Reference Criteria Research Articles

Consistency analysis of pepsin immunohistochemistry and pepsin test box in the diagnosis of laryngopharyngeal reflux

Objective:To analyze the consistency of pepsin assay kit, pepsin IHC, reflux symptom index（RSI） and reflux finding score（RFS） in the diagnosis of laryngopharyngeal reflux disease（LPRD）. Methods:The clinical data of 61 inpatients with laryngeal diseases who were admitted to the Department of Otolaryngology, the First Affiliated Hospital of Kunming Medical University from May 2020 to December 2021 were retrospectively analyzed. The RSI and RFS scores, the Formwitz score of pepsin immunohistochemistry, and the results of pepsin detection kit were recorded. ICC group correlation coefficient and Kappa consistency analysis was used for three detection methods. Results:Among 61 patients, 30 cases were positive and 31 cases were negative for the pepsin test kit, with a positive rate of 49.18%. The positive rate of pepsin immunohistochemistry was 45.90%（28/61）, and the diagnostic agreement rate between the two was 70.49%. The consistency between them was high（κ=0.409）. The positive rate of RSI and RFS in diagnosing LPRD was 62.30%（38/61）, and the consistency rate was 73.77% with pepsin detection kit. The consistency between them was high（κ=0.486）. Taking pepsin IHC as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 71.43%（20/28）, 69.70%（23/33）, 66.67%（20/30） and 74.19%（23/31）, respectively. Using RSI and RFS scales as reference criteria, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 89.29%（25/28）, 60.61%（20/33）, 65.79%（25/38） and 86.96%（20/23）, respectively. Analysis of correlation coefficient within ICC group: ICC value was 0.628, 95% confidence interval（0.497-0.741）, the three methods have good consistency. Conclusion:The RSI and RFS scale scores were in good agreement with the pepsin test kit, and the pepsin test kit was also in good agreement with pepsin immunohistochemistry. As a non-invasive diagnostic technique, the pepsin test kit can be widely used in the diagnosis of pharyngeal reflux in combination with pepsin immunohistochemistry and RSI and RFS scale.

Psychometric validation of the Chinese version of the Shirom-Melamed Burnout Questionnaire among parents of children with cancer

PurposeAlthough burnout recently emerged as a harmful syndrome in parents, no instrument has been validated to suitably assess burnout among parents of children with cancer in China. In this study, we aimed to psychometrically validate the Shirom-Melamed Burnout Questionnaire (SMBQ) among Chinese parents of children with cancer. Design and methodsWe conducted a cross-sectional survey of 380 parents of children with cancer to psychometrically validate the SMBQ. Content validity, construct validity, convergent validity, discriminant validity, criterion-related validity, diagnosis accuracy, internal consistency, and test-retest reliability were evaluated. ResultsThe Chinese version of the SMBQ demonstrated adequate internal consistency, good test-retest reliability, good content validity, excellent convergent and discriminant validity, and appropriate criterion-related validity. Using the parental burnout assessment as a reference criterion, the area under the curve was 0.903. The optimal cut-off point for the SMBQ was 4.833. The factor model of the SMBQ used in Chinese parents of children with cancer had a good fit. The survey revealed that Chinese parents of children with cancer experienced a high level of burnout (3.86 ± 1.03). ConclusionsThe Chinese version of SMBQ was reliable and valid for assessing burnout in parents of children with cancer. Parents of children with cancer experienced a high level of burnout in China. Implications for practiceThis SMBQ can be used in Chinese clinical and research settings to investigate burnout in parents who have children with cancer. Further research could examine the predictive validity and validity.

Validity of self-reported hypertension and related factors in the adult population: Preliminary results from the cohort in the west of Iran.

