The goal of this research is to investigate the determinants of subjective health and quality of life with a particular focus on middle- and old-aged citizens. Subjective health is an antecedent of quality of life. For both attributes, travel frequency, economic activity, and cultural activity frequency are the main explanatory variables. Korean middle- and old-aged citizen research panel data was used to derive the data; the study periods are 2008, 2010, 2012, 2014, and 2016. The present work used an econometric method to analyze this panel data. The results show that subjective health positively affects quality of life; meanwhile, economic activity positively affects both subjective health and quality of life. It is also found that cultural activity and travel exert inverted U-shape impacts on subjective health and quality of life. The control variables in this research were gender, body mass index, birth year, and personal assets. These results could help guide policy makers in designing more efficient welfare policies for middle- and old-aged citizens. Statistics Korean  forecastThe main explained attributes of this work are quality of life and subjective health. Both attributes have been commonly explored by scholars because the elements represent the mental and physical status of an individual as well as their overall happiness in living ,6,7,8,9.The main theoretical background of this work is the law of diminishing marginal utility. According to the law of diminishing marginal utility, highly frequent goods consumption reduces utility, which in turn results in negative utility because of the huge cost ,13,14. TAll things considered, the purpose of this research is to investigate the influential attributes on subjective health and quality life of Korean middle and old aged senior citizens. This study also intends to provide information to help policy makers establish more adequate systems for middle and old aged senior citizens’ welfare. Quality of life refers to individuals’ self-evaluations about their life conditions ,20. QualSubjective health refers to how individuals perceive their own health conditions, and it includes both physical and mental aspects together ,26. PrioHypothesis 1:Subjective health has a significant positive effect on quality of life.Travel helps people have better health conditions and improved life quality because it allows people to stray away from their daily lives and have exotic and fruitful experiences ,35,36,37People create, achieve, and develop their life goals and attain earnings through economic activities ,44. In sCultural activities include music, art performances, exhibitions, concert, musical, etc. ,55,56. SThe law of diminishing marginal utility also argues that marginal utility through additional consumption declines with more consumption ,16. The Hypothesis 2a:Travel frequency has a significant curvilinear (inverted U-shaped) effect on quality of life.Hypothesis 2b:Travel frequency has a significant curvilinear (inverted U-shaped) effect on subjective health.Hypothesis 3a:Economic activity has a significant positive effect on quality of life.Hypothesis 3b:Economic activity has a significant positive effect on subjective health.Hypothesis 4a:Cultural activity frequency has a significant curvilinear (inverted U-shaped) effect on quality of life.Hypothesis 4b:Cultural activity has a significant curvilinear (inverted U-shaped) effect on subjective health.This research uses archival data. The data was attained from Korean Senior citizen research panel data  that is collected by the Korea Employment Information Service. The data defines senior citizens as Koreans who are older than 45 years old. Therefore, the scope of survey participants are middle and old aged senior citizens. The Korea Employment Information Service has performed this survey every two years since 2006. The survey data has been used by several prior studies ,67,68,692) (BMI) birth year (BYR), gender  (GEN), and individual total assets (Unit is ten thousand KRW) (AST). As of March 2022, the currency rate for 1,200 KRW is approximately equivalent to 1 USD. The explained variables in this research are quality of life (QOL) and subjective health (SHE). These are measured by point values ranging from 0 to 100. The other variables are the frequency of annual traveling (TRF) and cultural life (CAF): movie, musical, exhibition, sports, and etc. Economic activity is measured by a binary variable . This work also selects four control variables: body mass index (kg/m0: No difference between OLS and FE) and Hausman test to choose better model between FE and RE (H0: No difference between RE and FE) [2). Altogether, STATA 13 was used for the statistical package for data analysis. This study computed mean, standard deviation (SD), minimum, and maximum as the descriptive statistics. Then, correlation matrix analysis was conducted to examine the relationships between variables. To test the hypotheses, this study performed the following panel regression methods: ordinary least square (OLS), fixed effect (FE), and random effect (RE). This study ensured the consistency of the coefficients across three results of multiple regression analysis. The fixed effects model incorporates a multiple year dummy into the regression model to minimize omitted variable bias in the panel data, while random effect adds an unobserved effect into the model for estimation ,71. This and FE) ,71,72. TWe present the following regression equation:ith participants, t: tth year.Note: i: The respective means of QOL and SHE are 62.70 and 58.74 and the standard deviations are 15.91 and 19.68, respectively. For EAC and GEN, the means are 0.40 and 0.57, respectively. p < 0.05), TRF , EAC , CAF , BMI , BYR , and AST . SHE is also positively correlated with TRF , EAC , CAF , BMI , BYR , and AST . TRF is positively correlated with EAC , CAF , BYR , and AST . EAC is also positively correlated