Synthetic minority over-sampling technique-enhanced machine learning models for predicting recurrence of postoperative chronic subdural hematoma.

Objective: Chronic subdural hematoma (CSDH) is a neurological condition with high recurrence rates, primarily observed in the elderly population. Although several risk factors have been identified, predicting CSDH recurrence remains a challenge. Given the potential of machine learning (ML) to extract meaningful insights from complex data sets, our study aims to develop and validate ML models capable of accurately predicting postoperative CSDH recurrence. Methods: Data from 447 CSDH patients treated with consecutive burr-hole irrigations at Wenzhou Medical University's First Affiliated Hospital (December 2014-April 2019) were studied. 312 patients formed the development cohort, while 135 comprised the test cohort. The Least Absolute Shrinkage and Selection Operator (LASSO) method was employed to select crucial features associated with recurrence. Eight machine learning algorithms were used to construct prediction models for hematoma recurrence, using demographic, laboratory, and radiological features. The Border-line Synthetic Minority Over-sampling Technique (SMOTE) was applied to address data imbalance, and Shapley Additive Explanation (SHAP) analysis was utilized to improve model visualization and interpretability. Model performance was assessed using metrics such as AUROC, sensitivity, specificity, F1 score, calibration plots, and decision curve analysis (DCA). Results: Our optimized ML models exhibited prediction accuracies ranging from 61.0% to 86.2% for hematoma recurrence in the validation set. Notably, the Random Forest (RF) model surpassed other algorithms, achieving an accuracy of 86.2%. SHAP analysis confirmed these results, highlighting key clinical predictors for CSDH recurrence risk, including age, alanine aminotransferase level, fibrinogen level, thrombin time, and maximum hematoma diameter. The RF model yielded an accuracy of 92.6% with an AUC value of 0.834 in the test dataset. Conclusion: Our findings underscore the efficacy of machine learning algorithms, notably the integration of the RF model with SMOTE, in forecasting the recurrence of postoperative chronic subdural hematoma. Leveraging the RF model, we devised an online calculator that may serve as a pivotal instrument in tailoring therapeutic strategies and implementing timely preventive interventions for high-risk patients.

Application of Dual-Layer Spectral-Detector Computed Tomography Angiography in Identifying Symptomatic Carotid Atherosclerosis: A Prospective Observational Study.

BACKGROUND: Dual-layer spectral-detector dual-energy computed tomography angiography (DLCTA) can distinguish components of carotid plaques. Data on identifying symptomatic carotid plaques in patients using DLCTA are not available. METHODS AND RESULTS: In this prospective observational study, patients with carotid plaques were enrolled and received DLCTA. The attenuation for both polyenergetic image and virtual monoenergetic images (40, 70, 100, and 140 keV), as well as Z-effective value, were recorded in the noncalcified regions of plaques. Logistic regression models were used to assess the association between attenuations of DLCTA and the presence of symptomatic carotid plaques. In total, 100 participants (mean±SD age, 64.37±8.31 years; 82.0% were men) were included, and 36% of the cases were identified with the symptomatic group. DLCTA parameters were different between 2 groups (symptomatic versus asymptomatic: computed tomography [CT] 40 keV, 152.63 [interquartile range (IQR), 70.22-259.78] versus 256.78 [IQR, 150.34-408.13]; CT 70 keV, 81.28 [IQR, 50.13-119.33] versus 108.87 [IQR, 77.01-165.88]; slope40-140 keV, 0.91 [IQR, 0.35-1.87] versus 1.92 [IQR, 0.96-3.00]; Z-effective value, 7.92 [IQR, 7.53-8.46] versus 8.41 [IQR, 7.94-8.92]), whereas no difference was found in conventional polyenergetic images. The risk of symptomatic plaque was lower in the highest tertiles of attenuations in CT 40 keV (adjusted odds ratio [OR], 0.243 [95% CI, 0.078-0.754]), CT 70 keV (adjusted OR, 0.313 [95% CI, 0.104-0.940]), Z-effective values (adjusted OR, 0.138 [95% CI, 0.039-0.490]), and slope40-140 keV (adjusted OR, 0.157 [95% CI, 0.046-0.539]), with all P values and P trends <0.05. The areas under the curve for CT 40 keV, CT 70 keV, slope 40 to 140 keV, and Z-effective values were 0.64, 0.61, 0.64, and 0.63, respectively. CONCLUSIONS: Parameters of DLCTA might help assist in distinguishing symptomatic carotid plaques. Further studies with a larger sample size may address the overlap and improve the diagnostic accuracy.