This study aimed to investigate the validity of self-reported hypertension and related factors in the Dehgolan Prospective Cohort Study (DehPCS). Data were obtained from 3996 participants aged 35-70 years in the enrolment phase of DehPCS. Self-reported hypertension and sociodemographic factors were collected by well-trained interviewers before hypertension diagnosis based on the reference criteria. The history of anti-hypertensive medication use and/or systolic blood pressure ≥140 (mmHg), or diastolic blood pressure ≥90 (mmHg) were considered as hypertension. Disagreement between self-reported and reference measures was assessed using sensitivity, specificity, positive, and negative predictive values (PPV and NPV), and kappa values. Binary and multinomial logistic regressions were used to investigate the correlates of validity of self-reported hypertension. The hypertension prevalence based on self-reports and the reference criteria was 19.49% and 21.60%, respectively. An acceptable percentage of kappa agreement value of 68.7% and relatively good overall agreement of 89.8% were found. Self-reported hypertension was guaranteed moderate sensitivity of 72.0% and high specificity of 94.5%, as well as the NPV and PPV of 92/7% and 77/9%, respectively. The chances of false-positive and false-negative reporting increased with older age, higher BMI, and a family history of hypertension. Being female, older age, higher BMI, concurrent diabetes, and stronger family ties to hypertension patients significantly increased the chance of reporting true positives relative to true negatives. Although, self-reported hypertension has an acceptable validity and can be used as a valid tool for screening epidemiological studies, it needs to be investigated because its validity is affected by age, gender, family history of hypertension, and other socio-demographic characteristics.

The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation.

Atlantoaxial dislocation patients with neurological defects require surgery. Sometimes, release surgery is necessary for irreducible atlantoaxial dislocation to further achieve reduction. Whether release surgery is essential relies on the surgeon's experience and lacks objective reference criteria. To evaluate the value of atlantoaxial joint inclination angle (AAJI) in sagittal and coronal planes and reduction index (RI) in the surgical approach selection for atlantoaxial dislocation. Retrospectively analyzed 87 cases (42 males and 45 females, 9-89 years) of atlantoaxial dislocation from January 2011 to November 2020. In addition, 40 individuals without atlantoaxial dislocation were selected as the control group. Imaging parameters were compared between the two groups. According to surgical methods, the experiment group was divided into two groups including Group A(release surgery group) and Group B (conventional operation group). The parameters were measured based on CT and x-ray. The relevant imaging parameters and clinical scores, including the AAJI in sagittal and coronal planes, the atlas-dens interval (ADI) before and after traction, the RI, and JOA scores were measured and analyzed. The sagittal and coronal atlantoaxial joint inclination angles(SAAJI and CAAJI) in the control group were 7.91 ± 0.42(L), 7.99 ± 0.39°(R), 12.92 ± 0.41°(L), 12.97 ± 0.37°(R), in A were 28.94 ± 1.46°(L), 28.57 ± 1.55°(R), 27.41 ± 1.29°(L), 27.84 ± 1.55°(R), and in B were 16.16 ± 0.95°(L), 16.80 ± 1.00°(R), 24.60 ± 0.84°(L), 24.92 ± 0.93°(R) respectively. Statistical analysis showed that there was a statistical difference in the SAAJI between the control group and the experiment group (P < 0.01), as well as between groups A and B (P < 0.01). The RI in groups A and B was 27.78 ± 1.46% and 48.60 ± 1.22% respectively, and there was also a significant difference between the two groups (P < 0.01). There was negative correlation between SAAJI and RI. The SAAJI and RI can be used as objective imaging indexes to evaluate the reducibility of atlantoaxial dislocation. And these parameters could further guide the selection of surgery methods. When the RI is smaller than 48.60% and SAAJI is bigger than 28.94°, anterior release may be required.

Examining Factors of Health Information Communicant Activeness of Chinese Residents in Outdoor Activities during Public Health Emergencies

This study explores the influencing factors of residents' outdoor health information communicant activeness under public health emergencies and analyzes the relationship between cognition, motivation, and dissemination behavior. Based on the theory of perceived risk and the Situational Theory of Problem-Solving (STOPS), this study builds a model demonstrating the factors that affect the health information communicant activeness of residents' outdoor activities under public health emergencies and conducts empirical analysis through questionnaires and a structural equation model. Results showed that (1) perceived risk, problem recognition, and involvement recognition positively affected health information communicant activeness through situational motivation; (2) constraint recognition negatively affects health information communicant activeness through situational motivation; and (3) the referent criterion has a direct effect on communicant activeness. This study has great significance for understanding residents' health information communicant activeness in outdoor activities and providing them with high-quality health information services.

