Quantitative ultrasound image assessment of the optic nerve subarachnoid space during 90-day head-down tilt bed rest.

The elevation in the optic nerve sheath (ONS) pressure (ONSP) due to microgravity-induced headward fluid shift is the primary hypothesized contributor to SANS. This longitudinal study aims to quantify the axial plane of the optic nerve subarachnoid space area (ONSSA), which is filled with cerebrospinal fluid (CSF) and expands with elevated ONSP during and after head-down tilt (HDT) bed rest (BR). 36 healthy male volunteers (72 eyes) underwent a 90-day strict 6° HDT BR. Without obtaining the pre-HDT data, measurements were performed on days 30, 60, and 90 during HDT and at 6 recovery time points extended to 180-days (R + 180) in a supine position. Portable B-scan ultrasound was performed using the 12 MHz linear array probe binocularly. The measurements of the ONS and the calculation of the ONSSA were performed with ImageJ 1.51 analysis software by two experienced observers in a masked manner. Compared to R + 180, the ONSSA on HDT30, HDT60, and HDT90 exhibited a consistently significant distention of 0.44 mm2 (95% CI: 0.13 to 0.76 mm2, P = 0.001), 0.45 mm2 (95% CI: 0.15 to 0.75 mm2, P = 0.001), and 0.46 mm2 (95% CI: 0.15 to 0.76 mm2, P < 0.001), respectively, and recovered immediately after HDT on R + 2. Such small changes in the ONSSA were below the lateral resolution limit of ultrasound (0.4 mm) and may not be clinically relevant, possibly due to ONS hysteresis causing persistent ONS distension. Future research can explore advanced quantitative portable ultrasound-based techniques and establish comparisons containing the pre-HDT measurements to deepen our understanding of SANS.

3D Printed Conformal Strain and Humidity Sensors for Human Motion Prediction and Health Monitoring via Machine Learning.

Wearable sensors have garnered considerable attention due to their flexibility and lightweight characteristics in the realm of healthcare applications. However, developing robust wearable sensors with facile fabrication and good conformity remains a challenge. In this study, a conductive graphene nanoplate-carbon nanotube (GC) ink is synthesized for multi jet fusion (MJF) printing. The layer-by-layer fabrication process of MJF not only improves the mechanical and flame-retardant properties of the printed GC sensor but also bolsters its robustness and sensitivity. The direction of sensor bending significantly impacts the relative resistance changes, allowing for precise investigations of joint motions in the human body, such as those of the fingers, wrists, elbows, necks, and knees. Furthermore, the data of resistance changes collected by the GC sensor are utilized to train a support vector machine with a 95.83% accuracy rate for predicting human motions. Due to its stable humidity sensitivity, the sensor also demonstrates excellent performance in monitoring human breath and predicting breath modes (normal, fast, and deep breath), thereby expanding its potential applications in healthcare. This work opens up new avenues for using MJF-printed wearable sensors for a variety of healthcare applications.

Hydrogel Bioelectronics for Health Monitoring.

Hydrogels are considered an ideal platform for personalized healthcare due to their unique characteristics, such as their outstanding softness, appealing biocompatibility, excellent mechanical properties, etc. Owing to the high similarity between hydrogels and biological tissues, hydrogels have emerged as a promising material candidate for next generation bioelectronic interfaces. In this review, we discuss (i) the introduction of hydrogel and its traditional applications, (ii) the work principles of hydrogel in bioelectronics, (iii) the recent advances in hydrogel bioelectronics for health monitoring, and (iv) the outlook for future hydrogel bioelectronics' development.

Quantitative Assessment of Iteratively Denoised 3D SPACE with Inner-Volume Excitation and Simultaneous Multi-Slice BLADE for Optimizing Female Pelvis Magnetic Resonance Imaging at 1.5 T.