Association between body stature and prevalence of reduced visual acuity in high school graduates in Hangzhou, China.

CLINICAL RELEVANCE: The association between myopia and body stature is of great significance for understanding prevention and control of myopia. It has been extensively studied in previous studies but without consistent conclusions. BACKGROUND: The aim of this study is to investigate the association between body stature and prevalence of reduced visual acuity in high school graduates in Hangzhou, China. METHODS: 50,620 high school graduates who finished the physical examination of the national college entrance examination in 2020 were included. Data were derived from the database of physical examination of the national college entrance examination. Height and weight were measured, and body mass index (BMI) was calculated according to the general formula. Visual acuity was measured by the standard logarithmic visual acuity chart. RESULTS: The prevalence of reduced visual acuity was 90.38% in high school graduates. Girls had a higher prevalence of reduced visual acuity than boys (93.07% vs 87.60%, P < 0.001). Boys with normal visual acuity were significantly taller (P < 0.001) and heavier (P < 0.001) than those with reduced visual acuity. Girls with normal visual acuity were significantly taller than those with reduced visual acuity (P < 0.001). The prevalence of reduced visual acuity was significantly inversely associated with height in both boys (P < 0.001) and girls (P < 0.001). The risk of reduced visual acuity was the lowest in the fourth quartile of height. The prevalence of reduced visual acuity was significantly associated with BMI only in boys (P < 0.001). The risk of reduced visual acuity was the lowest in the third quartile of BMI. CONCLUSIONS: The prevalence of reduced visual acuity was inversely associated with height in both boys and girls, and there was a U-shaped association with BMI only in boys.

Cosmetic augmentation of lower-lid pretarsal roll with injection of autologous fat for Asians.

BACKGROUND: Autologous fat has the advantages of regeneration, rejuvenation, homology, and support. There are currently no reports indicating that injecting autologous fat enhances the fullness of the lower-lid pretarsal roll. OBJECTIVES: In this retrospective, non-randomized study, the effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll were evaluated by comparison of preoperative and postoperative photographs and patient satisfaction during the follow-up. METHODS: First, fat tissues were manually sucked with a 20-ml syringe connected to a 2.5-mm three-hole liposuction cannula. The treated fat tissues were transferred to a 10-ml syringe and centrifuged at 2000 rpm for 2 min, and then the fibrous tissues were manually removed. Finally, autologous fat was injected using a 1-ml syringe linked to a sharp needle. RESULTS: Forty-seven patients who underwent surgery between 2018 and 2021 were retrospectively evaluated. Only three patients showed obvious asymmetry or uneven outlines after surgery and underwent a second fat injection. During recovery, bruising and minor contouring irregularities obviously improved after 1 or 2 weeks. Eight patients, who had severe bruising, were able to make a full recovery in more than 2 weeks. No patients experienced serious complications. All patients ultimately displayed pretarsal fullness in their lower eyelids and were satisfied with their outcomes. CONCLUSION: The effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll are long-lasting, esthetic, and safe.

Rapid detection of multiple antibiotics in chicken samples via a fluorescence nanobiosensor coupled with a homemade fluorescence analyzer.

