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Introduction: HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. Methods: MSM [greater than or equal to]16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. Results: 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). Conclusions: HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions. Keywords: HIV; men who have sex with men (MSM); community engagement; HIV testing; syphilis testing; China; low- and middle-income countries (LMICs), Introduction Men who have sex with men (MSM) worldwide confront barriers that limit access to key HIV prevention services [1-3]. HIV testing plays an essential role in the HIV care [...]

Ephedrae Herba (Ephedra), known as "MaHuang" in China, is the dried straw stem that is associated with the lung and urinary bladder meridians. At present, more than 60 species of Ephedra plants have been identified, which contain more than 100 compounds, including alkaloids, flavonoids, tannins, sugars, and organic phenolic acids. This herb has long been used to treat asthma, liver disease, skin disease, and other diseases, and has shown unique efficacy in the treatment of COVID-19 infection. Because alkaloids are the main components causing toxicity, the safety of Ephedra must be considered. However, the nonalkaloid components of Ephedra can be effectively used to replace ephedrine extracts to treat some diseases, and reasonable use can ensure the safety of Ephedra. We reviewed the phytochemistry, pharmacology, clinical application, and alkaloid toxicity of Ephedra, and describe prospects for its future development to facilitate the development of Ephedra. [ABSTRACT FROM AUTHOR]

Background: Many men who have sex with men (MSM) in China are 'in the closet.' The low rate of disclosure may impact sexual behaviours, testing for HIV and other sexually transmitted infections (STIs), and diseases transmission. This study examines factors associated with overall sexual orientation disclosure and disclosure to healthcare professionals. Methods: A nationwide cross-sectional online survey was conducted from September 2014 to October 2014 in China. Participants completed questions covering socio-demographic information, sexual behaviours, HIV/STI testing history, and self-reported HIV status. We defined healthcare professional disclosure as disclosing to a doctor or other medical provider. Results: A total of 1819 men started the survey and 1424 (78.3%) completed it. Among the 1424 participants, 62.2% (886/ 1424) reported overall disclosure, and 16.3% (232/1424) disclosed to healthcare professionals. In multivariate analyses, the odds of sexual orientation disclosure were 56% higher among MSM who used smartphone-based, sex-seeking applications [adjusted odds ratio (aOR) = 1.56, 95% CI: 1.25-2.95], but were lower among MSM reporting sex while drunk or recreational drug use. The odds of disclosure to a healthcare professional were greater among MSM who had ever tested for HIV or STIs (aOR = 3.36, 95% CI: 2.50-4.51 for HIV, and aOR = 4.92, 95% CI: 3.47-6.96 for STIs, respectively) or self-reported as living with HIV (aOR = 1.59, 95% CI: 0.93-2.72). Conclusion: Over 80% of MSM had not disclosed their sexual orientation to health professionals. This low level of disclosure likely represents a major obstacle to serving the unique needs of MSM in clinical settings. Further research and interventions to facilitate MSM sexual orientation disclosure, especially to health professionals, are urgently needed. Keywords: China; disclosure; healthcare professional; men who have sex with men (MSM); sexual behaviours; sexual orientation, Introduction Many men who have sex with men (MSM) in low- and middle-income countries (LMICs) are 'in the closet,' or have not disclosed their sexual orientation [1,2]. We define sexual [...]

