Development and Validation of Interpretable Machine Learning Models for Clinically Significant Prostate Cancer Diagnosis in Patients With Lesions of PI-RADS v2.1 Score ≥3.

BACKGROUND: For patients with PI-RADS v2.1 ≥ 3, prostate biopsy is strongly recommended. Due to the unsatisfactory positive rate of biopsy, improvements in clinically significant prostate cancer (csPCa) risk assessments are required. PURPOSE: To develop and validate machine learning (ML) models based on clinical and imaging parameters for csPCa detection in patients with PI-RADS v2.1 ≥ 3. STUDY TYPE: Retrospective. SUBJECTS: One thousand eighty-three patients with PI-RADS v2.1 ≥ 3, randomly split into training (70%, N = 759) and validation (30%, N = 324) datasets, and 147 patients enrolled prospectively for testing. FIELD STRENGTH/SEQUENCE: 3.0 T scanners/T2-weighted fast spin echo sequence and DWI with diffusion-weighted single-shot gradient echo planar imaging sequence. ASSESSMENT: The factors evaluated for csPCa detection were age, prostate specific antigen, prostate volume, and the diameter and location of the index lesion, PI-RADSv2.1. Five ML models for csPCa detection were developed: logistic regression (LR), extreme gradient boosting, random forest (RF), decision tree, and support vector machines. The csPCa was defined as Gleason grade ≥2. STATISTICAL TESTS: Univariable and multivariable LR analyses to identify parameters associated with csPCa. Area under the receiver operating characteristic curve (AUC), Brier score, and DeLong test were used to assess and compare the csPCa diagnostic performance with the LR model. The significance level was defined as 0.05. RESULTS: The RF model exhibited the highest AUC (0.880-0.904) and lowest Brier score (0.125-0.133) among the ML models in the validation and testing cohorts, however, there was no difference when compared to the LR model (P = 0.453 and 0.548). The sensitivity and negative predictive values in the validation and testing cohorts were 93.8%-97.6% and 82.7%-95.1%, respectively, at a threshold of 0.450 (99% sensitivity of the RF model). DATA CONCLUSION: The RF model might help for assessing the risk of csPCa and preventing overdiagnosis and unnecessary biopsy for men with PI-RADSv2.1 ≥ 3. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

Insights into urinary incontinence after robot-assisted radical prostatectomy: urgent urinary incontinence or stress urinary incontinence.

PURPOSE: Urinary incontinence is a common complication following robot-assisted radical prostatectomy (RARP). Few studies have explored the relationships and differences between stress urinary incontinence (SUI) and urgent urinary incontinence (UUI) after RARP. This study aimed to investigate the occurrence rates and risk factors of UUI and SUI in short term after RARP. METHODS: We prospectively included prostate cancer patients who underwent RARP by a single surgeon. Demographics, lower urinary tract function, oncology, and follow-ups were recorded. Occurrence rates and risk factors of UUI and SUI within 3 months after catheter withdrawal were calculated. RESULTS: The study cohort included 363 subjects with a mean age of 66.05 years. The median preoperative International Prostate Symptom Score (IPSS) was 14 (range 0-35), and the median Overactive Bladder Symptom Score (OABSS) was 3 (range 0-14). The occurrence rate of UUI and SUI at 3 months after catheter withdrawal was 8.5% (31/363) and 15.2% (55/363). Nearly all patients with UUI also had SUI. Diabetes history and high OABSS before RARP were independent risk factors for UUI, especially within 1 month after catheter withdrawal. The Gleason Score was an independent risk factor for SUI at 3 months after catheter withdrawal. Additionally, UUI but not SUI might be an influencing factor for decision-making regarding postoperative radiotherapy. CONCLUSION: The occurrence rate of SUI after RARP was persistently higher than that of UUI. Nearly all of the patients with UUI simultaneously had SUI. The risk factors of UUI and SUI after RARP were absolutely different.