RATIONALE AND OBJECTIVES: High-resolution T2-weighted magnetic resonance imaging (MRI) of the pelvis is the main technique used for diagnosing benign and malignant uterine diseases. However, the procedure may be time-consuming and requires training and experience. Therefore, this study was performed to compare the image quality of standard clinical BLADE (stBLADE) with a prototypical accelerated simultaneous multi-slice (SMS) BLADE procedure with either improved temporal resolution (tr) at the same slice thickness (SL) or improved spatial resolution (sr) with the same examination time and a prototypical isotropic 3D SPACE procedure with inner-volume excitation and iterative denoising. MATERIALS AND METHODS: Patients who underwent clinically indicated MRI of the uterus were included in this prospective study and underwent stBLADE (acquisition time, 2 min 59 s; SL, 4 mm) and SMS BLADE (tr) with the same SL (4 mm) but reduced examination time (1 min 20 s) as well as SMS BLADE (sr) with thinner slices (3 mm) and comparable examination time (3 min 16 s). In addition, 3D SPACE was acquired in a sagittal orientation (5 min 36 s). The short axis of the cervix and the long axis of the corpus uteri were reconstructed in 1-mm and 3-mm SLs, retrospectively. Subjective overall image impression, delineation of anatomy/organs, lesion demarcation, and motion artifacts were assessed using a 5-point Likert scale and compared among the different techniques. The preferred sequence was then selected by three independent assessors. RESULTS: The analysis was based on 38 women (mean age, 44 ± 15 years). The overall image impression was similar for stBLADE, SMS BLADE (sr), and SMS BLADE (tr) but was significantly lower for 3D SPACE than stBLADE (p = 0.01). SMS BLADE (sr) was considered the preferred sequence because of slightly better performance in terms of overall image impression, organ delineation, and lesion demarcation, but without statistical significance. Both SMS BLADE (tr) and (sr) produced significantly fewer motion artifacts than stBLADE (p < 0.01 and p = 0.01), with no significant difference between SMS BLADE (tr) and (sr), while 3D SPACE had a significantly lower rating than stBLADE (p < 0.01). Image quality was rated as the least diagnostic criterion in all sequences and all cases. CONCLUSION: SMS BLADE (sr) was the preferred sequence for MRI of the female pelvis, with higher sr than stBLADE. SMS BLADE (tr) may also be used to reduce the acquisition time without compromising image quality. Despite its lower image quality, 3D SPACE can also reduce the examination time and improve the workflow because of the possibility of retrospective multiplanar reconstructions.

Comprehensive Assessment of Subtyping Methods for Improved Surveillance of Foodborne Salmonella.

High-resolution and efficient typing for the bacterial pathogen is essential for tracking the sources, detecting or diagnosing variants, and conducting a risk assessment. However, a systematic in-field investigation of Salmonella along the food chain has not been documented. This study assessed 12 typing methods, such as antimicrobial-resistance (AMR) gene profile typing, Core Genome Multilocus Sequence Typing (cgMLST), and CRISPR multi-virulence locus sequence typing (CRISPR-MVLST), to evaluate their effectiveness for use in routine monitoring of foodborne Salmonella transmission along the poultry production chain. During 2015-16, a total of 1,064 samples were collected from poultry production chain, starting from breeding farms and slaughterhouses to the markets of Zhejiang province in China. A total of 61 consecutive unique Salmonella isolates recovered from these samples were selected for genome sequencing and further comparative typing analysis. Traditional typing methods, including serotyping, AMR phenotype-based typing, as well as modern genotyping approaches, were evaluated and compared by their discrimination index (DI). The results showed that the serotyping method identified nine serovars. The gold standard cgMLST method indicated only 18 different types (DI = 0.8541), while the CRISPR-MVLST method detected 30 types (DI = 0.9628), with a higher DI than all examined medium-resolution WGS-based genotyping methods. We demonstrate that the CRISPR-MVLST might be used as a tool with high discriminatory power, comparable ease of use, ability of tracking the source of Salmonella strains along the food chain and indication of genetic features especially virulence genes. The available methods with different purposes and laboratory expertise were also illustrated to assist in rational implementation. IMPORTANCE In public health field, high-resolution and efficient typing of the bacterial pathogen is essential, considering source-tracking and risk assessment are fundamental issues. Currently, there are no recommendations for applying molecular characterization methods for Salmonella along the food chain, and a systematic in-field investigation comparing subtyping methods in the context of routine surveillance was partially addressed. Using 1,064 samples along a poultry production chain with a considerable level of Salmonella contamination, we collected representative isolates for genome sequencing and comparative analysis by using 12 typing techniques, particularly with whole-genome sequence (WGS) based methods and a recently invented CRISPR multi-virulence locus sequence typing (CRISPR-MVLST) method. CRISPR-MVLST is identified as a tool with higher discriminatory power compared with medium-resolution WGS-based typing methods, comparable ease of use and proven ability of tracking Salmonella isolates. Besides, we also offer recommendations for rational choice of subtyping methods to assist in better implementation schemes.