Application and analysis of a model with environmental transmission in a periodic environment

&lt;abstract&gt;&lt;p&gt;The goal of this paper is to introduce a non-autonomous environmental transmission model for most respiratory and enteric infectious diseases to study the impact of periodic environmental changes on related infectious diseases. The transmission and decay rates of pathogens in the environment are set as periodic functions to summarize the influence of environmental fluctuations on diseases. The solutions of the model are qualitatively analyzed, and the equilibrium points and the reference criterion, $ R_0 $, for judging the infectivity of infectious diseases are deduced. The global stability of the disease-free equilibrium and the uniform persistence of the disease are proved by using the persistence theory. Common infectious diseases such as COVID-19, influenza, dysentery, pertussis and tuberculosis are selected to fit periodic and non-periodic models. Fitting experiments show that the periodic environmental model can respond to epidemic fluctuations more accurately than the non-periodic model. The periodic environment model is reasonable and applicable for seasonal infectious diseases. The response effects of the periodic and non-periodic models are basically the same for perennial infectious diseases. The periodic model can inform epidemiological trends in relevant emerging infectious diseases. Taking COVID-19 as an example, the sensitivity analysis results show that the virus-related parameters in the periodic model have the most significant influence on the system. It reminds us that, even late in the pandemic, we must focus on the viral load on the environment.&lt;/p&gt;&lt;/abstract&gt;

Clinicians’ Perspectives on Glucose Tolerance Test Practices at a Tertiary Care Hospital in Coimbatore, Tamil Nadu, India

Introduction: The overuse of laboratory investigations is prevalent in hospital settings, with a major contributing factor being ignorance of test characteristics. The utilisation of laboratory tests depends on clinicians' perspectives. Aim: Present study aimed to assess clinicians' perspectives on Glucose Tolerance Test (GTT) practices in a tertiary care hospital in Coimbatore and identify any process deviations. Materials and Methods: A descriptive study was conducted in the Department of Biochemistry at PSG IMSR, Coimbatore, Tamil Nadu, India, involving 27 clinicians. Structured interviews were conducted in March 2019, covering indications for GTT, preferred glucose loads, fasting duration, blood sample collection time intervals, cut-off levels for glucose values at different time intervals (0, 1, 2, 3, 4 hours), and reference criteria used for interpretation {World Health Organisation (WHO), American Diabetes Association (ADA), The International Association of Diabetes and Pregnancy Study Groups (IADPSG)} . Test Request Forms (TRFs) for GTT over a one-month period were also analysed. Quantitative data was expressed as mean±SD, and qualitative data was expressed as frequency and percentage. Results: The structured interviews were conducted with 27 clinicians, predominantly from the Department of Obstetrics and Gynaecology. GTT usage was rare in other departments. A total of 217 TRFs were received for the one-month duration, with 94.9% indicating a glucose load of 75 grams (g). Conclusion: GTT is influenced by various factors throughout the testing process, that can have an impact on results and patient care. This study revealed differences between end- users' requirements and the laboratory's procedures. By revising the TRF and sample collection manual according to clinicians' needs, better optimisation between the laboratory and end-users of the test can be achieved.

Low Birth Weight is Associated with Sperm DNA Fragmentation and Assisted Reproductive Technology Outcomes in Primary Infertile Men: Results of a Cross-Sectional Study.

