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.

Establishment of an Artificial Neural Network Model Using Immune-Infiltration Related Factors for Endometrial Receptivity Assessment.

BACKGROUND: A comprehensive clinical strategy for infertility involves treatment and, more importantly, post-treatment evaluation. As a component of assessment, endometrial receptivity does not have a validated tool. This study was anchored on immune factors, which are critical factors affecting embryonic implantation. We aimed at establishing novel approaches for assessing endometrial receptivity to guide clinical practice. METHODS: Immune-infiltration levels in the GSE58144 dataset (n = 115) from GEO were analysed by digital deconvolution and validated by immunofluorescence (n = 23). Then, modules that were most associated with M1/M2 macrophages and their hub genes were selected by weighted gene co-expression network as well as univariate analyses and validated using the GSE5099 macrophage dataset and qPCR analysis (n = 19). Finally, the artificial neural network model was established from hub genes and its predictive efficacy validated using the GSE165004 dataset (n = 72). RESULTS: Dysregulation of M1 to M2 macrophage ratio is an important factor contributing to defective endometrial receptivity. M1/M2 related gene modules were enriched in three biological processes in macrophages: antigen presentation, interleukin-1-mediated signalling pathway, and phagosome acidification. Their hub genes were significantly altered in patients and associated with ribosomal, lysosomal, and proteasomal pathways. The established model exhibited an excellent predictive value in both datasets, with an accuracy of 98.3% and an AUC of 0.975 (95% CI 0.945-1). CONCLUSIONS: M1/M2 polarization influences endometrial receptivity by regulating three gene modules, while the established ANN model can be used to effectively assess endometrial receptivity to inform pregnancy and individualized clinical management strategies.

Decision tree model predicts live birth after surgery for moderate-to-severe intrauterine adhesions.

BACKGROUND: After treatment of intrauterine adhesions, the rate of re-adhesion is high and the pregnancy outcome unpredictable and unsatisfactory. This study established and verified a decision tree predictive model of live birth in patients after surgery for moderate-to-severe intrauterine adhesions (IUAs). METHODS: A retrospective observational study initially comprised 394 patients with moderate-to-severe IUAs diagnosed via hysteroscopy. The patients underwent hysteroscopic adhesiolysis from January 2013 to January 2017, in a university-affiliated hospital. Follow-ups to determine the rate of live birth were conducted by telephone for at least the first postoperative year. A classification and regression tree algorithm was applied to establish a decision tree model of live birth after surgery. RESULTS: Within the final population of 374 patients, the total live birth rate after treatment was 29.7%. The accuracy of the model was 83.8%, and the area under the receiver operating characteristic curve (AUC) was 0.870 (95% CI 7.699-0.989). The root node variable was postoperative menstrual pattern. The predictive accuracy of the multivariate logistic regression model was 70.3%, and the AUC was 0.835 (95% CI 0.667-0.962). CONCLUSIONS: The decision tree predictive model is useful for predicting live birth after surgery for IUAs; postoperative menstrual pattern is a key factor in the model. This model will help clinicians make appropriate clinical decisions during patient consultations.

Assessment of Pelvic Floor Function and Quality of Life in Patients Treated for Cervical Cancer: A Multicenter Retrospective Study.