This study reports the first use of ultrasound (US) elastography for imaging spinal fractures by assessing the mechanical response of the soft tissue at the posterior vertebra boundary to a uniaxial compression in rabbit ex vivo samples. Three-dimensional finite-element (FE) models of the vertebra-soft tissue complex in rabbit samples are generated and analyzed to evaluate the distribution of the axial normal and shear strains at the vertebra-soft tissue interface. Experiments on the same samples are performed to corroborate simulation findings. Results of this study indicate that the distribution of the axial strains manifests as distinct patterns around intact and fractured vertebrae. Numerical characteristics of the axial strain’s spatial distribution are further used to construct two shape descriptors to make inferences on spinal abnormalities: 1) axial normal strain asymmetry for assessing the presence of fractures and 2) principal orientation of axial shear strain concentration regions (shear zones) for measurement of spinous process dislocation. This study demonstrates that axial normal strain and axial shear strain maps obtained via US elastography can provide a new means to detect spine fractures and abnormalities in the selected ex vivo animal models. Spinal fracture detection is important for the assessment of spinal cord injuries and stability. However, identification of spinal fractures using US is currently challenging. Our results show that features resulting from strain elastograms can serve as a useful adjunct to B-mode images in identifying spine fractures in the selected animal samples, and this information could be helpful in clinical settings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine reference values for oxygen saturation (SpO2 ) in neonates at mild and moderate altitudes.Methods: Our study included 41 097 consecutively born, asymptomatic neonates from 35 hospitals, located in Yunnan, China, with altitudes ranging from 267 to 2202 m. Pre-and post-ductal SpO2 of each neonate was measured at 24 hours of age and before hospital discharge. All study participants, according to the altitude of birth, were categorised into three groups: low (0-500 m), mild (500-1500 m) and moderate altitude (1500-2500 m).Results: Every 1000-m increase in altitude was associated with a 1.54 per cent decrease in mean SpO2 . The means of pre-ductal SpO2 at low, mild and moderate groups were 97.9%, 96.4% and 95.5%, respectively. We used the 2.5th percentile of SpO2 distribution as the cut-off for neonatal SpO2 screening and defined new cut-off values of ≤93% for mild altitudes, ≤92% for moderate altitudes and no adjustment for low altitudes.Conclusion: We recommend revised cut-off values for neonatal SpO2 at mild and moderate altitudes and provide new values for paediatricians to refer to when screening neonates for severe congenital heart or lung diseases. [ABSTRACT FROM AUTHOR]

The inter-fragmentary gap size (IFGS) is a critical factor affecting the propensity of bone healing. In this paper, we present a study to analyze ultrasound strain elastographic numerical features in samples with distinct IFGS using both simulations and experiments. Six fractured rabbit hind leg samples in total were used in this study with controlled IFGS of 1 mm, 5 mm and 1 cm. For the simulation, computed tomography (CT) scans of all six samples were used to create solid models. Finite element analysis (FEA) and subsequent elastography simulations were performed on the 3D models to produce tensorial strain field data. Features of bony fragment separation were defined on different strain components and computed for strains segmented at varying thresholds to evaluate their performance in estimating the IFGS. A threshold for each strain component was then determined, based on which extra 3D features of interest were defined and extracted from the segmented strain data. Then, all 3D features were compared statistically among the three nominal groups. Additional simulations and experiments of axial shear strain elastography (ASSE) on the median coronal plane of the same samples were also performed. Our results indicate that coronal plane axial shear (CPAS) strain elastography produces a separation feature which is statistically correlated with the IFGS, and that our elastography simulation module is effective in predicting the CPAS elastographic strain behavior for different IFGS. [ABSTRACT FROM AUTHOR]

The mechanical behavior of long bones and fractures has been under investigation for many decades due to its complexity and clinical relevance. In this paper, we report a new subject-specific methodology to predict and analyze the mechanical behavior of the soft tissue at a bone interface with the intent of identifying the presence and location of bone abnormalities with high accuracy, spatial resolution, and contrast. The proposed methodology was tested on both intact and fractured rabbit femur samples with finite element-based 3-D simulations, created from actual femur computed tomography data, and ultrasound elastography experiments. The results included in this study demonstrate that elastographic strains at the bone/soft tissue interface can be used to differentiate fractured femurs from the intact ones on a distribution level. These results also demonstrate that coronal plane axial shear strain creates a unique contrast mechanism that can be used to reliably detect fractures (both complete and incomplete) in long bones. Kruskal–Wallis test further demonstrates that the contrast measure for the fracture group (simulation: 2.1286±0.2206; experiment: 2.7034 ± 1.0672) is significantly different from that for the intact group (simulation: 0 ± 0; experiment: 1.1540±0.6909) when using coronal plane axial shear strain elastography ($p$ < 0.01). We conclude that: 1) elastography techniques can be used to accurately identify the presence and location of fractures in a long bone and 2) the proposed model-based approach can be used to predict and analyze strains at a bone fracture site and to better interpret experimental elastographic data. [ABSTRACT FROM AUTHOR]