To assess the relationship between clinical and semen characteristics and assisted reproductive technology (ART) outcomes with different birth weight (BW) categories in a cohort of infertile men. Data from 1,063 infertile men were analyzed. Patients with BW ≤2,500, 2,500-4,000, and ≥4,000 g were considered as having low BW (LBW), normal BW (NBW), and high BW (HBW), respectively. Testicular volume (TV) was assessed with a Prader orchidometer. Serum hormones were measured in all cases. Semen analyses were categorized based on 2021 World Health Organization reference criteria. Sperm DNA fragmentation (SDF) was tested in every patient and considered pathological for SDF >30%. ART outcomes were available for 282 (26.5%) patients. Descriptive statistics and logistic regression analyses detailed the association between semen parameters and clinical characteristics and the defined BW categories. Of all, LBW, NBW, and HBW categories were found in 79 (7.5%), 807 (76.0%), and 177 (16.5%) men, respectively. LBW men had smaller TV, presented higher follicle-stimulating hormone (FSH) but lower total testosterone levels compared to other groups (all p<0.01). Sperm progressive motility (p=0.01) and normal morphology (p<0.01) were lower and SDF values were higher (all p<0.01) in LBW compared to other groups. ART pregnancy outcomes were lower in LBW compared to both NBW and HBW categories (26.1% vs. 34.5% vs. 34.5%, p=0.01). At multivariable logistic regression analysis, LBW was associated with SDF >30% (odd ratio [OR] 3.7; p<0.001), after accounting for age, Charlson Comorbidity Index (CCI), FSH, and TV. Similarly, LBW (OR 2.2; p<0.001), SDF >30% (OR 2.9; p<0.001) and partner's age (OR 1.3; p=0.001) were associated with negative ART outcomes, after accounting for the same predictors. LBW was associated with impaired clinical and semen characteristics in infertile men compared to both NBW and HBW. SDF and ART outcomes were significantly worse in the LBW group.

Gestational age-specific reference standards of low-lying conus medullaris level in fetuses: a prospective cohort study.

To explore the position change of fetal conus medullaris by ultrasound, and to propose gestational age-specific references for the lower limits of fetal conus medullaris level. We prospectively collected the imaging and clinical data of fetuses whose mothers accepted routine prenatal ultrasonic follow-ups in the Department of Medical Ultrasonics, Chinese PLA General Hospital, between November 2020 and April 2021. By assigning to the conus medullaris levels, calculating statistical data, and performing linear regression analysis, we determined the correlation between the conus medullaris level and gestational week, as well as between the 95th percentile of the conus medullaris level, i.e., the lower limit of the conus medullaris level, and gestational week. We included 1202 different fetuses at 17-40 gestational weeks in the study. Both the conus medullaris level and the 95th percentile of the conus medullaris level were linearly correlated with gestational week. We calculated the adjusted values of the lower limits of fetal conus medullaris levels, that is, the theoretical references of the lower limits, according to the linear regression equation, and composed a comparison table. The fetal conus medullaris position continues changing cranially with gestational weeks during the whole pregnancy. The conus medullaris of a term fetus should not lie below the L2 vertebra level at birth. We proposed reference criteria of fetal low-lying conus medullaris for each gestational week from 17 to 40weeks of gestational age, which potentially help prompt diagnosis and improve prognosis of fetal tethered cord syndrome.

Evaluation of myocardial viability in patients with myocardial ischemia reperfusion injury using the dual-energy CT myocardial blood pool imaging.

To evaluate myocardial viability in patients with myocardial ischemia reperfusion injury (MIRI) via dual-energy computed tomography myocardial blood pool imaging (DECT MBPI). Between September 2017 and January 2019, we prospectively recruited 59 patients with acute myocardial infarction (AMI) who developed MIRI after revascularization during invasive coronary angiography (ICA). Then, they received DECT MBPI, SPECT, and PET sequentially within 1 week after the onset of MIRI. A total of 1003 myocardial segments of 59 patients were recruited for this study. The iodine reduction areas and delayed enhancement areas were calculated by cardiac iodine map with SPECT rest myocardial perfusion imaging (MPI) + PET myocardial metabolism imaging (MMI) as reference criteria. The paired sample t-test was used to measure the difference of the myocardial iodine value. Cohen's Kappa analysis was used to test the consistency among different observers. ROC analysis was used to calculate the myocardial viability of DECT MBPI. ROC showed the AUCs of DECT MBPI iodine value to identify a normal myocardium, an ischemic myocardium, and an infarcted myocardium were 0.957, 0.900, and 0.906 (p < 0.001). The sensitivity, specificity, and accuracy of DECT MBPI in identifying an ischemic myocardium were 87.6%, 89.3%, and 97.9% (p < 0.001). The sensitivity, specificity, and accuracy of DECT MBPI in identifying an infarcted myocardium were 88.9%, 92.2%, and 98.6% (p < 0.001). The cutoff value for DECT MBPI to differentiate between an ischemic and a normal myocardium was 0.84 mg I/mL. The cutoff value for DECT MBPI to differentiate between an infarct and a normal myocardium was 2.01 mg I/mL. DECT MBPI can be used to assess myocardial viability in patients with MIRI with high sensitivity and specificity. • Dual-energy computed tomography myocardial blood pool imaging (DECT MBPI) can evaluate myocardial viability of myocardial ischemia-reperfusion injury (MIRI). • DECT MBPI is a non-invasive and timesaving method for evaluation on myocardial ischemia-reperfusion injury in patients with acute myocardial infarction after coronary intervention.