Physics-informed machine learning methods for biomass gasification modeling by considering monotonic relationships.

Machine learning methods have recently shown a broad application prospect in biomass gasification modeling. However, a significant drawback of the machine learning approaches is their poor physical interpretability when relying on limited experimental data. In the present work, a physics-informed neural network method (PINN) is developed to predict biomass gasification products (N2, H2, CO, CO2, and CH4). PINN simultaneously considers regression, structure, and physical monotonicity constraints in the loss function, providing physically feasible predictions. Specifically, the PINN models have outperformed prediction capability (average test R2 0.91-0.97) compared to five other machine learning methods through 50 times random sample classifications. Furthermore, it is demonstrated that the developed models can maintain correct monotonicity even if the feedstock characteristics or gasification conditions are outside the training data. By using a reliable physical mechanism to guide machine learning, the model can ensure better generalizability and scientific interpretability.

The impact of catheter removal time on urinary continence and overactive bladder symptoms after robot-assisted radical prostatectomy: a retrospective analysis of consecutive 432 cases from a single institution.

Background: After radical prostatectomy, the optimal length of postoperative catheterization time remains to be determined. This study investigates the impact of catheter removal time on urinary continence and overactive bladder (OAB) symptoms after robot-assisted radical prostatectomy (RARP). Methods: Four hundred and thirty-two consecutive patients underwent RARP by a single surgeon between Nov 2020 and Oct 2021. Time to catheter removal was categorized into 7, 10, and ≥14 days. Continence was defined as no more than 1 pad used or no more than 20 g of urine leakage per 24 hours. The patients' continence rates and overactive bladder symptom score (OABSS) were assessed at 48 hours, 1 week, 4, 12, and 24 weeks after catheter removal. Results: Overall, continence rates were 37.3% 48 hours after catheter removal, 54.4% 1 week, 77.5% 4 weeks, 92.1% 12 weeks, and 97.9% 24 weeks after catheter removal. The median time to regain continence was 1 week. At 4 weeks after catheter removal, the continence rate in the ≥14 days group (70.5%) was significantly lower than the 7 days group (86.3%) and 10 days group (83.0%) (P=0.001). In a univariate Cox regression analysis, the presence of diabetes, higher pre-operative OABSS, and a catheterization time of 10 days were associated with worse continence recovery. The mean OABSS of patients in the continent group were significantly lower than the incontinent group at 48 hours, 4, 12 and 24 weeks after catheter removal. At 24 weeks after catheter removal, the mean OABSS in the 7 days group was significantly lower than in other groups. Conclusions: Early catheter removal (7 days) was associated with better continence results and lower OABSS at 4 and 24 weeks after catheter removal respectively.

Wet deposition of atmospheric selenium and sensitivity to emission and precipitation patterns.

Wet deposition has been well recognized to be affected by species concentration and precipitation; nevertheless, the regimes in the controlling factor of concentration or precipitation have not yet been clarified. Using a trace element, selenium (Se), with dual effects on human health as a testbed, we first reproduce the spatial distribution of atmospheric Se concentrations and wet deposition fluxes through GEOS-Chem on a global scale, and examine the spatial patterns and relative importance of anthropogenic emissions vs. natural emissions over various regions around the world. We find that over most Northern Hemisphere continental regions, anthropogenic emissions are the dominant source for atmospheric Se concentration and deposition, while it is dominated by natural sources in the other areas. Nested grid simulations covering China and the continental United States are further conducted. The factors (i.e., Se concentration and precipitation) controlling the wet deposition flux of atmospheric Se are analyzed in detail, through the construction of wet deposition-concentration-precipitation (WETD-C-P) diagram for two regions (mainland China and the continental United States) based on the monthly results. The two regions show distinctive features, reflecting the different spatial patterns of Se emissions and precipitation. Both Se emissions and precipitation are higher in the eastern United States than that in the western United States. In contrast, the emissions and precipitation in northern and southern China show dipole features with stronger emissions over the northern side and higher precipitation on the southern side. We further investigate the impacts of future emission changes in China on atmospheric Se deposition and its sensitivity to emissions and precipitation, revealing a modulation of regime shifts, i.e., from the precipitation dominant regime to the concurrent governance of both precipitation and emissions. The proposed WETD-C-P relationship is useful in elucidating the regime and factors governing the spatial and temporal variations in wet deposition.