A fast and robust image registration algorithm for high-dimensional brain Magnetic Resonance images was developed based on the statistical deformation models (SDMs). This model learns deformation fields and achieves fast and robust registration by greatly reducing transformation dimensionality. This model is trained via principal component analysis (PCA), which suffers from large transformation dimensionality and small samples. For the high-dimensional image registration, the dimensions of the deformation fields are huge, the basic functions computed from PCA cannot represent deformation fields well. Therefore, we proposed a local SDM (LSDM) in this paper to solve the aforementioned problems. We divided the images into several small parts, in which the dimensions of the deformation fields are greatly reduced. Then, we trained the LSDM using the deformation fields between sample images and a selected template by applying PCA in each small part. Given that the dimension of eigenvectors of LSDM decreases much more than that of SDM, the orthonormal basis functions of LSDM represent the deformation fields more accurately than those of SDM. We obtained the total deformation fields for warping the image by integrating the deformation fields of all LSDMs. Using the manually labeled MR images of different people, we demonstrated that LSDM could greatly reduce the image registration time while maintaining favorable registration accuracy. [ABSTRACT FROM AUTHOR]

Aims: To examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients’ social network characteristics. Design: Cross-sectional study. Setting: Four MMT clinics in Kunming, Yunnan province, China. Participants: 324 consecutive MMT clients. Measurements: A structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites. Analysis: The association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations. Findings: MMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use. Conclusion: Social networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients. [ABSTRACT FROM AUTHOR]

Ultrasound poroelastography aims at assessing the poroelastic behavior of biological tissues via estimation of the local temporal axial strains and effective Poisson’s ratios (EPR). Currently, reliable estimation of EPR using ultrasound is a challenging task due to the limited quality of lateral strain estimation. In this paper, we propose a new two-step EPR estimation technique based on dynamic programming elastography (DPE) and Horn-Schunck (HS) optical flow estimation. In the proposed method, DPE is used to estimate the integer axial and lateral displacements while HS is used to obtain subsample axial and lateral displacements from the motion-compensated pre-compressed and post-compressed radio frequency data. Axial and lateral strains are then calculated using Kalman filter-based least square estimation. The proposed two-step technique was tested using finite-element simulations, controlled experiments and in vivo experiments, and its performance was statistically compared with that of analytic minimization (AM) and correlation-based method (CM). Our results indicate that our technique provides EPR elastograms of higher quality and accuracy than those produced by AM and CM. Regarding signal-to-noise ratio and elastographic contrast-to-noise ratio, in simulated data, the proposed method provides an average improvement of 30% and 75%, respectively, with respect to AM and of 100% and 169%, respectively, with respect to CM, whereas, in experiments, the proposed approach provides an average improvement of 30% and 67% with respect to AM and of 230% and 525% with respect to CM. Based on these results, the proposed method may be the preferred one in experimental poroelastography applications. [ABSTRACT FROM PUBLISHER]

Background: Despite the reduction in reported incidence of tuberculosis globally, the burden of pulmonary tuberculosis (PTB) remains high in low- and middle- income countries, including China. The current study aims to evaluate the distribution and trend of PTB incidence in Xinjiang, the region with the highest PTB burden in China. Methods: We identified all confirmed PTB case records reported to the Chinese TB Information Management System (TBIMS) between 2011 and 2015. We analyzed these records to measure the annual incidence of reported smear-positive PTB cases in Xinjiang and its trend over time. We also analyzed incidence by gender, residential area, and region. Spatial analysis was used to describe the inter-regional disparity of the disease burden during the study period. Results: We identified 212,216 smear-positive PTB cases between 2011 and 2015. The reported incidence increased from 180.8 cases in 2011 to 195.8 cases in 2015 per 100,000 population. The southern region of Xinjiang had the highest disease burden (257.8/100,000 in 2011 and 312.7/100,000 in 2015). More than 60% cases occurred in persons >45 years, and 76% of cases lived in rural areas. Conclusion: To reach the goal of elimination and control of TB, more comprehensive STOP TB strategies should be implemented in Xinjiang. Residents in the southern region and rural areas of Xinjiang require particular attention. [ABSTRACT FROM AUTHOR]

