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The differential diagnosis of ACTH-dependent Cushing's disease (CS) is challenging. The gold standard approach bilateral inferior petrosal sinus sampling (BIPSS) is expensive and invasive, while other noninvasive tests, like the high-dose dexamethasone suppression test (HDDST), provide unsatisfactory diagnostic accuracy. This study aimed to find a new noninvasive practical approach with higher diagnostic accuracy to differently diagnose ACTH-dependent CS, which can be used in centers where BIPSS cannot be applied.264 Cushing's disease (CD) patients and 47 ectopic ACTH secretion syndrome (EAS) patients were analyzed in this single-center retrospective study (2011-2021). The multivariate logistic model was used to construct the scoring model.Female (adjusted OR 3.030, 95%CI 1.229-7.471), hypokalemia (0.209, 0.076-0.576), ACTH (0.988, 0.982-0.994), MRI pituitary lesion positive (8.671, 3.521-21.352), and HDDST positive (2.768, 1.139-6.726) have a strong association with the differential diagnosis of ACTH-dependent CS and were included in the final multivariable logistic regression model. A -14-to-14-point noninvasive scoring model was built on the model. The AUC of the noninvasive scoring model was 0.915 (95% CI 0.869-0.960), significantly higher than the AUC of HDDST (0.756, 95% CI 0.685-0.825, P = 0.004). The optimal cutoff of the model was ≥0 to diagnose CD. The sensitivity of the noninvasive scoring model was 91.3% (95% CI 87.3%-94.1%), and the specificity was 80.9% (95% CI 67.5%-89.6%). When the model's sensitivity was 100.0%, the cutoff was ≥ -10 with a specificity of 19.2%; when the model's specificity was 100.0%, the cutoff was ≥ 13 with a sensitivity of 22.7%.We developed a noninvasive scoring model to distinguish CD and EAS in ACTH-dependent CS patients with higher diagnostic utility than HDDST in the same cohort. The noninvasive scoring model might be applied in areas where BIPSS is unavailable, the CRH is hard to obtain, or the desmopressin stimulation is not widely applied. It also provided a triage tool for selecting patients that might benefit the most from a further BIPSS test.

Pancreatic cancer is the deadliest disease, with a five-year overall survival rate of just 11%. The pancreatic cancer patients diagnosed with early screening have a median overall survival of nearly ten years, compared with 1.5 years for those not diagnosed with early screening. Therefore, early diagnosis and early treatment of pancreatic cancer are particularly critical. However, as a rare disease, the general screening cost of pancreatic cancer is high, the accuracy of existing tumor markers is not enough, and the efficacy of treatment methods is not exact. In terms of early diagnosis, artificial intelligence technology can quickly locate high-risk groups through medical images, pathological examination, biomarkers, and other aspects, then screening pancreatic cancer lesions early. At the same time, the artificial intelligence algorithm can also be used to predict the survival time, recurrence risk, metastasis, and therapy response which could affect the prognosis. In addition, artificial intelligence is widely used in pancreatic cancer health records, estimating medical imaging parameters, developing computer-aided diagnosis systems, etc. Advances in AI applications for pancreatic cancer will require a concerted effort among clinicians, basic scientists, statisticians, and engineers. Although it has some limitations, it will play an essential role in overcoming pancreatic cancer in the foreseeable future due to its mighty computing power.

With the development of modern health technology, every aspect of people's clothing, food, housing, and transportation is affected by information data. Doctors can use information data to assist in daily decision-making, enabling patients to enjoy better medical services. With the promulgation of the government's policy on medical treatment in different places, patients need medical institutions to be connected nationwide for subsequent medical insurance reimbursement. This chapter aims to analyze and provide development suggestions for the current EHR system in China through data structure and blockchain technology. This study provides comprehensive processing of patients' health data, promotes the healthy development of the whole medical information-sharing platform, improves the level of medical information data in the entire medical industry, and makes deeper exploitation of medical information.