High serum alpha-fetoprotein levels in primary infertile men.

Alfa-fetoprotein (AFP) is a serum glycoprotein highly produced during fetal development. While AFP synthesis drops dramatically after birth, AFP production only persists or returns under specific pathological condition. We sought to investigate the rate of and the potential meaning of high AFP serum levels in men seeking first medical attention for couple's primary infertility. Socio-demographic and clinical data from 1803 non-Finnish, White-European primary infertile men were retrospectively analysed. AFP was routinely measured in each patient (high AFP was defined as>7ng/ml). Men with history of liver diseases, testicular cancer, or other known causes of increased AFP levels were excluded from the final analysis. Semen analyses were based on the 2010 World Health Organization reference criteria. Descriptive statistics and logistic regression models tested the association between serum AFP and clinical variables. Possible nonlinear relationships were graphically explored with locally estimated scatterplot smoothing method. Overall, high serum AFP level was found in 29 (1.7%) patients. Normal versus high AFP levels patients were comparable in terms of body mass index (BMI), Charlson Comorbidity Index, waist circumference, smoking habits, history of cryptorchidism, testicular volume, and serum hormones (i.e., follicle-stimulating hormone, luteinizing hormone, and total testosterone). Conversely, men with higher AFP levels were older (p=0.02), had lower sperm concentration (p=0.003), and were more frequently oligozoospermic and azoospermic (all p≤0.03). At multivariate analysis, high AFP levels were independently associated with oligozoospermia (OR 3.79; p=0.033) and azoospermia (OR 3.29; p=0.006). Likewise, if AFP levels increase, patients were found to be older, with higher BMI and to have more comorbidities (all p<0.05). Unexplained high AFP levels account for almost 2% of cases in primary infertile patients without a previous history of associated disorders. Higher serum AFP levels are linked with aberrant sperm counts, older age, obesity, and a greater amount of comorbid conditions. Despite the need for additional validation, these data suggest that serum AFP measurement might have a multifaceted role over the diagnostic work-up of males presenting for couple's infertility.

SC20 - The impact of different who reference criteria for semen analysis in clinical practice: who will benefit from the new 2021 cutoffs for normal sperm parameters?

SC20 - The impact of different who reference criteria for semen analysis in clinical practice: who will benefit from the new 2021 cutoffs for normal sperm parameters?

Online Program to Develop Teachers to Enhance Students’ Adaptability Skills

This research aimed to develop an online program for the development of the teachers' skills to enhance the students' adaptability. The research materials consisted of the teacher's learning manuals and teacher guidelines for student development. Based on the Research and Development (R&amp;D) methodology, the implication of the R1&amp;D1 and the R4&amp;D4 steps, six sets of teacher's learning manuals, and one workshop manual were obtained. Then the R5&amp;D5, the one group pretest-posttest experimental research methodology, was used with 15 teachers and 324 students in the Faculty of Education of Mahamakut Buddhist University, Isan Campus. These groups of samples were randomized to adequately represent the population of the main campus of Mahamakut Buddhist University and its other campuses. It was observed that the online lessons developed for this research could significantly increase the teacher's post-test scores that meet the reference criteria of 90/90. As for the students, their post-test scores on adaptability skills were significantly higher than the scores observed in the pre-test. This showed that the online programs developed in this research are effective educational innovations. This result ascertains that the findings from this research can be disseminated for the benefit of the target population from all campuses of Mahamakut Buddhist University.