Background: Among Kazakh-Chinese population in Xinjiang province of China, prevalence of obesity and hypertension were 40.1% and 50.3% respectively, the highest across all ethnic groups residing in this pastureland. Despite this, there remained a dearth of information regarding the association between the anthropometric measures [body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), Waist-to-height ratio (WHtR) etc.] and indicators for hypertension control [achieved levels of systolic and diastolic blood pressures (SBP and DBP), pulse pressure index (PPI), ankle-brachial index (ABI) etc.] among them. Method: A cross-sectional study was conducted in Xinjiang to determine the distribution and inter-relationships of the anthropometric measures and indicators for achieved BP control as well as their predictors among hypertension patients of Kazakh-Chinese ethnicity. Out of 550 randomly selected patients, 516 completed the interview, anthropometry and BP assessments. Results: In the sample population, average SBP, DBP and PP were 156.26±24.40mmHg, 87.55±14.73mmHg and 68.71±19.39mmHg respectively. Bivariate analysis identified age, gender, education, duration of hypertension, WC and BMI being factors influencing the achieved levels of BP. Adjusted multiple linear regression models elicited positive associations of age (βa = 0.152, p = 0.001) and duration of hypertension (βa = 0.132, p = 0.003) with achieved level of SBP as well as BMI (βa = 0.135, p = 0.002) with DBP. Age (βa = 0.207, p<0.001) and WHtR (βa = 0.304, p = 0.005) were positively and WC (βa = -0.406, p<0.001) was negatively associated with PPI. Increasing age (βa = -0.125, p = 0.005), female gender (βa = -0.122, p = 0.005) and 5years’ duration of hypertension (βa = -0.091, p<0.039) were negatively associated with ABI. After adjustment for socio-demographic variables, hypertensive patients with (reference = without) abdominal obesity had 93% (p = 0.013) higher odds of missing the target BP control. Conclusion: Anthropometric measures and indicators for blood pressure control among Kazakh-Chinese patients were far beyond normal. Several anthropometric measures appeared useful for monitoring BP. Using them, regular screening and consequent targeted intervention were required urgently to control hypertension among Kazakh-Chinese. [ABSTRACT FROM AUTHOR]

Background: Recreational drug use has increased considerably among Chinese men who have sex with men (MSM). The phenomenon has the potentially to increase HIV transmission among Chinese MSM. The aims of this study were: 1) to investigate the prevalence of recreational drug use among Chinese MSM, and 2) to explore the correlation between gay smartphone based sex-seeking applications (gay apps), HIV/STIs testing, group sex, commercial sex, sexual roles and poppers use among Chinese MSM. Methods: MSM who were born biologically male, were at least 16 years of age and had engaged in anal sex with a man at least once were recruited through a nation-wide online survey in 2014. Information regarding socio-demographics, risk behaviors, recreational drug use, HIV and other STIs testing history and gay app use were collected. Univariate and multivariate analysis were used to determine factors associated with recreational drug use among Chinese MSM. Results: Among 1424 participating MSM, 1100 (77.3%) reported ever using recreational drugs in their lifetime. In the last 12 months, 303 (21.3%) used poppers, 34 (2.4%) used crystal meth and 15 (1.0%) used ecstasy. The mean age of respondents was 25.6±6.8 years, 72.9% identified as gay, 41.3% were students, and 83.8% had never been married. Multiple logistic regression models revealed that compared with non-popper users, popper users were more likely to have been tested for HIV (adjusted OR (aOR) = 1.50, 95% CI: 1.15–1.96) and other STIs (aOR = 1.65, 95% CI: 1.26–2.17). In addition, popper users were more likely to engage in group sex (aOR = 2.63, 95% CI:1.80–3.86), commercial sex (aOR = 1.86, 95% CI:1.13–3.06) and used gay mobile apps to seek sexual partners (aOR = 2.10, 95% CI:1.58–2.80). Conclusion: Chinese MSM has a high rate of recreational drug use, including poppers. Public health programs serving MSM may consider integrating intervention programs to decrease recreational drug use related harms. [ABSTRACT FROM AUTHOR]

