Assessment of the Diagnostic Performance of Clinical Examinations and High-Frequency Ultrasound in Patients With Pigmented Skin Tumors.

OBJECTIVES: To investigate whether the integration of high-frequency ultrasound (HFUS) to routine clinical examinations could improve diagnostic performance and management decision for pigmented skin tumors. METHODS: Three general practitioners trained previously and a dermatologist independently assessed pigmented skin tumors and rendered management decision based on clinical examinations alone or clinical examinations integrating HFUS. RESULTS: After integrating HFUS, the diagnostic area under the curve (AUC) (0.658-0.693 versus 0.848, all P < .05) and specificity (46.6-58.6% versus 89.7%, all P < .05) for pigmented skin malignancies were improved for general practitioners, meanwhile unnecessary biopsy rate reduced (42.9-53.6% versus 10.7%, P < .001). To the dermatologist, the diagnostic AUC (0.822 versus 0.949, P < .001), sensitivity (81.7% versus 96.7%, P = .012) and specificity (0.828 versus 0.931, P = .031) improved significantly, meanwhile both missed biopsy rate (14.5% versus 4.8%, P = .031) and unnecessary biopsy rate (19.6% versus 7.1%, P = .016) decreased. Additionally, the diagnostic performance of the general practitioner with integrating HFUS could be comparable with the dermatologist based on clinical examinations alone (all P > .05). CONCLUSIONS: As a complementary tool of clinical examinations, HFUS could help physicians differentiate pigmented skin malignancies and manage decision.

Dynamic simulation of land use change and habitat quality assessment under climate change scenarios in Nanchang, China.

Investigating habitat quality under different climate scenarios holds significant importance for sustainable land resource management and ecological conservation. In this study, considering Nanchang as a case study, a coupled patch-generating land use simulation (PLUS) and system dynamics (SD) model was employed in the simulation and prediction of land usage under shared socioeconomic pathway (SSP) and representative concentration pathway (RCP) scenarios. To assess the habitat quality in Nanchang from 2000 to 2020 and in 2030 under three diverse climate scenarios, we used the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model to analyze spatial and temporal changes. The findings indicate that the regions of forest land, cultivated land, and grassland in Nanchang City will dramatically decrease by 2030, the construction land will rapidly expand, and the fluctuations in the unutilized land and water area will be minimal. Additionally, the habitat quality declined from 2000 to 2020, and its spatial distributions changed. Zones having a high overall habitat quality were distributed in the mountains, hills, and lake areas, whereas those with relatively low quality were found in cultivated and urban areas. Under three climate scenarios, in 2030, the habitat quality index for Nanchang City will show a decreasing trend, mainly owing to areas with an index of 0.3-0.5 transitioning to <0.3. Considering each scenario, the degree of habitat degradation increased in the order SSP585>SSP245>SSP119. The findings of this study will inform high-quality development and biodiversity conservation in Nanchang City.

The Application of a Physiologically Based Toxicokinetic Model in Health Risk Assessment.

Toxicokinetics plays a crucial role in the health risk assessments of xenobiotics. Classical compartmental models are limited in their ability to determine chemical concentrations in specific organs or tissues, particularly target organs or tissues, and their limited interspecific and exposure route extrapolation hinders satisfactory health risk assessment. In contrast, physiologically based toxicokinetic (PBTK) models quantitatively describe the absorption, distribution, metabolism, and excretion of chemicals across various exposure routes and doses in organisms, establishing correlations with toxic effects. Consequently, PBTK models serve as potent tools for extrapolation and provide a theoretical foundation for health risk assessment and management. This review outlines the construction and application of PBTK models in health risk assessment while analyzing their limitations and future perspectives.

Comparative ecological network pattern analysis: a case of Nanchang.

Urban-ecological landscape connectivity and pattern optimization can significantly enhance biodiversity and sustainable development capacity, which play an important role in continued ecosystem functioning. Previous studies identified ecological sources based on the area threshold method or combination with morphological spatial pattern analysis and the landscape connectivity index (CMSPACI) method, but few studies have compared the advantages, disadvantages, and applicability of the two methods. In this paper, taking Nanchang as the study area, we address the ecological sources via area threshold and the CMSPACI method. Then, the minimum cost distance method is used to generate potential corridors of different methods, and the differences in ecological networks are analyzed. Finally, the circuit theory is used to identify barriers, and we provide targeted recommendations for ecological network pattern optimization in the study area. The results show that (1) the ecological sources extracted by different methods are different. The ecological sources extracted by the area threshold are far away from the surrounding sources, and the landscape connectivity is low. The ecological sources identified by the CMSPACI method are closely related to the surrounding sources, and the landscape connectivity is high. (2) Compared with the area threshold method, the habitat quality of corridors under the CMSPACI method is better, and the interaction intensity between patches is larger. (3) There is little difference in the number of ecological barriers under different methods; all of them are located between patches or on the edge of patches, and most of them are roads or construction land. Overall, the area threshold method is simpler. Ecological sources can be effectively addressed through the CMSPACI method, and the landscape connectivity of the ecological network will be better. This study provides an important reference for the selection of ecological sources in the construction of ecological networks.

Quantitative assessment of crystal dissolution in gout during urate-lowering therapy with computer-aided MicroPure imaging: a cohort study.