Antibiotic residues in foods pose a serious threat to human health. However, routine analysis techniques require bulky laboratory instruments and skilled personnel or give single-channel analysis results, exhibiting low practicality. Here, we explored a rapid and easy-to-use detection system combining a fluorescence nanobiosensor with a homemade fluorescence analyzer for the simultaneous identification and quantification of multiple antibiotics. The nanobiosensor assay worked based on the targeted antibiotics competing with signal labels of antigen-quantum dots (IQDs) to bind with recognition elements of antibody-magnetic beads (IMBs). The fluorescence signals of IMB-unbound IQDs in a magnetically separated supernatant, related to antibiotic concentration, were automatically collected and processed by our self-designed and homemade fluorescence analyzer which integrated mechanical control hardware (consisting of a mechanical arm, a ten-channel rotary bench, and an optical detection unit) and user control software (installed on a built-in laptop). The fluorescence analyzer enabled the analysis of 10 samples within 5 min in one round and permitted the real-time uploading of sample data to the cloud. By employing three QDs with emission wavelengths of 525 nm, 575 nm, and 625 nm, this multiplex fluorescence biosensing system demonstrated great sensitivity and accuracy for simultaneously analyzing enrofloxacin, tilmicosin, and florfenicol in chicken samples with detection limits of 0.34 µg kg-1, 0.7 µg kg-1, and 0.16 µg kg-1, respectively. Moreover, the biosensing platform performed well in a wealth of chicken samples covering various breeds from three Chinese cities. This study identifies a generic and user-friendly multiplex biosensor platform with significant potential for use in food safety and regulation.

A profile of patients' and doctors' perceptions, acceptance, and utilization of e-health in a deprived region in southwestern China.

BACKGROUND: E-health has the potential to promote health accessibility, performance and cost-saving. However, the adoption and penetration of e-health in underprivileged areas remains insufficient. We aim to investigate patients' and doctors' perception, acceptance, and utilization of e-health in a rural, spatially isolated and poverty-stricken county in southwestern China. METHODS: A retrospective analysis based on a cross-sectional survey of patients and doctors in 2016 was conducted. Participants were recruited through convenience and purposive sampling, and questionnaires were self-designed and validated by investigators. The utilization, intention to use and preference of four e-health services were evaluated, including e-appointment, e-consultation, online drug purchase, and telemedicine. Predictors of utilization and intention to use e-health services were investigated by multivariable logistic regression. RESULTS: A total of 485 patients were included. The utilization rate of any type of e-health services was 29.9%, ranging from 6% in telemedicine to 18% in e-consultation. Additionally, 13.9%-30.3% of respondents as non-users revealed their willingness to use such services. Users and potential users of e-health services were inclined to specialized care from county, city or province hospitals, and they were most concerned with the quality, ease of use and price of e-health service. Patients' utilization and intention to use e-health could be associated with education and income level, cohabitants, working location, previous medical utilization, and access to digital device and internet. There remained 53.9%-78.3% of respondents reluctant to use e-health services, mainly due to perceived inability to use them. Of 212 doctors, 58% and 28% had provided online consultation and telemedicine before, and over 80% of county-hospital doctors (including actual providers) indicated their willingness to provide such services. Reliability, quality and ease of use were doctors' major concerns regarding e-health. Doctors' actual provision of e-health was predicted by their professional title, number of years in work, satisfaction with the wage incentive system, and self-rated health. Nevertheless, their willingness to adopt was only associated with the possession of smartphone. CONCLUSIONS: E-health is still in its infancy in western and rural China, where health resources are most scarce, and where e-health could prove most beneficial. Our study reveals the wide gaps between patients' low usage and their certain willingness to use e-health, as well as gaps between patients' moderate attention to use and physician's high preparedness to adopt e-health. Patients' and doctors' perceptions, needs, expectations, and concerns should be recognized and considered to promote the development of e-health in these underprivileged regions.

A Meaningful Strategy for Glioma Diagnosis via Independent Determination of hsa_circ_0004214.