Background: Innovation contests call on non-experts to help solve problems. While these contests have been used extensively in the private sector to increase engagement between organizations and clients, there is little data on the role of innovation contests to promote health campaigns. We implemented an innovation contest in China to increase sexual health awareness among youth and evaluated community engagement in the contest.Methods: The sexual health image contest consisted of an open call for sexual health images, contest promotion activities, judging of entries, and celebrating contributions. Contest promotion activities included in-person and social media feedback, classroom didactics, and community-driven activities. We conducted 19 semi-structured interviews with a purposive sample to ensure a range of participant scores, experts and non-expert participants, submitters and non-submitters. Transcripts of each interview were coded with Atlas.ti and evaluated by three reviewers.Results: We identified stages of community engagement in the contest which contributed to public health impact. Community engagement progressed across a continuum from passive, moderate, active, and finally strong engagement. Engagement was a dynamic process that appeared to have little relationship with formally submitting an image to the contest. Among non-expert participants, contest engagement increased knowledge, healthy attitudes, and empowered participants to share ideas about safe sex with others outside of the contest. Among experts who helped organize the contest, the process of implementing the contest fostered multi-sectoral collaboration and re-oriented public health leadership towards more patient-centered public health campaigns.Conclusion: The results of this study suggest that innovation contests may be a useful tool for public health promotion by enhancing community engagement and re-orienting health campaigns to make them more patient-centered. [ABSTRACT FROM AUTHOR]

Introduction: China is amidst a sexual revolution, with changing sexual practices and behaviors. Sex–seeking mobile phone applications (gay apps) that allow multiple people to meet up quickly may facilitate group sex. This study was therefore undertaken to evaluate group sex among Chinese MSM and to better understand factors associated with group sex. Methods: An online survey was conducted from September-October 2014, collecting data on socio-demographics, sexual behaviors, use of gay apps and occurrence of group sex among Chinese MSM. Univariate and multivariable logistic regressions were used to compare group sex and non-group sex participants. Results: Of the 1,424 MSM, the majority were under 30 years old (77.5%), unmarried (83.9%), and were gay apps users (57.9%). Overall, 141 (9.9%) participants engaged in group sex in the last 12 months. Multivariate analyses showed that men living with HIV, engaged in condomless anal intercourse with men, and used gay apps were more likely to engage in group sex, with adjusted ORs of 3.74 (95% CI 1.92–7.28), 2.88 (95% CI 2.00–4.16) and 1.46 (95% CI: 1.00–2.13), respectively. Among gay app users, the likelihood of group sex increases with the number of sex partners and the number of sex acts with partners met through a gay app. Conclusions: Chinese MSM who engage in group sex are also more likely to engage in other risky sexual behaviors, and gay app use may facilitate group sex. Further research is needed among MSM who engage in group sex in order to target interventions and surveillance. [ABSTRACT FROM AUTHOR]