Does preoperative morphology of multifidus influence the surgical outcomes of stand-alone lateral lumbar interbody fusion for lumbar spondylolisthesis?

OBJECTIVES: To investigate whether the preoperative morphology of multifidus influences the surgical outcomes of stand-alone lateral lumbar interbody fusion (LLIF) for lumbar spondylolisthesis. PATIENTS AND METHODS: Fifty-eight patients with lumbar spondylolisthesis who underwent single-level, stand-alone LLIF at the L4-5 level were included and followed up for at least 12 months. Preoperative axial cross-sectional area (CSA) and fat infiltration rate (FIR) of multifidus on MRI scans were measured using the ImageJ software. The CSA ratio and FIR were calculated and classified into three grades. Preoperative and final visual analogue scale (VAS) scores for back pain and leg pain, Oswestry Disability Index (ODI) scores were recorded. Cage subsidence and fusion were also evaluated at the final follow-up. Correlations between VAS scores, ODI scores, obvious cage subsidence and fusion rate with the CSA ratio and FIR were analyzed. RESULTS: There were significant correlations between preoperative and final VAS scores for back pain and ODI scores with the CSA ratio and FIR. There was an overall trend towards improvements in back pain and lumbar function in patients with superior morphology of multifidus. In addition, obvious cage subsidence was found to be associated with lower preoperative CSA ratios and higher FIR, whereas fusion rate was only correlated with FIR. CONCLUSIONS: The preoperative morphology of multifidus influenced the surgical outcomes of stand-alone LLIF for lumbar spondylolisthesis. Patients with superior morphology of multifidus showed better outcomes following stand-alone LLIF.

The diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies in clinically suspected interstitial cystitis/bladder pain syndrome.

OBJECTIVE: We aimed to explore the diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies for clinically suspected interstitial cystitis/bladder pain syndrome (IC/BPS). STUDY DESIGN: We reviewed the data of fifty-five clinically suspected IC/BPS patients underwent cystoscopy with hydrodistension and random biopsies. Global Response Assessment was used to evaluate the efficacy. Disease severity was assessed by thorough history, physical examination, 3-day frequency volume chart, visual analog scale of pain, Interstitial Cystitis Symptom Index (ICSI) and clinical phenotype system (UPOINT). RESULTS: According to the pathologic outcomes from random biopsies, three out of the 55 clinically suspected IC/BPS were diagnosed as bladder carcinoma. Among the 52 IC/BPS patients, thirty-six patients (69.2%) had initial chief complaints of urinary frequency and urgency. Under cystoscopy, twenty-nine patients and 23 patients were classified as Hunner ulcer type and diffuse global mucosal bleeding (grade III glomerulation). The median functional bladder capacity of the 52 IC/BPS patients was 100 ml. Hydrodistension was effective in 28 patients (53.8%) at postoperative 3 months, which decreased to 25% at post-hydrodistension 6 months and to 13.5% at 12 months. For the 28 hydrodistension-effective patients, the remission degrees of daytime frequency, nocturia, VAS bladder pain and ICSI score were 50.3%, 49.4%, 68.1% and 48%, which were significantly higher than the 16.9% (daytime frequency, P < 0.001), 20.5% (nocturia, P = 0.021), 7.4% (VAS pain score, P < 0.001) and 6.1% (ICSI, P < 0.001) in the hydrodistension-negative group. According to the UPOINT system, the hydrodistension-effective cases had significantly higher rates of symptom remission in U (P = 0.002), P (P = 0.026), O (P < 0.001), and T (P < 0.001) domains than the corresponding negative cases. In effective group, the O domain had the most remission rate (26 out of 28, 92.9%, P < 0.001), followed by the U domain (12 out of 28, 42.9%, P < 0.001) and T domain (12 out of 28, 42.9%, P < 0.001). CONCLUSION: Histopathological analysis from random biopsies could distinguish bladder carcinoma from clinically suspected IC/BPS. Hydrodistension is more likely to be effective when chronic pelvic pain is obviously alleviated. The efficacy of hydrodistension could act in a certain period of time.