Aims: This study aims to evaluate the differences in the characteristics of atherosclerotic plaques in the proximal, curved, and distal segments of the curved basilar artery (BA) through high-resolution magnetic resonance imaging(HR-MRI). Methods: The imaging and clinical data of 146 patients were retrospectively analyzed. On the basis of three-dimensional (3D) time -of -flight magnetic resonance angiography (3D-TOF-MRA), 51 patients with BA curvature were selected for the study. The BA plaque is divided into three groups: proximal, curved, and distal. Plaques were identified and analyzed according to spin echo acquisition imaging via T1-weighted 3D volumetric isotropic Tse acquisition (T1W-3D -VISTA), and compare the differences in clinical related factors and plaque characteristics between groups. Diffusion-weighted imaging (DWI) and/or T2WI identified brainstem infarction. The patients were divided into symptomatic and asymptomatic groups. The correlation between plaque location and symptoms was identified and analyzed. Results: Among 51 patients, a total of 376 plaques were detected. Plaques in the proximal and curved segments are more common than those in the distal segments. Proximal plaques are more likely to have intraplaque hemorrhage ( P =0.002 ＜0.05). There was no significant difference in the distribution of criminal plaques and non-criminal plaques between each group ( P =0.36 ＞0.05). Conclusion: Plaques in the proximal and curved segments of the BA are more common than those in the distal segments. The proximal plaque is more prone to intraplaque hemorrhage.

Large calves are considered unattractive. Botulinum toxin type A (BoNT-A), acting as a neurotoxin that reduces muscle contraction, is widely used in calf contouring. However, there lacks detailed anatomical data to guide clinical injection.This study aims to use ultrasonography to provide depth information of the calf muscles and determine the morphological types of the gastrocnemius muscle.Ultrasound scanning was performed at six sites on 40 Chinese adults. A real-time ultrasound scannerwas used to detect the depth of the gastrocnemius muscle and the soleus muscle.The thickness of the gastrocnemius muscle and the soleus muscle was measured. The depth from the skin to the surface, the middle, and the bottom of the gastrocnemius muscle was measured. The morphology of gastrocnemius muscle was classified into four different types under ultrasound according to the muscle bulge pattern.This study took ultrasonic measurements of Asian calves to guide accurate and effective BoNT-A injection in real clinical practice.

Yixin Sun,1,* Runzhu Liu,1,* Nanze Yu,1 Dingyue Zhang,2 Juan Chen,3 Jiuzuo Huang,1 Xiao Long1 1Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Clinical Medicine, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 3Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiuzuo Huang; Xiao Long, Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel/Fax +86-1069158730, Email hjz1983@126.com; pumclongxiao@126.comPurpose: Incisional double eyelid blepharoplasty is the most common cosmetic operation in East Asia. Although numerous articles on surgical techniques have been published, complications, such as fold loss, asymmetry, and visible scars, still exist. To create a stable and dynamic double-eyelid crease, the author has introduced a modified technique of double-eyelid blepharoplasty.Patients and Methods: The authors introduced a new surgical technique to reduce complications and create reliable and dynamic double eyelids. The orbicularis oculi muscle of the lower flap was anchored on the tarsus and sutured with the distal part of the septal flap. The skin incision was closed by skin–septal flap–skin suture. Postoperative evaluations were assessed at the twelfth postoperative month.Results: One hundred ninety-three patients underwent double eyelidplasty with the TOS fixation technique. The mean follow-up duration was 18.6 months (range, 12– 30 months). In the aesthetic outcome evaluation, 88 (45.6%) patients had very much improved results, 56 (29.0%) had much improved results, 29 (15.0%) had improved results, 8 (4.1%) had no change and 12 (6.2%) had worse results. Complications included crease asymmetry (n=7, 3.6%), partial fold loss (n=8, 4.1%) and complete fold loss (n =5, 2.6%).Conclusion: Tarsus-orbicularis-septum (TOS) fixation is a reliable and flexible surgical technique for creating stable and dynamic double-eyelid creases.Keywords: double eyelidplasty, primarily blepharoplasty, orbital septum, tarsus

Crawfish aquaculture in low-lying paddy fields is implemented after middle-season rice is harvested, namely, Rice–crawfish rotation (RCR), and has been practiced for almost 30 years in Jianghan pla...

Poor soil aeration is a limiting factor that influences rice (Oryza sativa L.) growth. Oxygenated compound fertilizer (OCF) is a vital strategy to address this challenge by improving soil aeration....

