporate Finance and Exchange Rate Correlation Based on Machine Learning Algorithms.

Based on the risk management of exposure to foreign exchange assets and liabilities and the application of financial derivatives, this paper provides an in-depth analysis of the financial and exchange rate risks of foreign-funded enterprises. Therefore, a method of evaluating the financial performance of listed financial enterprises based on principal component analysis and neural network model is proposed. First, principal components of alternative financial performance input-output indicators are extracted using principal component analysis. Subsequently, these principal components are used as input-output data for the DEA model to derive the relative validity evaluation results of the financial performance of individual financial enterprises and to provide a reference for decision making to improve the financial performance level of financial enterprises. Combined with the economic business data of the enterprises, an empirical test on exchange rate risk management is conducted and relevant suggestions are made on how foreign enterprises can reduce exchange rate risk losses. It has important theoretical value and practical significance for enterprise finance and exchange rate management.

Cost-effectiveness of Same-day Discharge Surgery for Primary Total Hip Arthroplasty: A Pragmatic Randomized Controlled Study.

Background: Total hip arthroplasty (THA) causes a great medical burden globally, and the same-day discharge (SDD) method has previously been considered to be cost saving. However, a standard cost-effectiveness analysis (CEA) in a randomized controlled trial (RCT) is needed to evaluated the benefits of SDD when performing THA from the perspective of both economic and clinical outcomes. Methods: Eighty-four participants undergoing primary THA were randomized to either the SDD group or the inpatient group. Outcomes were assessed by an independent orthopedist who was not in the surgical team, using the Oxford Hip Score (OHS), EuroQol 5D (EQ-5D), SF-36 scores and the quality-adjusted life years (QALYs). All the cost information was also collected. Results: The mean stay of patients in the SDD group was 21.70 ± 3.45 h, while the inpatient group was 78.15 ± 26.36 h. This trial did not detect any significant differences in OHS and QALYs. The total cost in the SDD group was significantly lower than that in the inpatient group (¥69,771.27 ± 6,608.00 vs. ¥80,666.17 ± 8,421.96, p < 0.001). From the perspective of total cost, when measuring OHS, the incremental effect was -0.12 and the incremental cost was -¥10,894.90. The mean incremental cost-effectiveness ratio (ICER) was 90,790.83. When measuring QALYs, the incremental effect was 0.02, and the ICER was negative. Sensitivity analysis produced similar results. Conclusions: SDD has an acceptable likelihood of being more cost-effective than the traditional inpatient option. After conducting cost-utility analysis, SDD resulted in better QALYs, while significantly reducing the total cost.

Multi-objective optimal water resources allocation in the middle and upper reaches of the Huaihe River Basin (China) based on equilibrium theory.

In the river basin water resources allocation (WRA) problem, an unbalanced WRA poses challenges to water resources management departments. Many studies focus on achieving a lower water shortage rate while ignoring the equilibrium relationship among the socio-economic system, water resources system and eco-environmental system, as well as the equilibrium relationship among different regions. In this study, a water resources allocation model(WRAM) based on equilibrium theory is constructed to achieve the balance between different systems and different spaces in a basin. First, the relationship among the water resources system, socio-economic system and eco-environmental system is described. Then, the regional equilibrium index and system equilibrium index are constructed. Finally, the first model based on equilibrium theory is constructed. The results show that: (1) the Pareto Front reflects the contradictory relationship between economic development and environmental sustainability; (2) with the restructuring of industry and cropping, both economic efficiency and water shortage rates improve; (3) the equilibrium of the basin could also be further improved if water resources utilisation is further improved. Therefore, this study improves the existing WRAM, which can be applied to guide the water resources management of river basin.

An efficient, economical, and easy mass production biochar supported zero-valent iron composite derived from direct-reduction natural goethite for Cu(II) and Cr(VI) remove.