In this paper, a practical control law is proposed for wheeled mobile robots in order to both improve the transient performance and repress the tracking errors. In particular, a two time-scale filtering technique, which can derive a fast variable to compensate for the disturbance, is applied during the carbot’s moving process. The nominal system is governed using a controller derived under the back-stepping framework. Such a design can effectively realize the system’s tracking objective and enhance robustness via properly configured parameters. In the meantime, a two time-scale filter is applied to the system function to estimate the disturbances, essentially improving the system’s precision. By virtue of this innovative technique, the final performance of the system is satisfactory in terms of both transient response and tracking error rejection. A previous sliding mode based control law is compared with the propounded one with respect to transient behavior and steady-state errors, and two types of disturbances, respectively the constant and sinusoid are simulated to verify the filter’s effectiveness. Since, from the results, there is significant improvement in both transient and steady-state performance, the proposed method is confirmed to be practical for tracking control of the wheeled mobile robots. [ABSTRACT FROM AUTHOR]

Background: HIV prevalence has increased rapidly among men who have sex with men (MSM) in China reaching alarmingly high levels in some cities. Bisexual MSM have potential to transmit HIV and syphilis to their female partners through condomless vaginal intercourse (CVI). Thus, estimation of the burden of CVI and identification of its associates seemed necessary to control this cross-gender transmission. Method: In a cross-sectional study, using respondent-driven-sampling and snowball sampling, 2958 MSM were recruited from seven Chinese cities, interviewed and tested for HIV and syphilis. Descriptive analysis of the socio-demographic and behaviors followed by simple and multiple logistic regressions [adjusted for income, city, race and social network size to determine adjusted odds ratio (aOR)] were performed using SAS-9.1. Results: Among participating MSM, 19.03% were engaged in CVI. Prevalence of HIV and syphilis among participants involved in CVI were 5.86% and 14.74% respectively. MSM who were older [aOR for aged 40–49 = 2.60 (95% CI: 1.54–4.37)], married [aOR = 6.13 (4.95–7.58)], attended primary school or below [aOR = 3.86 (2.26–6.69)], met male partners at spa/bathhouse/sauna/massage parlor [aOR = 3.52 (2.62–4.72)] and had heterosexual orientation [aOR = 13.81 (7.14–26.70)] were more likely to have CVI. Furthermore, correct knowledge regarding HIV [aOR = 0.70 (0.55, 0.88)] and exposure to HIV prevention interventions [aOR = 0.67 (0.54, 0.82)] were negatively associated with CVI. Conclusions: CVI was found to be common among MSM in China. To minimize the transmission of HIV and syphilis from bisexual MSM to their relatively female partners, targeted interventions should specifically focus on bisexual MSM especially the older and married subgroups. [ABSTRACT FROM AUTHOR]

Background: Considering the importance of health literacy (HL) for the maximum yield from the hypertension control programs, development of a reliable and valid instrument of hypertension-related HL is critical. This study aimed to translate and validate the High Blood Pressure-Health Literacy Scale (HBP-HLS) into Chinese (C-HBP-HLS) and evaluate its psychometric properties in Chinese context. Method: Between June 2013 and January 2014, a cross-sectional study was conducted among recruited hypertensive patients belonging to the Han and Kazakh-Chinese communities in Urumqi, Xinjiang, China. Results: A pilot sample (n = 242) was selected for the exploratory factor analysis of the translated and modified instrument. Another sample (n = 308) was recruited for the confirmatory factor analysis. C-HBP-HLS consisted of five dimensions (Print Health Literacy, Medication Label, Understanding Ability, Newest Vital Sign Test, and Avoiding Food Allergy) containing 15 items, accounting for 77.7% of the total variance. The 5-factor model demonstrated a good overall fit. The scale-level content validity index was 0.85. Cronbach’s alpha of the overall scale was 0.78 and test-retest reliability was 0.96. Education level had a strong positive correlation with the scores for items Q1, Q2, and Q3(r = 0.481, 0.492, 0.475, respectively). Health Literacy scores among Kazakh patients were significantly lower than Han (7.13±7.90 vs. 30.10±13.42, Z = -14.573, P<0.001). Conclusion: C-HBP-HLS demonstrated suitable factor structure and robust psychometric properties for measuring health literacy level among hypertensive patients in China. [ABSTRACT FROM AUTHOR]