Glioma is one of the most common primary tumors in the central nervous system. Circular RNAs (circRNAs) may serve as novel biomarkers of various cancers. The purpose of this study is to reveal the diagnostic value of hsa_circ_0004214 for glioma and to predict its molecular interaction network. The expression of hsa_circ_0004214 was evaluated by RT-qPCR. The vector and siRNAs changed the expression of hsa_circ_0004214 to judge its influence on the migration degree of glioma cells. hsa_circ_0004214 can be stably expressed at a high level in high-grade glioma tissue (WHO III/IV). The area under the ROC curve of hsa_circ_0000745 in glioma tissue was 0.88, suggesting good diagnostic value. While used to distinguish high-grade glioma, AUC value can be increased to 0.931. The multi-factor correlation analysis found that the expression of hsa_circ_0004214 was correlated with GFAP (+) and Ki67 (+) in immunohistochemistry. In addition, the migration capacity of U87 was enhanced by overexpression of hsa_circ_0004214. Through miRNA microarray analysis and database screening, we finally identified 4 miRNAs and 9 RBPs that were most likely to interact with hsa_circ_0004214 and regulate the biological functions of glioma. Hsa_circ_0004 214 plays an important role in glioma, its expression level is a promising diagnostic marker for this malignancy.

Comprehensive assessment of the ecological risk of exposure to triphenyl phosphate in a bioindicator tadpole.

The toxicity of triphenyl phosphate (TPhP) to aquatic organisms in surface waters has been demonstrated; However, an understanding of toxicity profiles of TPhP in amphibians is limited. Therefore, the adverse effects and threshold concentrations of TPhP on metamorphosis, growth, locomotion, and hepatic antioxidants of Gosner stage 25 Polypedates megacephalus tadpoles under long-term (35 d) exposure to six TPhP concentrations until complete metamorphosis were assessed. Additionally, the overall effect of using integrated multiple biomarkers were determined to demonstrate the potential ecological risks of waterborne TPhP at environmentally relevant concentrations in amphibian tadpoles. With increasing TPhP concentrations, physical parameters (snout-vent length, body mass, condition factor, and hepatic somatic index), jumping distance, hepatic catalase, and superoxide dismutase activities decreased, whereas metamorphosis time and malondialdehyde content increased. The threshold concentration of TPhP that affected the tadpole biomarker, except for metamorphosis rate and jumping distance, was 50-400 µg/L. Furthermore, the standardized scores of the examined integrated biomarkers in the six TPhP concentrations were visualized using radar plots and calculated as the integrated biomarker responses (IBRs). The varying TPhP concentrations had different scores in the radar plots, and the threshold for affecting the IBR value was 10 µg/L, which was close to the TPhP concentration in surface waters. Additionally, IBR values were strongly positively correlated with the TPhP concentrations. These findings indicate that environmentally relevant exposure to waterborne TPhP can pose an ecological risk to amphibian tadpoles. This study can serve as a reference and assist in the formulation of relevant policies and strategies to control TPhP pollution in water bodies.

Trends in growth and nutritional status of high school graduates in Hangzhou, China, 2011-2020.

BACKGROUND: During past decades, there was a positive trend in growth and nutrition status of adolescents in China, but there was significant regional disparity. The purpose of this study is to investigate the trends in growth and nutritional status of high school graduates in Hangzhou between 2011 and 2020. METHODS: High school graduates (Grade 12) who finished the physical examination of the national college entrance examination between 2011 and 2020 (n=481,353)were included in this study. Data were obtained from the database of physical examination of the national college entrance exam. Height and weight were measured; body mass index (BMI) was calculated from height and weight. Thinness, overweight and obesity were defined according to the International Obesity Task Force criteria. For the vast majority of the high school graduates were 18 years old or nearly 18 years old, the cutoffs of 18 years were adopted. Those are 18.5, 25 and 30 kg/m2, for thinness, overweight and obesity respectively. RESULTS: There was a significant growth trend in height, weight and BMI in both sexes (P < 0.001). Height increased by 1.80 cm in boys and 1.45 cm in girls. Weight increased by 4.62 kg in boys and 2.51 kg in girls. BMI increased by 1.09 kg/m2 in boys and 0.60 kg/m2 in girls. An increase trend was found in the prevalence of overweight and obesity in both sexes (P < 0.001). Overweight increased by 7.43% (from 9.05 to 16.48%) among boys and 4.05% (from 4.57 to 8.62%) among girls. Obesity increased by 3.85% (from 2.29 to 6.14%) among boys and 1.76% (from 0.64 to 2.40%) among girls. The prevalence of thinness fluctuated in both boys and girls, 12.42-15.59% among boys and 18.97-23.68% among girls. Boys had higher odds of overweight and obesity and lower odds of thinness than girls (P < 0.001). CONCLUSIONS: There is a positive trend in growth and nutritional status of high school graduates in Hangzhou. However, there is still a considerable prevalence of thinness, it indicates a double burden of undernutrition and overnutrition.