Can the Supido Radar Be Used for Measuring Ball Speed during Soccer Kicking? A Reliability and Concurrent Validity Study of a New Low-Cost Device.

The aim was to analyze the reliability and validity of a low-cost instrument, based on a radar system, to quantify the kicking ball speed in soccer. A group of 153 male soccer players (under-13, n = 53; under-15, n = 54; under-18, n = 46) participated in this study. Each player performed three kicks on the goal in a standardized condition while the ball speed was measured with three different devices: one Radar Stalker ATS II® (reference criterion) and two Supido Radar® (Supido-front of the goal and Supido-back of the goal). The standard error of measurement (SEM) expressed as a coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were employed for assessing the reliability of each instrument. Stalker and Supido-back showed very high absolute (CV = 4.0–5.4%) and relative (ICC = 0.945–0.958) reliability, whereas Supido-front resulted in moderate to low reliability scores (CV = 7.4–15%, ICC = 0.134–0.693). In addition, Lin’s concordance correlation coefficient (CCC) values revealed an ‘almost perfect’ agreement between Stalker and Supido-back for the average (r = 0.99) and maximal (r = 0.98) ball speed, regardless of the ball speed range analyzed. However, Supido-front resulted in a poor degree of concordance (CCC = 0.688) and a high magnitude of error (17.0–37.5 km·h−1) with the reference Stalker radar gun. The Supido Radar® placed behind the goal could be considered a reliable and valid device for measuring ball speed in soccer.

The role of width of pars compacta of substantia nigra and the midbrain area in patients with Parkinson’s disease and progressive supranuclear palsy with healthy aged individuals

Introduction and Aim: Though numerous image processing software exists to analyse the images, measurement of substantia nigra width and midbrain area are simple yet definite tools to distinguish and diagnose the Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) when complimented with clinical findings. Comparing the brainstem parameters in healthy, (neurodegenerative) diseased, and during the treatment helps us to assess the disease monitoring i.e., severity and progress of the disease, and formulate the best treatment strategies. This study aimed at comparison of the thickness of substantia nigra (SN) in Parkinson's disease (PD) and progressive supranuclear palsy (PSP) with aged healthy individuals by magnetic resonance (MR) imaging. Material and Methods: This observational study includes the evaluation of MR images of 50 aged healthy individuals with no obvious neurological diseases, 35 classical PD, and 15 PSP patients from the Department of Radiology. Quantitative planimetric evaluation of midbrain area was calculated and the width of substantia nigra (SN) was evaluated as per standard reference criteria with computer assisted image analysis and interpretation program. Results: The parameters like means of midbrain area and the pars compacta thickness on both right and left sides were compared both in PD and PSP patients with healthy individuals. MR image analysis showed significant decrease in the thickness of pars compacta of SN in PD patients than in PSP patients when compared with age matched healthy aged individuals. Conclusion: Parkinsonian diseases are always associated with the neuronal loss leading to volume alterations by causing midbrain atrophy. Magnetic resonance imaging of the thickness of SN is simple and reliable imaging markers to differentiate PD and PSP when combined with clinical symptomatology.

Concurrent validity and intra-unit reliability of the Speedtrack X radar gun device for measuring tennis ball speed

The aim of this study was two-fold: (i) to test the concurrent validity of the Speedtrack X radar device for measuring tennis ball speed in comparison to a Pocket radar gun and (ii) to test the intra-unit reliability of the Speedtrack X radar device for measuring tennis ball speed. A total sample of 116 tennis ball throws performed by the same machine were measured in a single session. All throws were simultaneously measured by one Pocket radar device (reference criterion) and one Speedtrack X radar gun. Reliability levels were calculated using Pearson’s correlation test ( r), the intra-class correlation test (ICC), and coefficient of variation (CV), while concurrent validity was tested using Bland-Altman and effect size (for measuring between-device differences). High correlation between the data obtained from the two devices was found ( r = 0.932, p &lt; 0.001). The ICC of the measurements of the data obtained from the two devices is high ( r = 0.964, p &lt; 0.001). The results allow us to conclude that the Speedtrack X radar gun is valid and reliable for measuring tennis ball speed.

