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To investigate the ability of ultrasomics to predict Ki-67 expression in hepatocellular carcinoma (HCC).A total of 244 patients from three hospitals were retrospectively recruited (training dataset, n = 168; test dataset, n = 43; and validation dataset, n = 33). Lesion segmentation of the ultrasound images was performed manually by two radiologists. In total, 1409 ultrasomics features were extracted. Feature selection was conducted using the intra-class correlation coefficient, variance threshold, mutual information, and recursive feature elimination plus eXtreme Gradient Boosting. The support vector machine was combined with the learning curve and grid search parameter tuning to construct the clinical, ultrasomics, and combined models. The predictive performance of the models was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and accuracy.The ultrasomics model performed well on the training, test, and validation datasets. The AUC (95% confidence interval [CI]) for these datasets were 0.955 (0.912-0.981), 0.861 (0.721-0.947), and 0.665 (0.480-0.819), respectively. The combination of ultrasomics and clinical features significantly improved model performance on all three datasets. The AUC (95% CI), sensitivity, specificity, and accuracy were 0.986 (0.955-0.998), 0.973, 0.840, and 0.869 on the training dataset; 0.871 (0.734-0.954), 0.750, 0.829, and 0.814 on the test dataset; and 0.742 (0.560-0.878), 0.714, 0.808, and 0.788 on the validation dataset, respectively.Ultrasomics was proved to be a potential noninvasive method to predict Ki-67 expression in HCC.

Telemedicine refers to a discipline in which medical personnel use modern communication technology, electronic technology, and computer technology to realize the remote collection, storage, processing, transmission, and inquiry of various medical information, so as to cross the barriers of time and space and provide medical services to a wider range of people With the rapid development of Internet technology, telemedicine is being used more widely in case consultation, imaging, ECG and pathology. The demand for remote echocardiography is increasingly strong and its potential applications becoming more extensive, however, the development of remote ultrasound imaging, especially remote echocardiography, is lagging behind due to the limitation of dynamic image codec, immature multi-channel information synchronization technology, and slow network transmission speeds. This article reviews the development status and application prospects of remote diagnosis and treatment of echocardiography at home and abroad.

For symptomatic hypertrophic obstructive cardiomyopathy (HOCM), how to effectively relieve left ventricular outflow tract obstruction is of great significance. Relying on drugs and double-chamber pacing to reduce left ventricular outflow tract pressure gradient can alleviate symptoms. Methods to reduce the thickness of inter-ventricular septum include myocardial myectomy, percutaneous transluminal septal myocardial ablation, radiofrequency catheter ablation of ventricular tachycardia, and high-intensity focused ultrasound (HIFU) ablation of the ventricular septum that were performed on animal experiments to reduce inter-ventricular septal thickness, and showed significant therapeutic effects. Ultrasound-guided percutaneous intramyocardial septal ablation, as a less invasive and more effective treatment, exhibited great application prospects in reducing the pressure gradient of left ventricular outflow tract. This article reviews the research progress of several ventricular septal ablation techniques for the treatment of HOCM.

Introduction/Background Ovarian clear cell carcinoma (OCCC) is a special subtype of epithelial ovarian carcinoma with unique characteristics and no specific tumour markers. Due to the inherent chemoresistance, there are no effective chemotherapy regimen for OCCC, resulting in the extremely poor prognosis of patients, especially at advanced stage. Therefore, the purpose of our research is to investigate the clinical characteristics and outcomes of ovarian clear cell carcinoma (OCCC) and to provide additional supporting evidence to aid in the clinical diagnosis and management. Methodology This was a retrospective study investigating the clinical characteristics and survival outcomes of 87 patients with OCCC treated at The First Affiliated Hospital of University of Science and Technology of China (USTC), between January 2010 and March 2020. Survival analysis was also performed on 179 patients with OCCC diagnosed between 1975 and 2017, obtained from the Surveillance, Epidemiology and End Results (SEER) cancer registry database. Results The median age of study participants was 49.28 ± 9.8 years old, with 74.71% diagnosed at an early stage. Median CA125 level was 607.26 IU/mL, with 23.94% having a normal CA125 level. 16 patients (18.39%) had co-existing endometriosis and 8 patients (9.2%) had a preoperative history or developed postoperative complications of venous thromboembolism (VTE). Surgical staging procedures were performed on 65 patients and cytoreduction was performed on 22 patients, among whom 17 patients received optimal cytoreduction. 67 patients (77.01%) underwent lymphadenectomy, and only 3 (4.48%) were found to have positive lymph nodes. Positive HNF1β, and negative WT-1, ER, and PR are reliable immunohistochemical indicators of OCCC. Patients diagnosed at an early stage had higher 3-year overall survival (OS) (89.47% vs. 44.44%) and progression-free survival (PFS) rates (78.95% vs. 22.22%) than those with advanced stage OCCC at diagnosis. CA199 (P = 0.025) and ascites (P = 0.001) were significantly associated with OS, while HE4 (P = 0.027) and ascites (P = 0.001) were significantly associated with PFS. Analysis of data from the SEER database showed that the presence of positive lymph nodes is also an independent prognostic factor for OS (P = 0.001). Conclusion OCCC often presents at an early stage and young age with a mild elevation in CA125 level. CA199, HE4, massive ascites and positive lymph node are independent prognostic factors for overall survival in OCCC. Disclosures This work was supported by the National Natural Science Foundation of China (81872110, 81902632), National Key Research and Development Program (2018YFC1003900), Anhui Provincial Key Research and Development Program (1704a0802151). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No conflicts of interest to disclose.