with CAF , BYR , and AST .p < 0.05). Next, TRF , TRF2 , CAF , and CAF2  significantly account for SHE. Using the coefficients, this research performed differentiation and the first-order condition was computed to obtain the point to maximize SHE . GEN is found to be negatively associated with SHE ; meanwhile, BMI , BYR , and AST  are positively related to SHE. The results are consistent across all three models (Models 1 through 4). The results of the Chow test indicate no difference between OLS and FE . Also, the Hausman test results imply that there is no difference between RE and FE . All things considered, OLS is regarded as the most adequate model (Model 1).p < 0.05) and EAC  exerted positive effects on QOL, TRF , TRF2 , CAF , and CAF2 . Given the coefficients, this study carried out differentiation and the first-order condition was calculated to obtain the point to maximize QOL . The results also show that BYR  is negatively related to QOL, whereas GEN  and AST  are positively related to QOL. All VIF values are less than 10, indicating that the model is less likely to be biased by multicollinearity, as listed in p > 0.05). In addition, the results of the Hausman test present no difference between RE and FE . This indicates that OLS is the most appropriate (Model 5).This work aimed to examine the influential attributes of quality life and subjective health for Korean middle- and old-aged citizens. The results suggest that improving subjective health is essential for improving quality of life. The results also demonstrated that the frequency of travel and cultural activities both exerted inverted U-shaped effects. This can be inferred to mean that too high a frequency of travel and cultural activities could diminish the associated utility gained by middle- and old-aged citizens, while simply costing them time and effort to participate in travel and cultural activities. In other words, the repeated consumption of travel and cultural products reduces utility over time. Therefore, maintaining an optimal frequency of travel and cultural activities is imperative for subjective health and life quality. The results also showed that economic activity enhances both subjective health and quality of life for middle- and old-aged citizens. It implies that jobs for middle- and old-aged citizens in Korea are more worthwhile for accomplishing better life and health conditions. In terms of subjective health, women showed a lower level of subjective health, and body mass index improved subjective health. Meanwhile, quality of life among females was better than that among males. Namely, women had a better quality of life and worse subjective health than men. Further, younger senior citizens have better subjective health and quality of life. Finally, possessing more personal assets is critical for enhancing both subjective health and quality of life for Korean middle- and old-aged citizens.This study makes important theoretical contributions: Above all, this research ensured the accountability of the law of marginal utility decline in the areas of quality of life and subjective health by using travel and cultural life as the explanatory attributes. Specifically, this work demonstrates that travel and cultural activity frequency both have curvilinear effects on subjective health and quality of life by researching Korean middle and old aged senior citizens. Moreover, the results of this research externally validate the findings of prior research. In particular, this research confirmed the link between subjective health and quality of life in the context of Korean middle and old aged senior citizens ,33. The This work has practical implications. First, this information could be used by policy makers. Specifically, a government budget could be allocated for creating jobs for middle- and old-aged citizens. Financial resources could also be allocated to education for improving middle- and old-aged citizens’ job skills. Second, it could be necessary for policy makers to invest in travel and cultural destinations. However, careless spending should be avoided because middle- and old-aged citizens’ marginal utility could be decreased with repetitive activities. Hence, the costs of travel and cultural programs would need to be considered by policy makers because the resources of middle- and aged citizens are constrained. In terms of the results of the control variables, government policy for subjective health and quality of life needs to be differentiated depending on gender. For example, policies related to better life quality should focus more on males, whereas policies related to improving health should focus more on females. In addition, policy makers should contemplate how to enhance both the subjective health and the quality of life of older senior citizens. Government resources should also be dedicated to improving the health of middle- and old-aged citizens. This could be achieved through various channels, for example, offering medical support and healthy food while also addressing the isolation of some citizens.This study has limitations. First, the data were only available up until 2016. Future research might be able to use more updated information because pre-pandemic data might not be sufficient to offer a real picture of the current situation. In particular, the period of data in future studies should include 2020, which would allow researchers to investigate the effects of COVID-19 on senior citizens. This research also depended on archival data. Future studies should consider more advanced items for the measurement of the attributes in this research. Furthermore, it is possible that there could be a more influential attribute to account for both subjective health and quality of life. Future research thus needs to search for more influential variables because the R-square of this research could be improved. Such an effort might lead to more useful future research.