A novel multi-model fusion framework diagnoses the complex variation characteristics of ecological indicators and quantitatively reveals their driving mechanism.

Systematic analysis of the change law and driving mechanism of ecological indicators (GPP, ET, WUE), as well as the study of maximum threshold of water resources benefit changing with ecological benefit, are important prerequisites for realizing the scientific allocation and efficient utilization of water resources in desert riparian forests. However, previous studies have defects in the detailed description of the change characteristics of ecological indicators. How to accurately diagnose the characteristics of a site, mutation year, pattern (linear, exponential, logarithmic, etc.), duration of change, future change trends of ecological indicators in a desert riparian environment, as well as quantitatively revealing their driving mechanisms, are major scientific problems that need to be solved urgently. In this regard, an ensemble function coupling a logistic function and an asymmetric Gaussian function was creatively adopted, a novel framework was created to integrate the time-series trajectory fitting method and the sensitivity analysis method, and the arid and ecologically fragile Tarim River Basin was taken as a typical area. The results showed that with enhanced water resource management in the Tarim River Basin, GPP, ET, and WUE all showed patterns of increasing change and could be expected to continue to rise or to remain at a high-level stable state. The longest continuous period of GPP change was 15 years, showing that ecological restoration is a long-term process. The years of GPP mutation were consistent with the implementation periods of major measures in the Tarim River Basin (1990, 2001, and 2011), indicating the reliability of this framework. More importantly, when GPP increased to 216.44 gCm-2, the maximum WUE threshold of 0.93 gCm-2mm-1 occurred. This threshold can be used as a reference criterion for efficient utilization of ecological water in the basin. Among the ecological indicators studied, GPP was the most sensitive to environmental change, but GPP, with 80.60% of pixel area, showed a weak memory effect（α<0.4). Besides, GPP was the most sensitive to the leaf area index (LAI) and had the strongest correlation with it (p<0.001). Therefore, LAI can be used as the main control factor for judging plant growth. This research can provide important scientific guidance and reference for the analysis of ecological indicator changes and the sustainable utilization of water resources in arid areas.

An in-depth discussion of cholesteatoma, middle ear Inflammation, and langerhans cell histiocytosis of the temporal bone, based on diagnostic results.

ObjectiveThis study aimed to conduct an in-depth investigation of the learning framework used for deriving diagnostic results of temporal bone diseases, including cholesteatoma and Langerhans cell histiocytosis (LCH). In addition, middle ear inflammation (MEI) was diagnosed by CT scanning of the temporal bone in pediatric patients.DesignA total of 119 patients were included in this retrospective study; among them, 40 patients had MEI, 38 patients had histology-proven cholesteatoma, and 41 patients had histology-proven LCH of the temporal bone. Each of the 119 patients was matched with one-third of the disease labels. The study included otologists and radiologists, and the reference criteria were histopathology results (70% of cases for training and 30% of cases for validation). A multilayer perceptron artificial neural network (VGG16_BN) was employed and classified, based on radiometrics. This framework structure was compared and analyzed by clinical experts according to CT images and performance.ResultsThe deep learning framework results vs. a physician’s diagnosis, respectively, in multiclassification tasks, were as follows. Receiver operating characteristic (ROC) (cholesteatoma): (0.98 vs. 0.91), LCH (0.99 vs. 0.98), and MEI (0.99 vs. 0.85). Accuracy (cholesteatoma): (0.99 vs. 0.89), LCH (0.99 vs. 0.97), and MEI (0.99 vs. 0.89). Sensitivity (cholesteatoma): (0.96 vs. 0.97), LCH (0.99 vs. 0.98), and MEI (1 vs. 0.69). Specificity (cholesteatoma): (1 vs. 0.89), LCH (0.99 vs. 0.97), and MEI (0.99 vs. 0.89).ConclusionThis article presents a research and learning framework for the diagnosis of cholesteatoma, MEI, and temporal bone LCH in children, based on CT scans. The research framework performed better than the clinical experts.