BACKGROUND: To evaluate whether MicroPure imaging, an ultrasound (US) image-processing technique with computer-aided analysis, can quantitatively detect crystal dissolution during urate-lowering therapy (ULT) in gout. METHODS: This was a prospective study of gout patients requiring ULT. The first metatarsophalangeal joints were examined using US and MicroPure before and after 3 months of ULT. Elementary lesions of gout, including the double contour sign (DCS), aggregates, tophi, erosion, and other US features were recorded at baseline and 3 months. MicroPure imaging features were automatically calculated by a self-developed software. Patients were divided into goal-achieved and goal-not-achieved groups according to their urate levels at 3 months. The US and MicroPure imaging features of the two groups were analyzed at baseline and 3 months. RESULTS: A total of 55 consecutive patients were enrolled (25: goal-achieved group; 30: goal-not-achieved group). US findings demonstrated that the power Doppler signal grade decreased at 3 months, regardless of the group (both P<0.05). From baseline to 3 months, tophi size and the DCS reduced in the goal-achieved group (both P<0.05), while the US aggregate features showed no difference (P=0.250). However, on the MicroPure imaging, the number and density of aggregates at 3 months decreased in the goal-achieved group (both P<0.05). There were no significant changes at 3 months in any of the MicroPure imaging features in the goal-not-achieved group (all P>0.05). CONCLUSIONS: In comparison with B-mode US, computer-aided MicroPure imaging can sensitively and quantitatively detect aggregate dissolution during effective ULT after only 3 months of treatment.

Utilization and expenses of outpatient services among tuberculosis patients in three Chinese counties: an observational comparison study.

BACKGROUND: The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014, designed specifically for patients diagnosed with Tuberculosis (TB). This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation, among TB patients in the three counties in China. METHODS: We collected quantitative data using surveys in 2013 (baseline year) and 2015 (final year). We used outpatient hospital records to measure service utilization and medical expenses of TB patients. We conducted qualitative interviews with local health authorities, officers of health insurance agencies, and hospital managers (n = 18). We utilized three focus group discussions with hospital staff and TB doctors and nurses. The χ2 tests and Mann-Whitney U tests were used to analyse quantitative data, and the thematic analysis using a framework approach was applied to analyse qualitative data. RESULTS: Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014. Jurong County maintained global budget payment but raised the reimbursement rate for TB care. Compared to the baseline, the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1% and from 22.1 to 53.1% in the final survey, respectively. Jurong experienced the opposite trend, decreasing from 63.0 to 9.8%. In the final survey, the total outpatient expenses per patient during a full treatment course in Dantu (RMB 2939.7) and Yangzhong (RMB 2520.6) were significantly higher than those in the baseline (RMB 690.4 and RMB 1001.5, respectively), while the total outpatient expenses in Jurong decreased significantly (RMB 1976.0 in the baseline and RMB 660.8 in the final survey). Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together, revealed by qualitative interviews. Furthermore, staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses. Many TB doctors complained about their reduced salary, which might be due to decreased hospital revenue generated from TB care after the payment method reform. CONCLUSIONS: The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong. In Jurong, where the global budget payment system maintained with the reimbursement rate enhanced, we found an effect on cost containment, but the quality of TB care might be compromised. The TB-specific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course. Local health insurance agencies have to provide explicit explanations on the payment method. TB care providers should be provided with proper incentives. Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals.

[The present situation and development of acupuncture and moxibustion in Portugal].

The development courses of acupuncture and moxibustion as well as the present situation, education and legislation in Portugal were reviewed in this article. Acupuncture and Moxibustion has been developed in Portugal since 1980's. The first acupuncture school appeared in the year of 1992. Until now, courses on Chinese medicine and acupuncture has already been set up in about six universities. Acupuncture legislation started in the year 2003. At present, professional levels of acupuncture practitioners vary a lot. There are over 50 indications currently. And acupuncture treatment is basically at one's own expense.

[Present situation and development of acupuncture and moxibustion in Singapore].

The development history, education, legislation, charge and institutes of acupuncture and moxibustion in Singapore are introduced in this article. Acupuncture and moxibustion has been developed in Singapore since 1840. Nowadays there are three universities that set up standard Chinese medicine courses and two acupuncture-moxibustion associations. Legislation of acupuncture and moxibustion is published in 2000. The acupuncture and moxibustion is applied for approximately 50 kinds of diseases. The acupuncture and moxibustion is at one's own expense in public or private institutions, but cheap or completely free in charity.

[The assessment of reliability and validity of musculoskeletal questionnaire].

OBJECTIVE: To evaluate the reliability and validity of musculoskeletal questionnaire. METHODS: A self-administered modified musculoskeletal questionnaire was used to investigate 12 098 workers from eight occupations, i.e. coal mining, petroleum, metallurgical, mechanical manufacturing, chemical, garment and railroad transportation industries and education. The Cronbach's α coefficient, analysis of covariance and multiple logistic regression were used to assess the reliability and validity of musculoskeletal questionnaire. RESULTS: The consistent test between total items of Musculoskeletal Questionnaire and each factor showed that the range of Cronbach's α was 0.52 ∼ 0.92, except from vibration factor, other Cronbach's α was more than 0.7. All 55 items of Musculoskeletal Questionnaire were subjected to factor analysis, and ten latent factors were identified, which explained 55.17% of the total variance. The potentially hazardous working conditions could be categorized into seven dimensions (force, dynamic load, static load, repetitive load, climate factors, vibration exposure and environmental ergonomic factor), which consisted with the theory model. The results of covariance analysis indicated that there were significant difference among 7 dimension indices in different jobs (P < 0.01). CONCLUSION: The modified Musculoskeletal Questionnaire is a valid and reliable tool for measuring musculoskeletal workload.