In this study, a novel biochar-supported zero-valent iron (ZVI) composite was synthesised by a one-pot co-pyrolysis reduction method, and was used to remove Cu(II) and Cr(VI). The raw materials for the composite were derived from natural bagasse/straw and goethite. Scanning electron microscopy (SEM), X-ray diffraction (XRD) analysis, Fourier-transform infrared (FTIR) spectroscopy, thermogravimetry (TG), and Brunauer-Emmett-Teller (BET) analysis were used to characterise the biochar and biochar-supported ZVI composites. Batch removal experiments on the effects of the initial pH and citric acid concentrations were performed as well as kinetic studies and isotherm experiments. The composite materials showed better Cu(II) and Cr(VI) removal performance than single biochar and mineral. The removal of Cu(II) and Cr(VI) is pH-dependent, and proceeds via heterogeneous multilayer chemisorption. Electrochemical analysis revealed that straw biochar-supported ZVI composite exhibited greater electrical conductivity and electron transfer rate than pure biochar and ZVI. FTIR spectroscopy and X-ray photoelectron spectroscopy (XPS) elucidated the uptake mechanism, showing that Cu(II) and Cr(VI) were easily adsorbed onto the biochar surface and were then reduced by ZVI. These results indicate that biochar-supported ZVI composite is effective for heavy metal remediation, which is economical, environment-friendly, and suitable for mass production.

Pollution Haven Hypothesis of Global CO2, SO2, NOx-Evidence from 43 Economies and 56 Sectors.

With the development of trade liberalization, the pollutants emissions embodied in global trade are increasing. The pollution haven hypothesis caused by trade has aroused wide attention. The fragmentation of international production has reshaped trade patterns. The proportion of intermediate product trade in global trade is increasing. However, little has been done to study the pollution haven of different pollutants under different trade patterns. In this paper, major environmental pollutants CO2 (carbon dioxide), SO2 (sulfur dioxide), and NOx (nitrogen oxides) are selected as the research objects. This study investigated the global pollution haven phenomenon in 43 countries and 56 major industries from 2000 to 2014. Based on the MRIO model, the trade mode is divided into three specific patterns: final product trade, intermediate product trade in the last stage of production, and the trade related to the global value chain. The results show that trade liberalization could reduce global CO2, SO2, and NOx emissions, and intermediate product trade has a more significant emission reduction effect than final product trade. Trade's impacts on each country are various, and the main drivers are also different. For example, the European Union avoids becoming a pollution haven mainly through the trade related to the global value chain. The suppressed emissions under this trade pattern are 71.8 Mt CO2, 2.2 Mt SO2, 2.2 Mt NOx. India avoids most pollutants emissions through intermediate product trade. China has become the most serious pollution haven through final product trade. The trade pattern could increase China 829.4 Mt CO2, 4.5 Mt SO2, 2.6 Mt NOx emissions in 2014.

Can the human development level in middle-income regions meet the challenges of natural capital change from the perspective of decoupling? Evidence from Shaanxi Province.

Human activities in middle-income regions (MIRs) accelerate the appropriation of natural capital (NC) through production and living activities. The environmental changes caused by these activities in turn have an impact on human development and challenge the human adaptability of MIRs. Therefore, it is very important to realize the decoupling of NC and human development. This study takes China's Shaanxi Province as a case and establishes a research framework that decouples the human development index (HDI) from the perspective of NC stock and flow. Shaanxi is evaluated based on an analysis of the changing HDI and measuring changes in NC indicators from 2005 to 2018. The state of decoupling between the HDI and NC utilization levels is also discussed. The results show that the average annual growth of the HDI and per capita ecological footprint is 1.54% and 3.22%, respectively. The rate of consumption of the NC stock is greater than the rate of NC flow consumption. The HDI and the three-dimensional ecological footprint have not achieved real decoupling, and the changes in the two are the same as those in the left half of the inverted U-shaped environmental Kuznets curve. However, the inflection point has not been reached. This shows that the NC and HDI in Shaanxi have not achieved decoupling, and rapid NC changes hinder the ability to improve human well-being. This discovery helps MIRs focus on the role of restoration ecosystems in supporting regional human development and respond to the challenge of insufficient human adaptability due to excessive consumption of NC.

[Quality of life assessment after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory].