Environmental Regulation, Rural Residents' Health Investment, and Agricultural Eco-Efficiency: An Empirical Analysis Based on 31 Chinese Provinces.

This paper explores the effects of environmental regulation (ER) and rural residents' health investment (RRHI) on agricultural eco-efficiency (AEE) to provide a reference for the Chinese Government and other developing countries for implementing environmental regulation policies and to provide new paths to further improve green development in agriculture. Using the panel data of 31 Chinese provinces from 2009-2018, the Super-SBM model was used to measure AEE. The role of ER on AEE was analyzed based on panel two-way fixed effects with endogeneity treatment and a robustness test, and this mediating effect analysis was conducted to analyze the role of RRHI in ER and AEE, examining the extent of the effect of ER on AEE in three regions of China-eastern, central and western-using a heterogeneity analysis. The results of the study show that: (1) from a national perspective, ER has a significant positive impact on AEE, showing that ER is effective at this stage; (2) when RRHI is used as a mediating variable, the rising ER's intensity can promote AEE by increasing RRHI; and (3) the results of the heterogeneity analysis show that ER has the greatest impact on AEE in the economically developed eastern region; the western region with a weaker level of economic development is in second place. However, ER has a negative impact on AEE in the central region with a medium level of economic development. Thus, the impact of ER on AEE will show great differences depending on the stage of economic development.

BLADE turbo gradient- and spin-echo in the assessment of sinonasal lesions: a comprehensive comparison of image quality in readout-segmented echo-planar imaging.

BACKGROUND: A two-dimensional turbo gradient-echo and spin-echo diffusion-weighted pulse sequence with a non-Cartesian BLADE trajectory (TGSE BLADE) can eliminate image artifacts and distortion with clinically acceptable scan times. This process has the potential to overcome the shortcomings of current diffusion-weighted imaging (DWI) techniques, especially in the sinonasal region. PURPOSE: To investigate the feasibility of TGSE BLADE in the assessment of sinonasal lesions and compare the quality of TGSE BLADE with RESOLVE images both qualitatively and quantitatively. MATERIAL AND METHODS: A total of 36 patients with sinonasal lesions were included in this prospective study. DW images acquired using TGSE BLADE and RESOLVE were performed with the same acquisition time. Two independent observers evaluated the qualitative parameters (overall image quality, lesion visibility, and geometric distortion) and quantitative parameters (geometric distortion ratio [GDR], signal-to-noise ratio [SNR], contrast, contrast-to-noise ratio [CNR], and apparent diffusion coefficient [ADC] value) of the two sequences. RESULTS: Qualitative assessment revealed that TGSE BLADE exhibited higher overall image quality (P < 0.001) and lesion visibility (P < 0.001) and less geometric distortion (P < 0.001) than RESOLVE. Quantitative assessment showed that TGSE BLADE images exhibited higher contrast (P < 0.001) and CNR (P < 0.001) and lower GDR (P < 0.05) and SNR (P < 0.001) than RESOLVE images. The ADC value of TGSE BLADE was significantly lower than that of RESOLVE (P < 0.05). CONCLUSION: TGSE BLADE can reduce susceptibility artifacts and geometric distortion more than RESOLVE and appears to be a promising diffusion imaging sequence for the assessment of sinonasal lesions.