A rare presentation of lung squamous cell carcinoma metastasis to the distal phalanx of the little finger: a case report.

Lung cancer is one of the most common malignant tumors worldwide. Early detection is the most important factor that affects the prognosis of lung cancer patients. The distal phalanx is a highly unusual metastatic site of lung cancer, and is often misdiagnosed, especially when accompanied by trauma. Herein, we present the case of a 68-year-old male patient who injured his right little finger. We hope this rare case will help clinicians to better diagnosis acral metastases of lung cancer to prolong patient survival.

Associations of Sex Hormone-binding Globulin with Bone Mineral Density Among US Adults, NHANES 2013-2016.

BACKGROUND: Bone metabolism can be influenced by sex steroid hormones. However, the relationship between sex steroid hormones and bone mineral density (BMD) remains inconsistent. Our study explored existing evidence of the association between sex hormones, blood glucose and BMD. METHODS: We conducted a cross-sectional study of 6434 participants aged 18-80 years in the National Health and Nutrition Examination Survey (NHANES) 2013-2016 to assess the association between SHBG and BMD. The multivariable linear regression models were performed to evaluate the associations between testosterone, estrogen, sex hormone-binding globulin (SHBG) and BMD. RESULTS: On adjustment for traditional risk factors (age, BMI, ALB, ALK, ASP, calcium, cholesterol, potassium, sodium, total protein, uric acid), SHBG could be regarded as an independent predictor for BMD, while fasting blood glucose did not. SHBG levels were significant associated with BMD in the multivariate model; however, it will be a different effect between the genders. On comparative analysis, high level SHBG was predictive of lumbar BMD irrespective of other two sex steroid hormones. CONCLUSION: This study indicated that SHBG may improve the predictive value for bone loss in adults.

TRPC5 mediates TMZ resistance in TMZ-resistant glioblastoma cells via NFATc3-P-gp pathway.

P-glycoprotein (P-gp) acts as a pump to transport cytotoxic drugs out of cells and is upregulated in cancer cells. Suppressing the expression of P-gp is an effective strategy to overcome multidrug resistance in cancer chemotherapy. Temozolomide (TMZ) is the recommended drug for the standard treatment of patients with glioblastoma, but its clinical application is restricted due to drug resistance. Transient receptor potential channel-5 (TRPC5), a Ca2+-permeable channel, has been attributed to a different drug resistance mechanism except DNA repair system; therefore, we aimed to elucidate the mechanism regarding the role of TRPC5 in TMZ resistance. TRPC5 and P-glycoprotein (P-gp) are upregulated in TMZ-resistant glioblastoma cell lines. The downregulation of TRPC5 inhibited P-gp expression and led to a significant reversal of TMZ resistance in TMZ-resistant cell lines. TRPC5-siRNA restricted the growth of tumour xenografts in an athymic nude mouse model of TMZ-resistant cells. In specimens from patients with recurrent glioblastoma, TRPC5 was found to be highly expressed, accompanied by the upregulation of P-gp expression. The nuclear factor of activated T cell isoform c3 (NFATc3), which acts as a transcriptional factor, bridges TRPC5 activity to P-gp induction. In conclusion, these results demonstrate the functional role of the TRPC5-NFATc3-P-gp signalling pathway in TMZ resistance in glioblastoma cells.

Complete mitochondrial genome of the Red Keelback (Pseudagkistrodon rudis Boulenger, 1906).

The Red Keelback (Pseudagkistrodon rudis Boulenger, 1906) is widely distributed in the southern of China. The complete mitochondrial genome (mitogenome) of P. rudis was determined for the first time by using next-generation sequencing. The size of assembled mitogenome for P. rudis was 19,150 bp, which included 13 protein coding genes (PCGs), 22 tRNAs, two rRNAs and two control regions (d-loop1 and d-loop2). The Bayesian tree showed that P. rudis and Rhabdophis tigrinus have a closed relationship. These results can provide data for phylogeny and molecular classification of the genus.