Fast pyrolysis of torrefied holocellulose for producing long-chain ether precursors in a fluidized bed.

Combining torrefaction with fast pyrolysis is an achievable route for producing long-chain ether precursors. The results of structural characterization for native and torrefied holocellulose indicated that with increasing torrefaction temperature, the crystallinity index (CrI) decreased slightly and then sharply increased; hydroxyls, O-acetyl branches, ether bond and ß-1,4-glycosidic bond were eliminated but carbonyls increased. Maximum mass loss rate and apparent activation energy increased after torrefaction. With an increase in torrefaction temperature, gaseous yield continuously dropped, and liquid product yield climbed to the highest point of 49.04% for holocellulose torrefied at 240 °C (240CS). Torrefaction was unfavorable for the production of small-molecule gases. The bio-oil analysis demonstrated that the yield of acetic acid decreased from 6.35% to 1.43% with torrefaction temperature increasing from 105 °C to 260 °C. Significantly, yields of targeted compounds were dramatically improved after torrefaction, and 240CS afforded the maximum carbon yield of 14.79%.

Fast pyrolysis of holocellulose for the preparation of long-chain ether fuel precursors: Effect of holocellulose types.

The pyrolysis behaviors of nine biomass-derived holocelluloses (from seven agricultural and two forestry residues) were studied on a thermogravimetric analyzer (TGA) and pyrolysis-gas chromatography/mass spectrometer (Py-GC/MS). The results illustrated that compared with forestry holocellulose, agricultural holocellulose had quite high ash and hemicellulose contents. Moreover, agricultural holocellulose presented lower initial temperature and maximum mass loss rate. The results of GC/MS revealed that agricultural holocellulose produced more acids, ketones, aldehydes and furans and corn stalk holocellulose led to the highest targeted compounds (ketones, aldehydes and furans with carbonyl group) content of 51.4%. Woody holocellulose was suitable for the production of sugars, particularly levoglucosan, and pine sawdust holocellulose afforded the highest levoglucosan content of 46.55%. Intriguingly, the correlation of sugars/levoglucosan content with a mass ratio of cellulose to hemicellulose (CE/HCE) was put forward.

The Whitaker Test in the Follow-up of Complex Upper Urinary Tract Reconstruction: Is It Clinical Useful or Not.

PURPOSE: To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract. MATERIALS AND METHODS: Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected. RESULTS: A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 µmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047). CONCLUSION: Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function.

Global health effects of future atmospheric mercury emissions.

Mercury is a potent neurotoxin that poses health risks to the global population. Anthropogenic mercury emissions to the atmosphere are projected to decrease in the future due to enhanced policy efforts such as the Minamata Convention, a legally-binding international treaty entered into force in 2017. Here, we report the development of a comprehensive climate-atmosphere-land-ocean-ecosystem and exposure-risk model framework for mercury and its application to project the health effects of future atmospheric emissions. Our results show that the accumulated health effects associated with mercury exposure during 2010-2050 are $19 (95% confidence interval: 4.7-54) trillion (2020 USD) realized to 2050 (3% discount rate) for the current policy scenario. Our results suggest a substantial increase in global human health cost if emission reduction actions are delayed. This comprehensive modeling approach provides a much-needed tool to help parties to evaluate the effectiveness of Hg emission controls as required by the Minamata Convention.