Rapid golden-angle diffusion-weighted propeller MRI for simultaneous assessment of ADC and IVIM.

PURPOSE: Golden-angle single-shot PROPLLER (GA-SS-PROP) is proposed to accelerate the PROPELLER acquisition for distortion-free diffusion-weighted (DW) imaging. Acceleration is achieved by acquiring one-shot per b-value and several b-values can be acquired along a diffusion direction, where the DW signal follows a bi-exponential decay (i.e. IVIM). Sparse reconstruction is used to reconstruct full resolution DW images. Consequently, apparent diffusion coefficient (ADC) map and IVIM maps (i.e., perfusion fraction (f) and the perfusion-free diffusion coefficient (D)) are obtained simultaneously. The performance of GA-SS-PROP was demonstrated with simulation and human experiments. METHODS: A realistic numerical phantom of high-quality diffusion images of the brain was developed. The error of the reconstructed DW images and quantitative maps were compared to the ground truth. The pulse sequence was developed to acquire human brain data. For comparison, fully sampled PROPELLER and conventional single-shot echo planar imaging (SS-EPI) acquisitions were performed. RESULTS: GA-SS-PROP was 5 times faster than conventional PROPELLER acquisition with comparable image quality. The simulation demonstrated that sparse reconstruction is effective in restoring contrast and resolution. The human experiments demonstrated that GA-SS-PROP achieved superior image fidelity compared to SS-EPI for the same acquisition time and same in-plane resolution (1 × 1 mm2). CONCLUSION: GA-SS-PROP offers fast, high-resolution and distortion-free DW images. The generated quantitative maps (f, D and ADC) can provide valuable information on tissue perfusion and diffusion properties simultaneously, which are desirable in many applications, especially in oncology. As a turbo spin-echo based technique, it can be applied in most challenging regions where SS-EPI is problematic.

[Clinical Effect of Day Surgery in Patients with Lung Caner by Optimize Operating Process].

BACKGROUND: The types and number of day surgery are increasing, what is the result of day surgery of selected patients with lung cancer? To explore the operation process and clinical effect of day surgery in patients with lung cancer by fusing the concept of enhanced recovery after surgery (ERAS) and minimally invasive surgical techniques. METHODS: A prospective study was planned with the approval of our institutional review board. 153 lung cancer patients who underwent anatomic resection in a single medical group between June 2019 and Nov 2019 were randomized. 20 patients were applied day surgery and 28 patients by inpatient surgery and the average length of stay, average hospital cost , complications and adverse reactions were analysed. RESULTS: The average hospital day in DSG group (1 d) was significantly shorter than in ISG group (7.7±2.8) d (P=0.000). The average hospital cost in DSG group (38,297.3±3,408.7)¥ was significantly lower than in ISG group (47,831.1±7,376.1)¥ (P=0.000). There was no significant difference in the incidence of postoperative complications between the daytime surgery group (5.0%) and the inpatient surgery group (3.6%) (P=0.812). The postoperation adverse reactions in DSG (10.0%) and ISG (17.9%) is no difference (P=0.72). CONCLUSIONS: Our study showed that the same clinical effect achieved between DSG and ISG, and recover quickly lung cancer patients after day surgery.

An applicable method for PET/CT image quality assessment and comparison among three PET/CT systems with similar physical performance in cancer patients.

PURPOSE: This research proposes a method with specific procedure guideline for clinical PET/CT image quality assessment according to physicians' behavior of image interpretation and explore the relationship between image quality and image systems with similar physical performance. METHODS: Clinical PET/CT were divided according to body location: brain, chest, abdomen and pelvic cavity. We explored the lesions and suspicious regions where radiologists concerned most through eye-tracker and behavior observation study to generate an assessment checklist. Fifty-five patients who were statistically consistent in age, weight and height were studied. Thirty-seven were scanned with an experimental scanner A and control systems B or C because their clinical pathways required PET/CT examinations at short intervals, the other 18 were scanned with scanners A and C. The grade of every system's PET, CT and PET/CT image performance on the four parts was calculated by subtraction of mean value and variance between experimental and control systems. RESULTS: The scoring checklist was set for PET, CT and PET/CT images in four parts respectively, and a standard procedure guideline was formulated for assessment. Using assessment criteria, the statistical results objectively reflected certain systems' superiority on certain modalities and certain parts of the body. CONCLUSION: Our criteria for clinical PET/CT image quality assessment and comparison were efficient.