Background Vaginal laxity, usually accompanied with prolapse symptoms, affects women’s sexual satisfaction and quality of life. Vaginal tightening surgery aims to reinforce perivaginal muscle strength and restore normal vaginal anatomy. Objectives The aim of this study was to introduce a new surgical approach to vaginal tightening that uses acellular dermal matrix. Methods In this retrospective study, data from 80 patients with vaginal laxity who underwent surgery between April 2017 and April 2021 were analyzed. Three-dimensional transvaginal ultrasound was performed and the Female Sexual Function Index was evaluated. Results The mean age of the patients was 44.6 years. The mean patient follow-up was 13.2 months. No infection, rectovaginal fistula, or implant explantation occurred. Transvaginal ultrasound examination demonstrated a significant reduction of introital diameter on a maximum Valsalva maneuver (2.3 cm vs 4.1 cm; P < 0.05) and the reconstruction of acute vaginal angulation. The Female Sexual Function Index orgasm subscore increased significantly. Conclusions Vaginal tightening with acellular dermal matrix is a minimally invasive surgery that offers a safe and effective treatment for patients with vaginal laxity. Level of Evidence: 4

BACKGROUND Rosacea is a chronic inflammatory disease mainly with skin or ocular manifestations. Topical calcineurin inhibitors, pimecrolimus and tacrolimus, can be used to treat rosacea. However, they can also induce rosacea-like eruptions. AIMS This study systematically reviewed the double-edged sword effects of pimecrolimus and tacrolimus on rosacea. METHODS Four databases were retrieved to search for articles on the effects of pimecrolimus and tacrolimus on rosacea, including Cochrane Library, Embase, PubMed, and Web of Science. Only English articles were included in the systematic review. Relevant data were collected, and the levels of evidence were evaluated. RESULTS 28 articles published between 2001 and 2016 were included. 11 articles were about pimecrolimus as the treatment of rosacea, 4 articles were about the pimecrolimus-induced rosacea, 9 articles were about tacrolimus as the treatment of rosacea, and 4 articles were about tacrolimus-induced rosacea. Participants for each study ranged from 1 to 200. Several types of outcome measurements were used for these publications. CONCLUSIONS Both pimecrolimus and tacrolimus might have double-edged sword effects on rosacea. Pimecrolimus and tacrolimus could be effective for rosacea. However, both of them could also induce rosacea. Larger, randomized, controlled studies on pimecrolimus and tacrolimus as the treatment of rosacea and studies on the mechanisms of pimecrolimus and tacrolimus in treating or inducing rosacea are needed. This systematic review emphasized the double-edged sword role of topical calcineurin inhibitors in rosacea, which may pave the way for future research.

Alzheimer’s disease is the most common type of dementia placing a heavy burden on the healthcare system worldwide. Skin diseases are also one of the most common health problems. Several skin diseases are associated with Alzheimer’s disease through different mechanisms. This review summarizes the relationship between Alzheimer’s disease and several types of skin diseases, including bullous pemphigoid, hidradenitis suppurativa, psoriasis, skin cancer, and cutaneous amyloidosis, and provides suggestions based on these associations. Neurologists, dermatologists, and general practitioners should be aware of the relationship between Alzheimer’s disease and skin diseases. Dermatology/neurology consultation or referral is necessary when needed.

The deubiquitinating enzyme (DUB)–mediated cleavage of ubiquitin plays a critical role in balancing protein synthesis and degradation. Ubiquitin-specific protease 4 (USP4), a member of the largest subfamily of cysteine protease DUBs, removes monoubiquitinated and polyubiquitinated chains from its target proteins. USP4 contains a DUSP (domain in USP)–UBL (ubiquitin-like) domain and a UBL-insert catalytic domain, sharing a common domain organization with its paralogs USP11 and USP15. USP4 plays a critical role in multiple cellular and biological processes and is tightly regulated under normal physiological conditions. When its expression or activity is aberrant, USP4 is implicated in the progression of a wide range of pathologies, especially cancers. In this review, we comprehensively summarize the current knowledge of USP4 structure, biological functions, pathological roles, and cellular regulation, highlighting the importance of exploring effective therapeutic interventions to target USP4.