Molecular dynamics simulations data of six compounds F3J-BRD4/CBP, EX1-BRD4/CBP, and E2T-BRD4/CBP.

The data here described are related to the research article entitled "Molecular dynamics insights into binding selectivity of inhibitors toward BRD4 and CBP" [1]. Bromodomain-containing protein 4 (BRD4) and CREB binding protein (CBP) play important roles in tumorigenesis and development. We performed 200-ns molecular dynamics (MD) simulations on three pairs of inhibitor-BRD4 and inhibitor-CBP complexes to clarify binding selectivity of inhibitors toward BRD4 and CBP. Principal component (PC) analysis was used to probe changes in internal dynamics and conformations of BRD4 and CBP due to inhibitor bindings. Analysis of residue-based free energy decomposition was employed to explore the roles of separate residues in binding selectivity of inhibitors to BRD4 versus CBP.

A modified Whitaker test (upper urinary tract videourodynamics) using for evaluating complex upper urinary tract reconstruction surgical effect.

BACKGROUND: To evaluate the feasibility and effect of upper urinary tract videourodynamics in complex reconstructed upper urinary tract. METHODS: From January 2016 to December 2018, patients who underwent complex upper urinary tract reconstruction and received upper urinary tract videourodynamics were included in the study. The modified Whitaker test was performed at 3 months after operation. The relative pelvic pressure was defined as the pelvic pressure minus the bladder pressure. Based on the flow rate, the test was divided into physiological phase and high flow phase. The results of pressure and image were classified into 3 types. Successful nephrostomy removal was defined as no symptoms and improved or stable hydronephrosis. RESULTS: A total of 12 patients who underwent complex upper urinary tract reconstruction received modified Whitaker test. All tests were successfully completed without adverse reactions. The relative pelvic pressure of 3 patients kept steady near the baseline throughout the examination and was classified into type 1. The pelvic pressure of 7 patients increased as the perfusion continued, and the relative pressure dropped to relative low level due to the peristalsis of ureter (type 2). The pressure of 2 patients increased along with increasing perfusion speed, and the relative pelvis pressure could easily reach 15 cmH2O. The peristalsis of ureter disappeared or appeared very weakly on the video record (type 3). Patients in type 1 (3 cases) and type 2 (7 cases) groups were allowed to remove the nephrostomy tube immediately. Patients in type 3 group needed to keep the nephrostomy for close follow up, and the tubes were removed 2 weeks and 4 weeks after the examination, respectively. None of the 12 patients received further treatment for recurrent symptoms and exacerbation of hydronephrosis. CONCLUSIONS: The modified Whitaker test is initially safe and feasible in postoperative evaluation of complex upper urinary tract reconstruction surgery. Detailed results can provide more evidence to judge whether nephrostomy tube could be removed safely.

The Prevalence, Coinfection, and Evolutionary and Molecular Characteristics of Prevalent Goose Circovirus in Guangdong, China.

To understand the prevalence, coinfection with other viruses, underlying genetic evolution, recombination, and molecular biological characteristics of goose circovirus (GoCV) in Guangdong, China, from December 2019 to August 2020, 310 tissue samples of geese showing stunted growth and feather disorder syndrome were collected from this region and analyzed. GoCV, Tembusu virus, waterfowl paramyxovirus, avian influenza virus, fowl adenovirus type 4, and duck plague virus were detected with PCR or real-time PCR. Thirty-one complete GoCV viral genomes were obtained from 164 PCR-verified GoCV nucleotide-positive samples and subjected to phylogenetic analysis, gene recombination analysis, and genome secondary structure prediction. The results showed that more than half of the samples were GoCV positive, and 31.1% of the GoCV-positive samples were from coinfections with at least one of the other viruses. The phylogenetic analysis showed that the GoCVs could be divided into three genome types. The genes of most main epidemic strains now circulating in Guangdong belonged to the Ia subtype, and some strains gradually formed a new Ib subtype. The secondary structure of the viral genome was similar to that of other known circoviruses. Furthermore, B cell linear epitope prediction and protein structure homology modeling of the viral capsid protein were performed based on the viral amino acid sequences. The results showed that the spatial structure of the capsid protein of the 31 sequenced strains was similar to that of duck circovirus and consisted of two ß-sandwich conformations. A total of five B cell linear epitopes were predicted, and four of them were mapped on the predicted model of the capsid protein of GoCVs. This report provides a reference for the epidemiology of GoCV in Guangdong, understanding the elemental composition of the virus genes and proteins, selecting representative vaccine strains, constructing targeted immune preparations for GoCV, and strengthening prevention and control of the disease.