Quantification index, such as standardized uptake value ratio (SUVR) and distribution volume ratio (DVR), has been exploited to effectively distinguish between healthy and subjects with AD. However, these measures require a long wait/scan time, as well as the selection of an optimal reference region. In this study, we propose an alternate measure named amyloid quantification index (AQI), which can be obtained with the first 30-min scan without the selection of the reference region.11C-labeled Pittsburgh compound B PET scan data were obtained from the public dataset “OASIS-3”. A total of 60 mild subjects with AD and 60 healthy controls were included, with 50 used for training and 10 used for testing in each group. The proposed measure AQI combines information of clearance rate and mid-phase PIB retention in featured brain regions from the first 30-min scan. For each subject in the training set, AQI, SUVR, and DVR were calculated and used for classification by the logistic regression classifier. The receiver operating characteristic (ROC) analysis was performed to evaluate the performance of these measures. Accuracy, sensitivity, and specificity were reported. The Kruskal–Wallis test and effect size were also performed and evaluated for all measures. Then, the performance of three measures was further validated on the testing set using the same method. The correlations between these measures and clinical MMSE and CDR-SOB scores were analyzed.p < 0.001). For the training set, ROC analysis showed that AQI achieved the best classification performance with an accuracy rate of 0.93, higher than 0.88 for SUVR and 0.89 for DVR. The effect size of AQI, SUVR, and DVR were 2.35, 2.12, and 2.06, respectively, indicating that AQI was the most effective among these measures. For the testing set, all three measures achieved less superior performance, while AQI still performed the best with the highest accuracy of 0.85. Some false-negative cases with below-threshold SUVR and DVR values were correctly identified using AQI. All three measures showed significant and comparable correlations with clinical scores (p < 0.01).The Kruskal–Wallis test suggested that AQI, SUVR, and DVR can all differentiate between the healthy and subjects with mild AD (Amyloid quantification index combines early-phase kinetic information and a certain degree of β-amyloid deposition, and can provide a better differentiating performance using the data from the first 30-min dynamic scan. Moreover, it was shown that clinically indistinguishable AD cases regarding PiB retention potentially can be correctly identified. SUVR measures the ratio of SUV in target and reference regions over a late-scan period. The value of SUVR reflects the degree of PiB retention and thus the amyloid deposition in the region of interest (ROI) at the equilibrium stage of tracer distribution. This semi-quantitative method works effectively in assisting AD diagnosis, although it was known to suffer from non-specific tracer binding , requires only the first 30-min scan which reflects both clearance rate from tissue at the early stage and PiB retention before equilibrium. Its performance in differentiating mild AD and HC subjects was assessed and compared with those of SUVR and DVR. Limitations and future work were discussed at the end of this paper.A total of 60 mild AD subjects and 60 healthy controls (HCs) from the OASIS-3 dataset  PET imaging was performed on each subject. Subjects were given 6–20 mCi 11C-labeled PiB intravenously. Dynamic scans  were conducted on one of the three Siemens PET scanners: ECAT HR+ 962 PET, Biograph 40 PET/CT, and BioGraph mMR PET-MR. PET imaging analysis was performed as follows . Reference region-based Logan graphical analysis was implemented on each segmented region to calculate DVR . Linear interpolation was performed on TACs to obtain a fine sampling time for all scans.According to the kinetics of PiB  represents the activity concentration (Bq/ml) of PiB as a function of t. S(0) is the average activity concentration of the first frame (0–10 s). Normalization was performed using injected dose for each scan. The optimal values for t1 and t2 and the coefficient “a” were determined by maximizing the classification accuracy. Then, a 10-fold cross-validation procedure using logistic regression classifier was applied to evaluate the performance of AQI_roi on differentiating subjects in the training set. The parameters that had the best compromise between accuracy and scan time were chosen to be the optimal value.Here Conventional analysis of quantification methods is based on single or several regions known to contain amyloid deposition