OBJECTIVES: Our study aimed to evaluate the quality of life (QoL) and pelvic floor function of cervical cancer (CC) patients after treatment. DESIGN: This was a cross-sectional observational cohort study. PARTICIPANTS: The participants included in this study were CC patients who underwent radical hysterectomy (RH) from 2012 to 2018 at 18 medical centers across China. METHODS: The validated versions of the Pelvic floor Distress Inventory-Short Form 20, Overactive Bladder Symptom Score, and Euro Qol Five-Dimension questionnaires were used to evaluate postoperative pelvic floor dysfunction (PFD) and QoL. RESULTS: A total of 689 CC patients were enrolled. The incidence of stress urinary incontinence (SUI), incomplete urinary emptying, and constipation were 32.7, 27.7, and 28.6%, respectively. Multivariate analysis confirmed that laparoscopic RH (LRH) and vaginal wall resection greater than 3 cm were risk factors for lower urinary tract symptoms (LUTS). LRH and chemotherapy were risk factors for SUI. Chemoradiotherapy and LRH were risk factors for overactive bladder (OAB). A high body mass index and LRH were risk factors for more severe defecation symptoms. ARH and large amount of operative blood loss were risk factors for poor QoL. CONCLUSION: PFD is common in CC patients after treatment. LRH seems to increase the postoperative distress, including LUTS and defecation symptoms. Postoperative urinary incontinence and OAB are more bothersome for patients undergoing chemotherapy and radiotherapy. We recommend evaluating pelvic floor function as a standard assessment during follow-up.

Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer.

BACKGROUND: After radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function. METHODS: A multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function. RESULTS: Two hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P < 0.001). A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO, while radiotherapy exerted a stronger effect than chemotherapy. Additionally, patients who received chemoradiotherapy frequently developed a DMCC. The follow-up time was not correlated with bladder storage function. CONCLUSION: A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.

Rapid detection of biodegradable organic matter in polluted water with microbial fuel cell sensor: Method of partial coulombic yield.

The quantification of biodegradable organic matter (BOM) in polluted water plays an essential role for biodegradation-based processing of wastewater and management of water environment. Compared with the traditional detection of five-day biochemical oxygen demand (BOD5), microbial fuel cell (MFC) sensors have shown an advantage for rapid and more accurate BOM assessment in several hours using coulombic yield of MFC as the signal. In this study, we propose a new calculation method that relies on the partial coulombic yield (P-CY) to further shorten the duration of the measurement. The P-CY is the cumulative coulomb at the point at which the voltage acquisition reaches a maximum voltage drop rate. The detection results with the standard GGA solution (a mixture of glucose and glutamic acid) show an enhanced linear relationship ranging from 37.5 mg L-1 to 375 mg L-1 in comparison to conventional methods. Notably, the response time for P-CY is remarkably shortened (0.99 ± 0.18-18.08 ± 0.58 h). The cutoff point for P-CY has more stable electrochemical characteristics, which enhances the accuracy of BOM detection. Furthermore, the validity of our determination of the cutoff point for P-CY is demonstrated by a mathematical model based on the Michaelis-Menten equation. Thus, the P-CY method is viable for the rapid detection of BOM in polluted water.

Co-mutational assessment of circulating tumour DNA (ctDNA) during osimertinib treatment for T790M mutant lung cancer.

Osimertinib is designed to target the secondary resistant EGFR T790M mutant and has shown outstanding clinical efficacy. However, the prognostic prediction of osimertinib patients is a big problem in clinical practice. The resistance mechanism of osimertinib is also not fully understood. NGS and a 1021 gene capture panel were used to analyse the somatic mutation profile of thirty-six lung adenocarcinoma patients' serial ctDNA samples. Progression-free survival of subgroup patients is analysed. Patients harbour TP53 mutations and patients with higher TMB value in pre-treatment samples showed a shorter PFS. Moreover, compared to CT evaluation, ctDNA changes generally correlated with treatment responses in most patients. Novel resistance mechanisms are discovered including EGFR mutations and alternative activation pathway. Our results implied a broad potential of ctDNA as an adjuvant tool in practical clinical management of NSCLC patients. ctDNA could help with clinical practice during osimertinib treatment, regarding monitoring tumour response, detecting development of heterogeneity, identifying potential resistance mechanisms, predicting treatment efficacy and patient outcome.

Characteristics influencing high-risk sexual behaviours in elderly men.