Clarifying the impact mechanisms of landscape patterns on ecosystem services is highly important for effective ecosystem protection, policymaking, and landscape planning. However, previous literature lacks knowledge about the impact mechanisms of landscape patterns on ecosystem services from a spatial perspective. Thus, this study measured landscape patterns and the ecosystem services value (ESV) using a series of landscape pattern metrics and an improved benefit transfer method based on land-use data from 2015. It explores the impact mechanisms of the landscape pattern metrics on the ESV using the ordinary least-squares method and spatial regression models in the middle reaches of the Yangtze River Urban Agglomerations (MRYRUA), China. We found that forestland was the main landscape type in the MRYRUA, followed by cultivated land, and the fragmentation degree of cultivated land was significantly higher than that of forestland. The findings demonstrate that landscape pattern metrics had a significant impact on ecosystem services, but could vary greatly. Moreover, ecosystem services in the MRYRUA exhibited significant spatial spillover effects and cross-regional collaborative governance was an effective means of landscape planning. This paper acts as a scientific reference and effective guidance for landscape planning and regional ecosystem conservation in MRYRUA and other similarly fast-growing urban agglomerations.

BACKGROUND The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. OBJECTIVE The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. METHODS Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. RESULTS Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. CONCLUSIONS Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.

Ultrasound-responsive nanodroplets show great potential in ultrasound diagnosis and targeted tumour therapy due to their unique phase transition properties. However, the mechanism underlying the phase transition and the properties of contrast-enhanced imaging have not been well elucidated, which impedes the development and application of nanodroplets in clinic. Herein, the phase transition of polymeric nanodroplets with a core of perfluoronpentane (PFP) was studied through the measurement of particle size and in vitro/in vivo contrast-enhanced imaging, and imaging performance was further evaluated by introducing intensity analysis of acoustic signals. The average particle size of nanodroplets increased and became polydispersed when heated at 37 °C, which may result from vaporization of a portion of nanodroplets. For imaging in vitro, no acoustic signals were observed at 25 °C when the mechanical index (MI) varied from 0.08 to 1.0. At 37 °C, acoustic signals were observed for MI ≥ 0.4, and the intensity was stronger for higher MIs. For imaging in mice livers, the nanodroplets showed similar contrast enhancement behaviours with SonoVue® at low MI (0.08), which produced strong acoustic signals immediately and were cleared within 10 min. The acoustic signals at high MI (1.0) were weaker but lasted more than 1 h. These results indicated that the phase transition of polymeric nanodroplets could be induced by diagnostic ultrasound, and contrast-enhanced imaging is closely related to particle size, temperature and MI. This study provides a better understanding of phase transition and contrast-enhanced imaging for ultrasound-responsive nanodroplets with polymer shells.

