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BackgroundThere is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. ObjectiveThe first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. MethodsAn operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. ResultsIntra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). ConclusionsTaken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.

[Objective] The ecological effect of urban spatial expansion is the key problem of human-environment relationship in the process of urbanization. It is of great significance to explore the complex scientific problem of ecological effect caused by urban spatial expansion from multiple angles to promote the sustainable and high-quality development of urban and ecological space. [Methods] Taking the main urban area of Lanzhou City in China as an example, this study calculated the scale, intensity, and landscape pattern indices of urban spatial expansion in 1995, 2005, 2015, and 2020 to reflect the spatiotemporal variation characteristics of urban spatial expansion in the city from 1995 to 2020, and divided the research area into 12184 grids. Using the spatial principal component analysis method, atmospheric radiation transfer equation method, and revised ecosystem service value estimation model, this study analyzed the ecological risk effect, heat island effect, and ecosystem service effect of urban spatial expansion from various angles, and discussed the impact of natural environment conditions on the ecological effect of urban spatial expansion of cities in river valleys. [Results] The results show that from 1995 to 2020, the scale and intensity of urban expansion in Lanzhou City have increased, the fragmentation of urban landscape has decreased, urban expansion has mainly occurred in the western and northern parts of the city, and the urban expansion mode has changed from group expansion to leaping expansion. The overall ecological risk effect and heat island effect in the city have shown a weakening trend, but a rising trend was observed in the river valley, and the overall pattern of effects has been characterized by high in the valley and low at the peripheries. There is a slight improvement in the ecosystem service effect, which mainly shows that the ecosystem service value in the surrounding areas of the river valley has improved significantly, and some areas in the built-up area have changed from low-value area to medium-value area. Urban expansion negatively affects the natural substrates of the region, while the natural substrates also affects the scale, direction, and mode of urban expansion. Coordinating the relationship between the two is essential for the sustainable and harmonious development of human beings and nature. [Conclusion] The research framework of ecological effects of urban spatial expansion was constructed from multiple perspectives. Urban spatial expansion has a significant impact on ecological risk, heat island, and ecosystem service effects at the grid scale, which provides a new way of quantitative visualization of the dynamic relationships between urban evolution and ecological environment.

Strategies for patient stratification and early intervention are required to improve clinical benefits for patients with prostate cancer. Here, we found that active DHEA utilization in the prostate gland correlated with tumor aggressiveness at early disease stages, and 3[beta]HSD1 inhibitors were promising for early intervention. [[sup.3]H]-labeled DHEA consumption was traced in fresh prostatic biopsies ex vivo. Active DHEA utilization was more frequently found in patients with metastatic disease or therapy-resistant disease. Genetic and transcriptomic features associated with the potency of prostatic DHEA utilization were analyzed to generate clinically accessible approaches for patient stratification. UBE3D, by regulating 3[beta]HSD1 homeostasis, was discovered to be a regulator of patient metabolic heterogeneity. Equilin suppressed DHEA utilization and inhibited tumor growth as a potent 3[beta]HSD1 antagonist, providing a promising strategy for the early treatment of aggressive prostate cancer. Overall, our findings indicate that patients with active prostatic DHEA utilization might benefit from 3[beta]HSD1 inhibitors as early intervention., Introduction Prostate cancer is the most common cancer malignancy in men in Western countries, and its incidence is increasing rapidly in China (1, 2). Therapy resistance is inevitable due to [...]

This study presents an analysis of daily temperature and precipitation extremes with return periods ranging from 2 to 50 years in phase 6 of the Coupled Model Intercomparison Project (CMIP6) multimodel ensemble of simulations. Judged by similarity with reanalyses, the new-generation models simulate the present-day temperature and precipitation extremes reasonably well. In line with previous CMIP simulations, the new simulations continue to project a large-scale picture of more frequent and more intense hot temperature extremes and precipitation extremes and vanishing cold extremes under continued global warming. Changes in temperature extremes outpace changes in global annual mean surface air temperature (GSAT) over most landmasses, while changes in precipitation extremes follow changes in GSAT globally at roughly the Clausius-Clapeyron rate of;7% 8C21. Changes in temperature and precipitation extremes normalized with respect to GSAT do not depend strongly on the choice of forcing scenario or model climate sensitivity, and do not vary strongly over time, but with notable regional variations. Over the majority of land regions, the projected intensity increases and relative frequency increases tend to be larger for more extreme hot temperature and precipitation events than for weaker events. To obtain robust estimates of these changes at local scales, large initial-condition ensemble simulations are needed. Appropriate spatial pooling of data from neighboring grid cells within individual simulations can, to some extent, reduce the needed ensemble size.