without investigating optimal regions. In this study, we identified featured brain regions for AQI using lasso regression analysis . The discriminatory performance of index AQI was compared with those of SUVR and DVR. Here the value of SUVR and DVR were calculated as the average values in anterior cingulate, frontal cortex, parietal cortex, and precuneus, which have been reported to accompany higher amyloid binding in subjects with AD than in HC  were found by grid search, where the searching intervals were t1 ∈ , t2∈ with a step size of 50 s and a∈ with a step size of 0.1. AQI_roi in the caudal anterior cingulate cortex was then calculated for all training subjects with each set of parameters and used for classifying the AD and HC groups. max was different for each subject, ranging from 80 to 240 s. Each AQI_roi value was normalized using an injected dose. As a result, one would only need scan data of the first 1,650 s (<30 min). All data after this time point were not necessary for computing AQI.where tThe contribution of AQI_roi in different brain regions was evaluated using lasso regression. The selected brain regions were caudal anterior cingulate cortex (β = 2.5214) and caudate(β = 0.1976), with the value of coefficient β reflecting their contribution for differentiating AD and HC subjects. An overall AQI was calculated for each subject by linearly combining AQI_roi in the caudal anterior cingulate cortex and caudate:X1 and X2 denote the z-score normalized value of AQI_roi in the caudal anterior cingulate cortex and caudate, respectively. The discriminative accuracy of AQIoverall on the 100 training subjects was 0.93.where The discriminating performance of SUVR, DVR, and AQI on the 100 training subjects were evaluated and compared using the 10-fold cross-validation. ROC analysis suggested that AQI performed the best in discriminating AD and HC subjects among all three methods. p < 0.001), while AQI had the least degree of overlap on two boxplots. Indeed, Cohen's effect size for SUVR, DVR, and AQI were 2.12, 2.06, and 2.35 respectively, which further proved that AQI was the most effective in discriminating these two groups.The performances of the three measures on the testing set were evaluated using the threshold derived from the training dataset. In To further investigate AD subjects that were misclassified as HC regarding SUVR and DVR, we analyzed SUVR images and TACs of these cases. SUVR images of AD_038, AD_001, AD_040, and AD_005 are shown in r ranging from 0.60 to 0.66. All of these associations between measures and clinical scores attained statistical significance with p < 0.01. AQI did not have a significantly higher correlation with the clinical scores than SUVR/ DVR did.Amyloid quantification index is a semi-quantitative measure for PiB PET imaging, which is calculated by linearly combining the information corresponding to clearance rate and mid-phase PiB retention. In this study, AQI was shown to effectively distinguish mild AD and HC subjects for 120 scans from a public dataset. AQI achieved an overall accuracy rate of 0.93, which was higher than SUVR and DVR, in the 100 subjects in the training set. The AUC and sensitivity of AQI were also higher than those of SUVR and DVR, while the specificity was comparable. Moreover, the effective size of AQI was 2.35, larger than 2.12 and 2.06, for SUVR and DVR, respectively. Compared with the training set, all three measures achieved less superior performance on the 20 subjects in the testing set, while AQI still performed best among these measures, with the highest accuracy of 0.85.The AQI can be obtained with the first 30-min scan, which enables a scan protocol with significantly reduced scan/wait time. This could, in turn, improve the scan efficiency, hence reducing the overall cost of a large-scale study. In terms of image quality, a shorter scan has the further advantage of reducing the possibility of motion artifacts .Data were provided by OASIS-3 dataset, which is publicly available via the website: The studies involving human participants were reviewed and approved by Washington University School of Medicine. The patients/participants provided their written informed consent to participate in this study.TS and CS: conception and design. TS, YY, DL, XL, HZ, and MW: administrative support. CS and TS: provision of study materials or patients. CS, TS, ZW, and HC: collection and assembly of data. TS, YY, HW, ZW, HC, YB, and XL: data analysis and interpretation. All authors: manuscript writing and final approval of manuscript.This work is supported by the Scientific Instrument Innovation Team of the Chinese Academy of Sciences (GJJSTD20180002), the Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province (2020B1212060051), the Chinese Academy of Sciences Engineering Laboratory for Medical Imaging Technology and Equipment (KFJ-PTXM-012), the National Natural Science Foundation of China (Nos. 81729003 and 61871373), the Pearl River Talent Recruitment Program of Guangdong Province (No. 2019QN01Y986), the Shenzhen Science and Technology Program (JCYJ20210324115810030), and the Shenzhen Peacock Plan Team Program (KQTD20180413181834876).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