Prevalencia, coinfección y características evolutivas y moleculares del circovirus del ganso prevalente en Guangdong, China. Para comprender la prevalencia, la coinfección con otros virus, su evolución genética subyacente, la recombinación y las características biológicas moleculares del circovirus del ganso (GoCV) en Guangdong, China, de diciembre de 2019 a agosto de 2020, 310 se recolectaron muestras de tejido de gansos que presentaban retraso en el crecimiento y síndrome del trastorno de las plumas en esta región y fueron analizadas. Se detectaron mediante PCR o por PCR en tiempo real el circovirus del ganso, el virus Tembusu (TMUV), el paramixovirus de aves acuáticas (WFPV), el virus de la influenza aviar (AIV), el adenovirus del pollo tipo 4 (Fadv-4) y el virus de la enteritis viral del pato (DPV). Se obtuvieron 31 genomas virales completos del circovirus del ganso de 164 muestras positivas de nucleótidos de circovirus del ganso verificadas por PCR y se sometieron a análisis filogenético, a análisis de recombinación de genes y predicción de la estructura secundaria del genoma. Los resultados mostraron que más de la mitad de las muestras eran positivas para circovirus del ganso y el 31.1% de las muestras positivas para circovirus del ganso eran de coinfecciones con al menos uno de los otros virus. El análisis filogenético mostró que los circovirus del ganso podrían dividirse en tres tipos de genomas. Los genes de la mayoría de las principales cepas epidémicas que ahora circulan en Guangdong pertenecían al subtipo Ia, y algunas cepas formaron gradualmente un nuevo subtipo Ib. La estructura secundaria del genoma viral era similar a la de otros circovirus conocidos. Además, la predicción del epítope lineal de células B y el modelo de la homología de la estructura de la proteína de la cápside viral se realizaron basándose en las secuencias de aminoácidos virales. Los resultados mostraron que la estructura espacial de la proteína de la cápside de las 31 cepas secuenciadas era similar a la del circovirus de pato y consistía de dos conformaciones de tipo sándwich ß. Se predijo un total de cinco epítopes lineales de células B y cuatro de ellos se mapearon en el modelo predicho de la proteína de la cápside del circovirus del ganso. Este informe proporciona una referencia para la epidemiología de circovirus del ganso en Guangdong, entendiendo la composición elemental de los genes y proteínas del virus, seleccionando cepas de vacunas representativas, construyendo preparaciones de blancos inmunitarios para circovirus del ganso y fortaleciendo la prevención y el control de la enfermedad.

Use of Facebook by Academic Medical Centers in Taiwan During the COVID-19 Pandemic: Observational Study.

BACKGROUND: The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan's success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success. OBJECTIVE: This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic. METHODS: We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19-related posts or non-COVID-19-related posts. COVID-19-related posts were split into 4 categories: policy of Taiwan's Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of "likes," number of messages left, number of shares, video or non-video post, and date of search. RESULTS: The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more "likes," comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook. CONCLUSIONS: Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19.

The decade long achievements of China's marine ecological civilization construction (2006-2016).