With the objective of investigating the characteristics influencing high-risk sexual behaviours in elderly men (60-74 years of age) in Chongqing, China, a total of 1433 healthy elderly men with sexual intercourse frequencies of one to six times/month who were willing to participate in the questionnaires were studied at four hospitals. We measured serum testosterone levels and performed follow-ups every six months, with a total of 1128 elderly men followed up after two years. We also investigated socio-economic and demographic characteristics (age, education, income, location, marital status and number of marriages), types of sexual partners, age differences with fixed sexual partners, frequency of sexual intercourse, combined basic age-related diseases, sexually transmitted infections (STIs) education, elderly self-care ability and high-risk sexual behaviours (frequency of sexual intercourse and number of sexual partners) using questionnaires. We analysed the influencing factors of high-risk sexual behaviours in elderly men using a univariate analysis, multivariate logistic regression analysis, BP neural network prediction and cluster analysis. Finally, we found that serum total testosterone, age, types of sexual partners, age differences with fixed partners and frequency of sexual intercourse are five factors that influence high-risk sexual behaviours in elderly men.

Decision Tree Analysis: A Retrospective Analysis of Postoperative Recurrence of Adhesions in Patients with Moderate-to-Severe Intrauterine.

OBJECTIVE: To establish and validate a decision tree model to predict the recurrence of intrauterine adhesions (IUAs) in patients after separation of moderate-to-severe IUAs. DESIGN: A retrospective study. SETTING: A tertiary hysteroscopic center at a teaching hospital. POPULATION: Patients were retrospectively selected who had undergone hysteroscopic adhesion separation surgery for treatment of moderate-to-severe IUAs. INTERVENTIONS: Hysteroscopic adhesion separation surgery and second-look hysteroscopy 3 months later. MEASUREMENTS AND MAIN RESULTS: Patients' demographics, clinical indicators, and hysteroscopy data were collected from the electronic database of the hospital. The patients were randomly apportioned to either a training or testing set (332 and 142 patients, respectively). A decision tree model of adhesion recurrence was established with a classification and regression tree algorithm and validated with reference to a multivariate logistic regression model. The decision tree model was constructed based on the training set. The classification node variables were the risk factors for recurrence of IUAs: American Fertility Society score (root node variable), isolation barrier, endometrial thickness, tubal opening, uterine volume, and menstrual volume. The accuracies of the decision tree model and multivariate logistic regression analysis model were 75.35% and 76.06%, respectively, and areas under the receiver operating characteristic curve were 0.763 (95% CI 0.681-0.846) and 0.785 (95% CI 0.702-0.868). CONCLUSIONS: The decision tree model can readily predict the recurrence of IUAs and provides a new theoretical basis upon which clinicians can make appropriate clinical decisions.

Buzz Factor or Innovation Potential: What Explains Cryptocurrencies' Returns?

Cryptocurrencies have become increasingly popular since the introduction of bitcoin in 2009. In this paper, we identify factors associated with variations in cryptocurrencies' market values. In the past, researchers argued that the "buzz" surrounding cryptocurrencies in online media explained their price variations. But this observation obfuscates the notion that cryptocurrencies, unlike fiat currencies, are technologies entailing a true innovation potential. By using, for the first time, a unique measure of innovation potential, we find that the latter is in fact the most important factor associated with increases in cryptocurrency returns. By contrast, we find that the buzz surrounding cryptocurrencies is negatively associated with returns after controlling for a variety of factors, such as supply growth and liquidity. Also interesting is our finding that a cryptocurrency's association with fraudulent activity is not negatively associated with weekly returns-a result that further qualifies the media's influence on cryptocurrencies. Finally, we find that an increase in supply is positively associated with weekly returns. Taken together, our findings show that cryptocurrencies do not behave like traditional currencies or commodities-unlike what most prior research has assumed-and depict an industry that is much more mature, and much less speculative, than has been implied by previous accounts.

Prenatal assessment of pulmonary maturity on 3-D ultrasound.