Upgrade of far infrared three-wave polarimeter-interferometer system on Joint-TEXT.

The far infrared polarimeter-interferometer system (POLARIS) on the Joint-TEXT has been upgraded recently. A new support structure has been applied to the mixer array of the POLARIS for adjusting the position of the mixers precisely. Five detection chords have been added to the system on the low field side by optimizing the utilization efficiency of the laser beams on both sides of the beam splitting grid. The spatial resolution can be improved from 3 to 1.5 cm. A better measurement on plasma electron density and current density has been obtained after the system is upgraded. The initial experimental result will be introduced along with the upgrade details.

Design of a dispersion interferometer on a field-reversed configuration device.

Dispersion interferometry (DI) is a promising method for density measurement. Compared with the traditional interferometer, the DI is immune to mechanical vibration and can avoid the fringe jump error. In addition, a simple optical configuration is also one of the advantages of the DI. The electron density of the Huazhong University of Science and Technology field-reversed configuration (HFRC) device can reach 1020 m-3 with a pulse length of 50 µs. In this case, the DI based on the CO2 laser on the HFRC device adopts the heterodyne technique based on the acousto-optic modulator, which can increase the temporal resolution to 40 MHz. It can realize density fluctuation measurements in the MHz range. The test of each optical element, especially the nonlinear crystal, has been completed. The AgGaSe2 crystal can produce a second harmonic wave of about 52.5 µW when the incident CO2 power is 10 W. Based on these designs and tests, a DI system can be expected on the HFRC device.

Complete mitochondrial genome of the Bingzhi's stout newt (Pachytriton granulosus Chang, 1933) and its phylogenetic placement.

The Bingzhi's stout newt (Pachytriton granulosus Chang, 1933) is distributed in mountainous areas of Zhejiang, China. The first complete mitochondrial genome (mitogenome) of P. granulosus was determined by next-generation sequencing. The size of the assembled mitogenome for P. granulosus was 16,293 bp, which included 13 protein coding genes, 22 tRNAs, 2 rRNAs, a non-coding region, and a control region (D-loop). The phylogenetic analysis using Bayesian Inference validated the taxonomic status of P. granulosus, showing the close relationship with the other two species from the genus Pachytriton.

Complete Genome Sequence of Enterobacter roggenkampii Strain KQ-01, Isolated from Bacterial Wilt-Resistant Mulberry Cultivar YS283.

An Enterobacter roggenkampii strain, named KQ-01, was isolated for the first time from the diseased roots of the bacterial wilt-resistant mulberry (Morus atropurpurea) cultivar YS283 in the western part of Guangxi Zhuang Autonomous Region, China. E. roggenkampii KQ-01 was characterized by a single, circular chromosome of 4,667,006 bp in size, with a 56.16% GC content. In total, 4,396 genes were annotated, of which 4,281 were assigned as protein-coding genes. In addition, 25 ribosomal RNA, 84 transfer RNA, and 6 noncoding RNA genes as well as 34 pseudogenes were predicted. The resource herein presented will help to explore the pathogenetic mechanisms of mulberry wilt disease caused by genus Enterobacter.

[Study on vascular remodeling, inflammatory response, and their correlations in acute spinal cord injury in rats].