China needs to balance between current population pressures and a vulnerable marine environment, creating a national, political outline or management strategy dubbed an ecological civilization construction. The nation's effort to protect and maintain a sustainable ocean and address the relevant economic, resource and environmental issues relies on Marine Ecological Civilization (MEC) construction. The quantification of MEC progress is essential to track the management performance and guide the subsequent development and implementation. This study evaluates the performance of China's MEC from 2006 to 2016 based on a comprehensive index system. Our findings are as follows: During 2006-2016, the overall MEC performance score increased from 0.3426 to 0.4850 nationwide. Large space-time variations exist among the eleven coastal regions. The Shandong and Guangdong regions showed relatively good performances, whereas the Jiangsu, Guangxi and Shanghai regions had low scores. A decade long change in MEC scores showed that Hebei achieved the largest increase ratio. Marine management was improved by implementing various conservation strategies by China's government. Marine education and human talent introduction deserve more attention in less developed areas such as Hainan and Guangxi, and poor marine environmental quality was an urgent issue of the Yangtze river estuary economic zone. More accessible marine monitoring dataset are needed to track future space-time progress dynamics towards MEC construction. Our results provide a decade long retrospect of China's MEC achievements, and the quantified evaluation for each coastal region can provide valuable insight to policy-makers.

Transvaginal management of symptomatic complex urethral diverticula by definite closure of diverticula and robust reconstruction of the urethra.

BACKGROUND: Management of complex urethral diverticula (UDs) is challenging not only for the ostia detection and urethral reconstruction in surgery but also for the high risk of postoperative complications. We aimed to present the experience of surgical management for UDs by transvaginal partial diverticulectomy and urethral reconstruction. METHODS: The database of medical record library was retrospectively searched for patients underwent partial diverticulectomy for symptomatic complex UDs. During the surgical procedure, the cystourethroscopy was firstly performed to locate the diverticular ostium. The surgeon exposed and opened the diverticulum along its maximum axis. The surgeon recorded the location of ostia where saline solution flowed out, when one assistant pressed suprapubic region to increase inner-pressure of bladder and urethra. We focused on definite closure of diverticular ostia and robust urethral reconstruction. RESULTS: The present study included 39 patients with mean age of 45 years. There were 28 patients, 23 patients and 21 patients suffering from recurrent urinary infection, frequency and urgency. Ten patients had stress urinary incontinence. All of the 39 patients had complex UDs because of U-shaped diverticula (24/39) and circumferential diverticula (15/39). Multiloculated UDs were detected in 17 out of 39 patients. During the median follow-up time of 2.0 (1.0-12.0) years, there was no case of de novo urinary incontinence. However, 2 patients still had mild stress urinary incontinence without additional treatment. At postoperative 3 months, five patients had para-urethral cysts with the size ranging from 0.3 to 0.4 cm, which were absorbed in follow-up. CONCLUSIONS: The method of transvaginal partial diverticulectomy, definite closure of diverticular ostium, and layered reconstruction of the urethra is a feasible surgical alternative for UDs.

Global impact of atmospheric arsenic on health risk: 2005 to 2015.

Arsenic is a toxic pollutant commonly found in the environment. Most of the previous studies on arsenic pollution have primarily focused on arsenic contamination in groundwater. In this study, we examine the impact on human health from atmospheric arsenic on the global scale. We first develop an improved global atmospheric arsenic emission inventory and connect it to a global model (Goddard Earth Observing System [GEOS]-Chem). Model evaluation using observational data from a variety of sources shows the model successfully reproduces the spatial distribution of atmospheric arsenic around the world. We found that for 2005, the highest airborne arsenic concentrations were found over Chile and eastern China, with mean values of 8.34 and 5.63 ng/m3, respectively. By 2015, the average atmospheric arsenic concentration in India (4.57 ng/m3) surpassed that in eastern China (4.38 ng/m3) due to the fast increase in coal burning in India. Our calculation shows that China has the largest population affected by cancer risk due to atmospheric arsenic inhalation in 2005, which is again surpassed by India in 2015. Based on potential exceedance of health-based limits, we find that the combined effect by including both atmospheric and groundwater arsenic may significantly enhance the risks, due to carcinogenic and noncarcinogenic effects. Therefore, this study clearly implies the necessity in accounting for both atmospheric and groundwater arsenic in future management.