AIM: The aim of this study was to assess the feasibility and accuracy of 3-D ultrasound indices to evaluate fetal lung maturity, and to establish a normal reference for fetal lung volume (FLV) and fetal lung-to-liver intensity ratio (FLLIR) in a Chinese population. METHODS: A total of 1022 pregnant women with singleton pregnancy were prospectively studied between June 2008 to June 2011. Ultrasound examination was performed. The breathing-related nasal fluid flow (BRNFF) spectrum, FLV, pulmonary artery blood flow parameters, and echo intensity of the lung were calculated. Phosphoglycerides in the amniotic fluid were measured on thin layer chromatography. RESULTS: FLLIR and FLV were positively and linearly correlated with gestational age (F = 0.915, 0.846). Indicators of fetal lung maturity included FLLIR >1.1, FLV >50 mL, and regular BRNFF spectrum, with positive likelihood ratios of 12.28, 11.78, and 11.63, independently. CONCLUSION: Ultrasound indices, including FLLIR, FLV and BRNFF may serve as useful alternatives to amniotic fluid phospholipids in analyzing fetal lung maturity in Chinese patients.

[Pollution Characteristics and Risk Assessment of Polybrominated Diphenyl Ethers in the Surface Sediments from Middle Reaches of the Yangtze River].

Polybrominated diphenyl ethers (PBDEs) are highly lipophilic compounds with high toxicity and long-term bioaccumulation, which have strong affinities to suspended particulates in water. So PBDEs are easily adsorbed to sediments, and cause potential risks to human beings and aquatic ecosystem. In order to investigate the levels and patterns of PBDEs in the Yangtze River, 13 surface sediment samples were collected from the middle reaches of the regions and the concentrations of 9 PBDE congeners in the sediments were determined using High Resolution Gas Chromatography/High Resolution Mass Spectrometry (HRGC/HRMS). The total concentrations of PBDEs ranged from 46.1 to 326 pg · g⁻¹ dry weight. BDE-99 and BDE-47 were the dominant PBDE congeners, which averagely contributed 51.6% and 19.6%, respectively. The concentrations of PBDEs were relatively low compared to those in other studies. The total organic carbon (TOC) was also analyzed in this study, and the results indicated that there was no obvious positive correlation between the levels of PBDEs and TOC. In addition, based on the PBDEs concentration levels, the ecotoxicological risks of PBDEs contamination in surface sediments of the Yangtze River were evaluated by the quotient method. The results showed that the levels of PBDEs were considerably low and these compounds should have no risk to human health.

[Levels distribution and risk assessment of the indicator and dioxin-like polychlorinated biphenyls in ten different species of marine fish of Bohai Bay, China].

Polychlorinated biphenyls (PCBs) are highly lipohilic compounds with high metabolic persistence and toxicity. PCBs tend to accumulate in the aquatic food chain and make fish a source of various environmental toxicants to humans. Industries in the Bohai Bay include iron and steel smelting, cement manufacturing and waste incineration, which are potential emission sources of PCBs. In this study, risks and potential effects of PCBs in the Bohai Bay were assessed. Twelve dioxin-like polychlorinated biphenyls (dl-PCBs) and seven indicator PCBs in marine fish samples were analyzed by High Resolution Gas Chromatography/High Resolution Mass Spectrometry (HRGC/HRMS). The concentrations of dl-PCBs in marine fishes ranged from 28.9 pg x g(-1) to 1067.6 pg x g(-1) wet weight. The concentrations of indicator PCBs were between 185.5 pg x g(-1) and 8 371.7 pg x g(-1) wet weight. PCB-118 and PCB-105 were the major congeners of the dl-PCBs congeners, which contributed 41% - 56% and 15% - 21%, respectively. The predominant indicator PCBs were PCB-153 and PCB-138, which contributed 27% and 22%, respectively. The concentrations of dl-PCBs and indicator PCBs were relatively low as compared with those in other studies.