Objective:To assess and compare therapeutic effects and quality of life after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory（ZCMEI）. Methods:Patients with chronic suppurative otitis media underwent myringoplasty at the Third Hospital of Peking University from October 2018 to September 2019 were included in this study and divided into two groups: endoscopic tympanoplasty group（n=40） and microscopic tympanoplasty group（n=57）. ZCMEI survey and pure tone audiometry were conducted preoperatively and 3-9 months postoperatively. The operation time, intraoperative blood loss, length of hospital, graft success rate, complication rate, hearing improvement and quality of life improvement were compared. Results:①The operation time, length of hospital and intraoperative blood loss of endoscopic group were significantly lower（P<0.05）. ②The graft success rate was 92.5% and 98.2%, respectively（P>0.05）. The difference between the complication rate in two groups was not significant, but patients in endoscopic group had no symptoms of wound numbness or pain. ③Air conduction threshold（AC） and air-bone gap（ABG） were significantly lower after surgery in endoscopic group（n=33） and microscopic group（n=43）. The analyzed result of generalized linear model indicated surgical approach had no influence on postoperative AC and ABG（P>0.05）. ④The total scores of ZCMEI were significantly improved in endoscopic group（n=32） and microscopic group（n=48） postoperatively, as well as the scores of ear symptoms, hearing and psychosocial impact（P<0.05）. Preoperative and postoperative scores of medical resources were not significantly different in either groups（P>0.05）. Controlling the course of disease, the total ZCMEI results and scores of each subscale in patients with single ear involved（n=71） had no significant difference between two groups. Conclusion:Endoscopic myringoplasty has the advantages of minimal invasiveness, short operation time, and quick recovery evaluated from subjective and objective aspects. Audiometry improvement, graft success rate, complication rate and quality of life improvements are comparable between endoscopic tympanoplasty and conventional microscopic tympanoplasty. The assessment of the quality of life is of great significance in efficacy evaluation of otitis media. Doctors should comprehensively consider patient's subjective experience and the objective improvement to obtain the best clinical efficacy.

Low-cost and efficient confocal imaging method for arabidopsis flower.

For an extensive period of time apical meristem (SAM) has been considered as a mysterious organ, due to its small, hidden and dynamic structure. Confocal imaging, combined with fluorescent reporters, enables researchers to unveil the mechanisms underlying cellular activities, such as gene expression, cell division, growth patterns and cell-cell communications. Recently, a series of protocols were developed for confocal imaging of inflorescence meristem (IM) and floral meristem (FM). However, the requirement of high configuration, such as the need of a water-dipping lens without coverslip and the specialized turrets associated with fixed-stage microscopes, impedes the wide adoption of these methods. We exploited an improved object slide and matching method aiming to decrease the configuration requirement. Following this protocol, various dry microscope lenses can be selected with flexibility for building 3D images of IM and FM.

Threat of infectious disease during an outbreak: Influence on tourists' emotional responses to disadvantaged price inequality.

The ongoing COVID-19 pandemic has negatively influenced the global tourism industry. Despite the documented negative impacts of diseases on tourism demand and people's perceived health risk, researchers have seldom examined the psychological responses of tourists travelling during an infectious disease outbreak. We therefore conducted three studies to examine this key aspect, and our findings indicate that tourists have a strong negative emotional reaction towards disadvantaged tourism-related prices in response to a high (vs low) infectious disease threat. Furthermore, risk aversion acts as an underlying mechanism driving this effect: tourists are more risk aversive under the threat of an infectious disease, which consequently magnifies their negative emotional reaction. At last, theoretical and practical implications of these findings for tourism are discussed.

Neurology practice and stroke services across East China: a multi-site, county-level hospital-based survey.

BACKGROUND: Neurological disorders are an economic and public health burden which requires efficient and adequate medical resources. Currently, little is known about the status of the quality of neurological care services available in China. As neurological primary care is mostly provided at the county hospital level, investigation of this geographical level is required. The aim of this study is to evaluate currently available neurology care services in Yangtze River Delta Urban Agglomerations in east China. METHODS: A multi-site, county-level hospital-based observational survey was conducted in east China from January 2017 to December 2017. A questionnaire was made to assess hospital and the departmental patient care capabilities, human resources and technical capacity in neurology departments. RESULTS: Of 228 hospitals across the Yangtze River Delta Urban Agglomerations, 217 documents were returned. Of these, 22 were excluded due to invalid hospital information or duplicate submission. Overall, most hospitals have neurology departments (162, 83.1%) while less than half of the hospitals have a stroke center (80, 41.0%) and neurology emergency department (46, 23.6%). Among 162 hospitals with neurology department, 5 were excluded due to inadequate sharing, leaving 157 hospitals for analysis. About 84.1% of these neurology departments can administer intravenous thrombolysis while about one third of them has the ability to perform arterial thrombectomy (36.9%). In addition, 46.2% of hospitals can carry out computed tomography angiography (CTA) in emergency room. Tertiary care hospitals are much more equipped with modern medical resources compared to the secondary hospitals. In four administrative regions, the neurology services are better in more economically advanced regions. CONCLUSIONS: Neurological care services need to be enhanced at the county-level hospitals to improve health care delivery.