OBJECTIVE: To study the local vascular remodeling, inflammatory response, and their correlations following acute spinal cord injury (SCI) with different grades, and to assess the histological changes in SCI rats. METHODS: One hundred and sixteen adult female Sprague Dawley rats were randomly divided into 4 groups ( n=29). The rats in sham group were received laminectomy only. A standard MASCIS spinal cord compactor was applied with drop height of 12.5, 25.0, or 50.0 mm to establish the mild, moderate, or severe SCI model, respectively. Quantitative rat endothelial cell antigen 1 (RECA1) and CD68 positive areas and the correlations were studied by double immunofluorescent (DIF) staining at 12 hours, 24 hours, 3 days, 7 days, and 28 days following SCI. Moreover, qualitative neurofilament-H (NF-H) and glial fibrillary acidic protein (GFAP) positive glial cells were studied by DIF staining at 28 days. ELISA was used to detect the levels of tumor necrosis factor α (TNF-α), interleukin 1ß (IL-1ß), and IL-6 in spinal cord homogenates at 12 hours, 24 hours, and 3 days, and the correlations between TNF-α, IL-1ß, or IL-6 levels and microvascular density (RECA1) were accordingly studied. Moreover, the neural tissue integrity and neuron damage were assessed by HE staining at 12 hours, 24 hours, 3 days, 7 days, and 28 days, and Nissl's staining at 28 days following SCI, respectively. RESULTS: DIF staining revealed that the ratio of RECA1 positive area was the highest in moderate group, higher in mild and severe groups, and the lowest in sham group with significant differences between groups ( P<0.05). The ratio of CD68 positive area was the highest in severe group, higher in moderate and mild groups, and the lowest in sham group with significant differences between groups ( P<0.05), except the comparisons between mild and moderate groups at 24 hours and 28 days after SCI ( P>0.05). There was no significant correlation between the RECA1 and CD68 expressions in sham group at different time points ( P>0.05). At 12 and 24 hours after SCI, the RECA1 and CD68 expressions in mild and moderate groups showed significant positive correlations ( P<0.05), while no significant correlation was found in severe group ( P>0.05). No significant correlations between the RECA1 and CD68 expressions was shown in all SCI groups at 3 days and in severe group at 7 days ( P>0.05), while the negative correlations were shown in mild and moderate groups at 7 days, and in all SCI groups at 28 days ( P<0.05). In mild, moderate, and severe groups, the axons became disrupted, shorter and thicker rods-like, or even merged blocks with increased injury, while the astrocytes decreased in number, unorganized and condensed in appearance. ELISA studies showed that TNF-α, IL-1ß, and IL-6 levels in sham group were significantly lower than those in other 3 groups at different time points ( P>0.05). The differences in TNF-α, IL-1ß, and IL-6 levels between SCI groups at different time points were sinificant ( P<0.05), except IL-1ß levels between the mild and moderate groups at 12 hours ( P>0.05). Three inflammatory factors were all significantly correlated with the microvascular density grades ( P<0.05). Histological analysis indicated that the damage to spinal cord tissue structure correlated with the extent of SCI. In severe group, local hemorrhage, edema, and infiltration of inflammatory cells were found the most drastic, the grey/white matter boundary was disappeared concurrently with the formation of cavity and shortage of normal neurons. CONCLUSION: In the acute stage following mild or moderate SCI, progressively aggravated injury result in higher microvessel density and increased inflammation. However, at the SCI region, the relation between microvessel density and inflammation inverse with time in the different grades of SCI. Accordingly, the destruction of neural structures positively relate to the grades of SCI and severity of inflammation.

Comparing Regional Distribution Equity among Doctors in China before and after the 2009 Medical Reform Policy: A Data Analysis from 2002 to 2017.

BACKGROUND: Although China began implementing medical reforms in 2009 aimed at fair allocation of the regional distribution of doctors, little is known of their impact. This study analyzed the geographic distribution of doctors from 2002 to 2017. METHODS: This study calculated the Gini coefficient and Theil index among doctors in the eastern, central, and western regions (Category 1) of China, and in urban and rural areas (Category 2). The statistical significance of fairness changes was analyzed using the Mann-Whitney U test. RESULTS: The annual growth rates of the number of doctors for the periods from 2002 to 2009 and 2010 to 2017 were 2.38% and 4.44%. The Gini coefficients among Category 1 were lower than those in Category 2, and statistically decreased after the medical reforms (P < 0.01) but continued to increase in Category 2 (P = 0.463). In 2017, the Theil decomposition result of Category 1 was 74.33% for the between-group, and in Category 2, it was 95.22% for the within-group. CONCLUSIONS: The fairness among the regional distribution of doctors in Category 1 is now at a high level and is better than that before the reforms. While the fairness in Category 2 is worse than that before the reforms, it causes moderate inequality and is continually decreasing. Overall unfairness was found to be derived from the between-group.