Spectral Computed Tomography for the Quantitative Assessment of Patients With Carcinoma of the Gastroesophageal Junction: Initial Differentiation Between a Diagnosis of Squamous Cell Carcinoma and Adenocarcinoma.

OBJECTIVE: This study aimed to distinguish between esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) using spectral computed tomography (CT) and to discuss the accuracy according to an optimal threshold of single and combined parameters. METHODS: In this monoinstitution study, 61 patients, 35 of whom had ESCC and 26 had EAC confirmed by surgery or esophagoscopy, were recruited from August 2016 to March 2017. Enrolled patients underwent dual-phase chest CT enhancement. The spectral CT parameters (NIC, NICD, NICratio, Zeff, Zeff-C, K40-70 keV, K80-100 keV, and K110-140 keV) were measured during arterial phase (AP) and venous phase (VP). Binary logistic regression was used to calculate combined predictive probability. Thresholds of quantitative parameters and diagnostic accuracy were calculated using receiver operating characteristic curve. RESULTS: Compared with ESCC, higher NICAP, NICVP, NICD, Zeff AP, Zeff VP, Zeff-C AP, and Zeff-C VP were observed for EAC, whereas NICratio was lower for EAC. Higher K40-70 keV, K80-100 keV, and K110-140 keV were exhibited in EAC than in ESCC. Area under the curve (AUC) of NICAP, K40-70 keV AP, and Zeff AP were 0.720, 0.730, and 0.706, respectively. The area under the curve of new combined predictive value of NICAP and λ40-0 keV AP was 0.804. The sensitivity and specificity were 77.80% and 80.60%, respectively, when the threshold of new predictive value was 0.60. CONCLUSION: The diagnostic accuracy obtained by using NICAP and K40-70 keV AP combined is better than that obtained using a single parameter in differentiation between a diagnosis of squamous cell carcinoma and adenocarcinoma.

Is surgical Apgar score an effective assessment tool for the prediction of postoperative complications in patients undergoing oesophagectomy?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the surgical Apgar score (SAS) was an effective assessment tool for the prediction of postoperative complications in patients undergoing oesophagectomy. In total, 7 papers were identified using the reported search, of which 6 cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Five of 6 cohort studies demonstrated that a low SAS was significantly associated with more postoperative complications in patients undergoing oesophagectomy. The rates of major individual complications in patients with a lower SAS were commonly higher than those in patients with a higher SAS. Two cohort studies further reported that a low SAS was significantly associated with the prolonged length of stay. The cut-off value of the SAS that had the discriminative power for patients who were considered at high morbidity risk, however, was not defined but was more likely to be 6 or less. Current available evidence suggests that the SAS system may serve as an effective assessment tool for the prediction of morbidity risk after oesophagectomy.

[Impact and Effect of Preoperative Short-term Pulmonary Rehabilitation Training on 
Lung Cancer Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease: 
A Randomized Trial].