Integrated rice-crayfish systems are expanding rapidly and are the most widely applied planting-breeding modes in Jianghan Plain in China. We conducted nutrient use efficiency, economic, and emergy analysis of three rice production modes, namely, rice monoculture (RM), rice-crayfish rotation (RCR), and rice-crayfish coculture (RCC), in Jingzhou City, which is located in the Jianghan Plain. Compared with RM mode, rice-crayfish systems using the RCR and RCC modes increased rice yield by 5-7%, showed more than 8% higher chemical nutrient use efficiency, and increased the value-to-cost ratio from 1.5-fold to 2.7-fold and the benefit-cost ratio from 2.5-fold to 3.8-fold, while decreasing irrigation water consumption and land occupation by 31% and 82-86%, respectively. RCC resulted in 10% higher crayfish yield, 12% higher phosphorus use efficiency, and 38% higher feed use efficiency than RCR. However, compared with RM, rice-crayfish systems decreased renewable fraction by 10-14%, emergy yield ratio by 9%, and emergy sustainability index by 23-26%, and they increased environmental loading ratio to 18-23%. Labor and service, fertilizer utilization, and machine and tools play important roles in these negative environmental effects. Scenario analysis showed that the rice-crayfish systems increased sustainability index by 38-45%. The technical training of new planting-breeding technology should be adopted by farmers for the efficient use of fertilizers and improvement of food yield. This study suggests that rice‑crayfish systems are not a panacea to sustain cleaner food production.

The potential environmental risk associated with nutrient surplus after switching from rice monoculture (RM) to rice–crayfish rotation (RCR) was assessed in the Jianghan Plains in China. Nutrient surplus was achieved by surveying 32 RM and 69 RCR and determining their nutrient inputs and outputs, and the soil nutrient status for different soil properties were recorded for 0–23 years. The annual average input of N, P2O5, and K2O in RCR was 536, 185, and 253 kg ha−1, respectively, wherein fertilizer and feed accounted for the major fraction of the total nutrient input. For instance, they accounted 58% and 18% of N, 74% and 24% of P2O5, and 70% and 30% of K2O, respectively. The annual apparent surplus of N, P2O5, and K2O was 397, 145, and 225 kg ha−1, respectively, leading to low apparent nutrient use efficiency. Consequently, compared with RM, the total N and soil readily oxidized organic carbon in the upper soil surface (0–20 cm) for the RCR field significantly increased by 0.42–0.96 g kg−1 and 1.63–3.19 g kg−1, respectively. The available N, Olsen P, and exchangeable K of the RCR in the upper soil layer also increased significantly. In the RCR system, a significant positive linear relationship between the apparent accumulated nutrient surplus of N, P, and K elements and the total N, Olsen P, and exchangeable K present in the 0–60 cm soil profile was observed. In RCR, the soil pH in 0–60 cm soil profile and cation exchange capacity in the 0–20 cm soil layer increased as the cultivation time progressed. Nutrient accumulation in the soil not only enhanced soil fertility but also negatively influenced the environment. Therefore, several measures (e.g., new fertilization technologies, new fertilizer, legislation approaches for nutrient surplus, and technical training) should be adopted to control the nutrient surplus.

There is increasing academic and pragmatic interest in leveraging patent rights to invigorate remanufacturing for waste products under governmental interventions via regulations and reward–penalty instruments. In practice, many original manufacturers that are possessed with intellectual property rights allow third-party remanufacturers to implement reproducing operations through authorization and charging licensing fees. The general purpose of this paper is to explore favorable strategies for a closed-loop supply chain (CLSC) system of waste product collection and remanufacturing, in the context of either manufacturer-remanufacturing or remanufacturer-remanufacturing. To achieve such an objective, game theory is adopted to establish models of three collection and remanufacturing modes among channel members involving a manufacturer, a seller, and a remanufacturer. In so doing, the results show that a government’s allocations of elementary remanufacturing ratio and the unit amount of reward–penalty count significantly in CLSC operations, especially for the manufacturer, who acts as the leader in the system and makes mode selections.