This study proposes a novel adaptive mesh expansion model (AMEM) for liver segmentation from computed tomography images. The virtual deformable simplex model (DSM) is introduced to represent the mesh, in which the motion of each vertex can be easily manipulated. The balloon, edge, and gradient forces are combined with the binary image to construct the external force of the deformable model, which can rapidly drive the DSM to approach the target liver boundaries. Moreover, tangential and normal forces are combined with the gradient image to control the internal force, such that the DSM degree of smoothness can be precisely controlled. The triangular facet of the DSM is adaptively decomposed into smaller triangular components, which can significantly improve the segmentation accuracy of the irregularly sharp corners of the liver. The proposed method is evaluated on the basis of different criteria applied to 10 clinical data sets. Experiments demonstrate that the proposed AMEM algorithm is effective and robust and thus outperforms six other up-to-date algorithms. Moreover, AMEM can achieve a mean overlap error of 6.8% and a mean volume difference of 2.7%, whereas the average symmetric surface distance and the root mean square symmetric surface distance can reach 1.3 mm and 2.7 mm, respectively. [ABSTRACT FROM AUTHOR]

The article explores tobacco control in China as of 2018, focusing on whether or not tobacco crop substitution could aid the cause. Additional topics discussed include how China sets a quota for tobacco leaf production to ensure revenue to the state, the health impact of China's transition to a developed country and world economic power, and social conditions for farmers in China. The WHO (World Health Organization) and the United Nations Development Program are also noted.

Introduction: Low oxygen saturation suggests severe heart or respiratory disease. Most practitioners consider less than 95% as abnormal oxygen saturation in infants. Experts have recommended this cut-off value based on large-sample studies at or near sea level. However, there are few large-sample studies of infants born at low to moderate altitudes. The aim of this study is to determine threshold values of newborn oxygen saturation at low to moderate altitudes. Methods: We included 35 hospitals located in the Yunnan province of China, with altitudes varying from 267 to 2,202 meters. The hospitals recruited 41,097 consecutively born, asymptomatic neonates between Aug. 2015 and Jun. 2016. Obstetric nurses measured pre- and post-ductal oxygen saturation of each baby at 24 hours of age and before hospital discharge. Results: We categorized all births, according to the altitude of birth, into three groups: low altitude (0 to 500 meters), low to moderate altitude (500 to 1,500 meters), and moderate altitude (1,500 to 2,500 meters). The mean of pre-ductal oxygen saturation measured at 24 hours of age was 97.9% at low attitudes, 96.4% at low to moderate altitudes and 95.5% at moderate attitudes. We considered the 2.5th percentile as the cut off threshold, and recommended cut-off values of 95% for low altitudes, 93% for low to moderate altitudes, and 92% for moderate altitudes. Conclusion: These findings provide revised threshold values of oxygen saturation for pediatricians and obstetricians when screening newborns for severe congenital heart and lung disease at low to moderate altitudes. [ABSTRACT FROM AUTHOR]

Medical ultrasound images are corrupted by speckle noise, which is multiplicative. This noise limits the contrast resolution in these images and complicates image-based quantitative measurement and diagnosis. In this study, the speckle noise in the ultrasound image is modeled by local statistics of the intensity distribution. And the non-local mean (NLM) filter is utilized to filter additional noise by applying the redundancy information in noisy images. A hybrid denoising method is proposed in consideration of the characteristics of both the local statistics of speckle noise and the NLM filter. The study combines local statistics with the NLM filter to reduce speckle in ultrasound images. The local statistics of speckle noise is estimated by local patches, while the intensity of the denoising pixel is computed by the weighted average of all the pixels by using the NLM. The weight is determined according to the similarity measures between the intensities of the local patches. The performance of the proposed method is evaluated on synthetic data, simulated images, and real images. Results of quantitative analysis and visual inspection of the synthetic data and of the real images demonstrate that the proposed method outperforms the original NLM, as well as many previously developed methods. [ABSTRACT FROM AUTHOR]