BACKGROUND: Pulmonary rehabilitation (PR) is proposed as an effective strategy to decrease surgical morbidity. However, appropriate rehabilitation plan, initiation time, and optimal duration of PR remain unclear. Lung cancer patients with chronic obstructive pulmonary disease (COPD) are considered high-risk population for postoperative pulmonary complications (PPCs) because of poor lung fitness and cardiopulmonary endurance. This study aims to assess the impact of a one-week, systematic and highly-intensive rehabilitation on surgical lung cancer patients with mild to moderate COPD. METHODS: A randomized controlled trial with 48 subjects was conducted (24 patients each for the intervention and groups). The intervention group received seven days of systematic, integrated and highly-intensive PR before surgical treatment, including: pharmacotherapy with atomizing terbutaline, pulmicort and infusion of ambroxol; and physical rehabilitation with respiratory training and endurance training. The control group underwent standard preoperative care. RESULTS: For the intervention group, the postoperative length of stay was shorter [(6.17±2.91) d vs (8.08±2.21) d; P=0.013]; likewise for the duration of antibiotics use [(3.61±2.53) d vs (5.36±3.12) d; P=0.032]. No significant difference was found between the groups in total in-hospital cost [(46,455.6±5,080.9) ¥ vs (45,536.0±4,195.8) ¥, P=0.498], medicine cost [(7,760.3±2,366.0) vs (6,993.0±2,022.5), P=0.223], and material cost [(21,155.5±10,512.1) ¥ vs (21,488.8±3,470.6) ¥, P=0.883]. In the intervention group, peak expiratory flow [(268.40±123.94) L/min vs (343.71±123.92) L/min; P<0.001], 6-min walk distance (6-MWD) [(595.42±106.74) m vs (620.90±99.27) m; P=0.004], and energy consumption [(59.93±10.61) kcal vs (61.03±10.47) kcal; P=0.004] were statistically different after the seven-day exercise, compared with those on the first day. Finally, for the intervention group the incidence of PPCs (8.3%, 2/24 vs 20.8%, 5/24, 20.8%; P=0.416) were lower. CONCLUSIONS: The systematic and highly-intensive pulmonary rehabilitation combining abdominal respiration training, respiratory exercise with incentive spirometry, and aerobic exercise could improve the cardiorespiratory endurance of lung cancer patients with mild to moderate COPD. The proposed program may be a practicable preoperative strategy.
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Simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B.

BACKGROUND AND AIM: In recent years, a great interest has been dedicated to the development of noninvasive predictive models to substitute liver biopsy for fibrosis assessment and follow-up. Our aim was to provide a simpler model consisting of routine laboratory markers for predicting liver fibrosis in patients chronically infected with hepatitis B virus (HBV) in order to optimize their clinical management. METHODS: Liver fibrosis was staged in 386 chronic HBV carriers who underwent liver biopsy and routine laboratory testing. Correlations between routine laboratory markers and fibrosis stage were statistically assessed. After logistic regression analysis, a novel predictive model was constructed. This S index was validated in an independent cohort of 146 chronic HBV carriers in comparison to the SLFG model, Fibrometer, Hepascore, Hui model, Forns score and APRI using receiver operating characteristic (ROC) curves. RESULTS: The diagnostic values of each marker panels were better than single routine laboratory markers. The S index consisting of gamma-glutamyltransferase (GGT), platelets (PLT) and albumin (ALB) (S-index: 1000 x GGT/(PLT x ALB(2))) had a higher diagnostic accuracy in predicting degree of fibrosis than any other mathematical model tested. The areas under the ROC curves (AUROC) were 0.812 and 0.890 for predicting significant fibrosis and cirrhosis in the validation cohort, respectively. CONCLUSIONS: The S index, a simpler mathematical model consisting of routine laboratory markers predicts significant fibrosis and cirrhosis in patients with chronic HBV infection with a high degree of accuracy, potentially decreasing the need for liver biopsy.

Assessment of fibrosis in chronic liver diseases.

The assessment of liver fibrosis provides useful information not only for diagnosis but also for therapeutic decisions. Although liver biopsy is the current gold standard for fibrosis assessment, it has some risks and limitations, including intra-observer and inter-observer variation, sampling error and variability. In recent years, many studies and great interest have been dedicated to the development of non-invasive tests to substitute a liver biopsy for fibrosis assessment and follow up. Advances in serological and radiological tests such as serum marker panels, transient elastography and their combinations can assess fibrosis accurately and reduce the need for a liver biopsy. But at present, all have failed to completely replace a liver biopsy because of their respective limitations and an imperfect gold standard used in current researches. The searching for an ideal surrogate is still in progress.