The climate impact on atmospheric stagnation and capability of stagnation indices in elucidating the haze events over North China Plain and Northeast China.

In this study, the spatial pattern and temporal evolution of PM2.5 over North China Plain (NCP) and Northeast China (NEC) during 2014-2018 was investigated. The annual mean PM2.5 shows clear decreasing trends over time, but the seasonal mean PM2.5 as well as the seasonal total duration and frequency of haze days shows large inter-annual fluctuation. Based on the atmospheric stagnation index (ASI), this study examined the correlation between ASI and haze events over NCP and NEC. Detailed analysis indicates that location dependency exists of ASI in the capability of capturing the haze events, and the ability is limited in NCP. Therefore, we first propose two alternative methods in defining the ASI to either account for the lag effect or enlarge the threshold value of wind speed at 500 hPa. The new methods can improve the ability of ASI to explain the haze events over NEC, though marginal improvement was achieved in NCP. Furthermore, this study constructed the equation based on the boundary layer height and wind speed at 10-meter, apparently improving the ability in haze capture rate (HCR), a ratio of haze days during the stagnation to the total haze days. Based on a multi-model ensemble analyses under Representative Concentration Pathway (RCP) 8.5, we found that by the end of this century, climate change may lead to increases in both the duration and frequency of wintertime stagnation events over NCP. In contrast, the models predict a decrease in stagnant events and the total duration of stagnation in winter over NEC.

Expression and prognostic value of PD-L1 in non-schistosoma-associated urinary bladder squamous cell carcinoma.

BACKGROUND: Non-schistosoma-associated urinary bladder squamous cell carcinoma (SqCC) has low incidence and is associated with chronic inflammation. Due to its unique etiology and pathology, expression of programmed cell death ligand 1 (PD-L1) in SqCC could be different from that of urothelial carcinoma, which may contribute to different responses to immunotherapy. In this study, we intended to explore the expression profile and prognostic value of PD-L1 in non-schistosoma-associated urinary bladder SqCC under the consideration of tumor-infiltrating lymphocytes' (TILs) density. METHODS: We conducted a retrospective study to review 604 bladder cancer patients who received radical cystectomy (RC) from 2009 to 2013 in Peking University First Hospital. We enrolled 67 bladder SqCC patients in total, including pure SqCC (n=19) and mixed SqCC (n=48, with urothelial carcinoma). PD-L1 protein expression and TILs density were evaluated by immunohistochemistry. RESULTS: Nine female and 58 male patients (median age 67.4 years) were enrolled in the present study. There were 15 stage T1-2 patients and 52 stage T3-4 patients. 27 patients had N1-2 lymph node metastasis. Overall, 61.2% cases were PD-L1-positive. Dense TILs coincided with higher PD-L1 expression rate. Median survival time of PD-L1 positive cases was significantly higher than negative cases (P=0.026). During multivariate analysis, positive PD-L1 expression and dense TILs were independent protective factors affecting overall survival (OS, PD-L1: P=0.022; TILs: P=0.010) and progression free survival (PFS, PD-L1: P=0.018; TILs: P=0.009). CONCLUSIONS: PD-L1 expression and dense TILs were frequently detected in urinary bladder SqCC tumors. Positive PD-L1 expression and dense TILs were correlated with better survival outcomes in non-schistosoma-associated urinary bladder SqCC. The immunotherapy targeting PD-L1 might be helpful to bladder SqCC patients.