To explore the shape characteristics of ablation lesions created via laser ablation (LA), radiofrequency ablation (RFA) and microwave ablation (MWA) in canine prostates and the clinical significance of these characteristics, six adult male beagles were randomly assigned to the LA, RFA, and MWA groups. These ablations were performed with common parameters applied in clinical practice (LA, 3 W/1200 J; RFA and MWA, 30 W/120 s). One ablation lesion was created in each lobe of the prostate via the ablation technique, resulting in a total of twelve ablation lesions. Transrectal ultrasound (TRUS) was used as guidance during puncture and to monitor changes in the ablation lesions. Finally, the ablation efficacy was assessed using transrectal contrast-enhanced ultrasonography (CEUS), and the transverse diameter (TRD), anteroposterior diameter (APD) and longitudinal diameter (LD) of each ablation lesion were measured. The volume (V) and the ratio (R) value were calculated. R reflects the shape characteristic of the ablation lesion (the R value close to 1.0 indicates a more spherical shape). The R values of the ablation lesions were 0.89 ± 0.02, 0.72 ± 0.01, and 0.65 ± 0.03 for RFA, MWA and LA, respectively, and they were significantly different (P = 0.027). The volumes of the ablation lesions were 2.17 ± 0.10 ml, 1.51 ± 0.20 ml, and 0.79 ± 0.07 ml for MWA, LA and RFA, respectively, and they were also significantly different (P = 0.001). The three abovementioned thermal ablation techniques with common parameters in clinical practice can be used for ablation in the prostate. The shapes and volumes of the ablation lesions of the three techniques were varied: The RFA-created lesions had the lowest volumes and were more spherical in shape, demonstrating that RFA could be used for the treatment of relatively small lesions or tumours adjacent to vital organs. The MWA lesions had the largest size with a spherical shape, which could be advantageous for the ablation of tumours with relatively large sizes. The sizes of the ablation lesions created via LA were between those of RFA and MWA but presented more oval in shape, suggesting that this method is highly appropriate for the ablation of benign prostatic hyperplasia (BPH).

BACKGROUND China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. OBJECTIVE This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. METHODS By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People’s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. RESULTS This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. CONCLUSIONS The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability.

Background The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. Objective The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. Methods Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. Results Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. Conclusions Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.

Objectives To explore the application values of layer-specific strain technology in the assessment of left ventricular (LV) systolic function and synchronicity before and after coronary artery bypass graft (CABG) in patients with coronary artery disease (CAD). Methods Thirty-three CAD patients scheduled for CABG were recruited, along with 35 controls without cardiovascular disease. The images of apical four, two and three chamber views of LV were collected before CABG and 1 week, 1 month and 3 months after CABG. The layer-specific longitudinal peak strains, time to peak and peak strain dispersion (PSD) were determined for 17 segments of LV using Echo PAC workstation software and Q-analysis software. The differences of these parameters were compared between groups. Results The absolute values of layer-specific longitudinal peak strains at subendocardium, middle layer and subepicardium, respectively represented by GLPSendo, GLPSmid and GLPSepi, decreased significantly (P 0.05) and absolute values of GLPSendo, GLPSmid and GLPSepi 3 months after CABG (P>0.05). At 1 month and 3 months, PSD decreased significantly (P 0.05). Conclusions Layer-specific strain technology provides a quantitative evaluation approach for LV systolic function and synchronicity before and after CABG in CAD patients. As a novel parameter in assessing LV systolic synchronicity, PSD is worthy of clinical popularization.

Background: China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. Objective: This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. Methods: By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People’s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. Results: This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. Conclusions: The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability.

Objectives To explore the feasibility, clinical significance and popularization value of tele-echocardiography consultation based on Internet cloud service technology. Methods Relying on the 4G Internet cloud service platform, using unique dynamic image codec and synchronization technology to integrate multi-dimensional communication information such as voice, text and pictures, we have constructed the tele-echocardiography consultation platform of Henan Provincial People's Hospital and two primary hospitals 300 kilometers apart.45 patients were consulted through the tele-echocardiography consultation platform. Results 45 patients achieved teleconsultation through the tele-echocardiography consultation platform. The total time spent was about 341.31 minutes, and the average length of consultation for each patient was 7.58 ± 6.17 minutes. There were 5 patients diagnosed with congenital heart disease, 34 patients with acquired heart disease, and 6 patients excluded with cardiac abnormalities. Compared with the initial diagnosis results of the primary hospitals, the consultation specialists newly discovered 7 cases of abnormal diagnosis, accounting for 16% of the total number of consultations; confirmed 6 cases of initial diagnosis, accounting for 13% of the total number of consultations; excluded 6 cases of suspicious diagnosis, accounting for 13% of the total number of consultations; and answered a number of difficult questions. The expert opinions of the remaining 26 cases were basically consistent with the initial diagnosis of primary hospitals, accounting for 58% of the total number of consultations. Patient and doctor satisfaction is 100%. Conclusions The three-synchronization dual real-time interactive tele-echocardiography consultation system based on Internet cloud service and unique dynamic image codec and synchronization technology has good feasibility and practicability, and is worthy of widespread application.