Effects of recreational cannabis on testicular function in primary infertile men.

Male factor contributes to up to 50% of cases of couples experiencing infertility. Cannabis is one of the most commonly used recreational drugs, and its effects on the reproductive system have been largely debated in the literature. The aim of this study is to evaluate the effect of recreational cannabis use on total T (tT) levels, gonadal status, and sperm parameters in a cohort of primary infertile non-Finnish, white-European men. Data of 2074 white-European men visited for primary couple's infertility were analyzed. Lifestyle factors and cannabis use were investigated in all participants. Semen analyses were based on the 2010 World Health Organization reference criteria. Serum hormones were evaluated, and patients were subdivided based on their gonadal status. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Descriptive statistics and linear regression analyses were used to test the association between cannabis use, sperm parameters, and hormonal levels. Logistic regression analyses tested potential predictors for abnormal sperm parameters and gonadal status. Of 2074, 225 (10.9%) patients reported cannabis use in their lifetime. Total Testosterone levels were lower in cannabis users compared to nonusers (p = 0.03). In a multivariable linear regression analysis, cannabis use was inversely associated with tT levels (ß = -0.372 ng/ml; p = 0.005) but not with follicle-stimulating hormone nor with luteinizing hormone levels. Conversely, at multivariable logistic regression model cannabis use was not associated with the type of hypogonadism. At multivariable linear regression analysis, cannabis use was inversely associated with sperm morphology (p = 0.007), while not with both sperm concentration and sperm motility. Similarly, at adjusted logistic regression analysis cannabis use resulted associated with teratozoospermia (p = 0.039) but not with oligo-, astheno-, and azoospermia. Infertile men using cannabis are at higher risk of having lower testosterone levels and altered sperm morphology as compared with nonusers.

Novel DEMON Spectra Analysis Techniques and Empirical Knowledge Based Reference Criterion for Acoustic Signal Classification

This paper presents some novel methods to estimate a vessel’s number of shafts, course, speed and classify it using the underwater acoustic noise it generates. A classification framework as well as a set of reference parameters for comparison are put forth. Identifying marine traffic in surroundings is an important task for vessels in an open sea. Vessels in vicinity can be identified using their signatures. One of the typical signatures emitted by a vessel is its acoustic measurements. The raw sonar data consisting of the acoustic signatures is generally observed manually by sonar operators for suggesting class of query vessel. The valuable information that can be extracted from the recorded acoustic signature includes shaft revolutions per minute (SRPM), number of blades (NOB), number of shafts, course and speed etc. Expert sonar operators use their empirical knowledge to estimate a vessel’s SRPM and NOB. Based on this information vessel classification is performed. Empirical knowledge comes with experience, and the manual process is prone to human error. To make the process systematic, calculation of the parameters of the received acoustic samples can be visually analyzed using Detection of Envelope Modulation on Noise (DEMON) spectra. Reported research mostly focuses on SRPM and NOB. Parameters such as number of shafts and vessel course and speed can effectively aid the vessel classification process. This paper makes three novel contributions in this area. Firstly, some novel DEMON spectra analysis techniques are proposed to estimate a water vessel’s number of shafts, speed, and relative course. Secondly, this paper presents a classification framework that uses the features extracted from DEMON spectra and compares them with a reference set. Thirdly, a novel set of reference parameters are provided that aid classification into categories of large merchant ship type 1, large merchant ship type 2, large merchant ship type 3, medium merchant ship, oiler, car carrier, cruise ship, fishing boat and fishing trawler. The proposed analysis and classification techniques were assessed through trials with 877 real acoustic signatures recorded under varying conditions of ship’s speed and sea state. The classification trials revealed a high accuracy of 94.7%.