P < 0.05). In conclusion, artificial intelligence algorithm-based MRI and comprehensive pelvic floor muscle exercise showed significant application prospects and values in the recovery of patients' intestinal functions after RC anus-preserving surgery.Based on magnetic resonance imaging (MRI) technology under artificial intelligence algorithm, the postoperative nursing effects of pelvic floor muscle rehabilitation exercise on gastrointestinal tract rectal cancer (RC) patients were investigated. A total of 88 patients receiving RC anus-preserving surgery in hospital were selected. The included patients were divided randomly into the experimental group (44 cases) and the control group (44 cases). Patients in the control group engaged in Kegel motion, while patients in the experimental group underwent self-designed comprehensive pelvic floor training. Anorectum function rating scale and quality of life questionnaire for colorectal cancer (EORTC QLQ-CR29) were utilized to compare and analyze anus functions and living quality of patients in the two groups. Besides, all patients in two groups received MRI examinations, and images were processed by a convolutional neural network (CNN) algorithm. The results showed that in MRI images, there were significant signal differences between lesion tissues and normal tissues. After being processed by an artificial intelligence algorithm, the definition of MRI images was remarkably enhanced with clearer lesion edges. The quality of images was also significantly improved. Besides, the comparison of anus functions of patients in two groups showed that the differences demonstrated statistical meaning after the intervention ( Relevant statistics show that the incidence of RC is ranked in the 3in China , 2. At pin China . Howeverin China . RC anusin China . Althougin China , 9. Aftein China , 11. At in China , 13. Forin China . The impin China .In recent years, imaging technology has constantly improved; RC diagnosis and therapeutic effect assessment methods have become more diversified gradually. Currently, the main assessment methods of diagnostic and therapeutic effects on RC include endorectal ultrasonography (ERUS), computed tomography (CT), and magnetic resonance imaging (MRI). For example, some scholars used MRI for the diagnosis of RC patients and an analysis of their diagnostic efficiency. The results showed that the accuracy, sensitivity, and specificity of MRI in diagnosing RC were 92%, 90%, and 85%, respectively. MRI has become the main method of clinical RC diagnosis. The extraction of effective features from numerous medical images is the focus of present studies to provide the basis for clinical diagnosis and treatment. The feature expression ability of traditional learning algorithms is weak because of their shallow training model level. As a result, the application of traditional learning algorithms is restricted in medical image feature extraction. On the contrary, deep learning algorithms make up for the defects of traditional learning algorithms . In partOn the grounds of the previous researches, a set of pelvic floor muscle exercise methods was designed independently. Besides, artificial intelligence algorithm-based MRI technology was utilized to discuss postoperative recovery therapeutic effects of the method on RC patients receiving anus-preserving surgery, which aimed to provide new ideas and a reference basis for the diagnosis, treatment, and postoperative recovery of clinically relevant diseases.A total of 88 patients receiving RC anus-preserving surgery in hospital between March 2019 and November 2020 were selected, including 58 male patients and 30 female patients. The average age of the included patients was 55.3 ± 11.3 years old, and they were divided randomly into the experimental group (44 cases) and the control group (44 cases). All the included patients had signed the informed consent forms and this research had been approved by the ethics committee of the hospital.Inclusion criteria: patients who were diagnosed with RC by colonoscopy or pathological examination and the distance between the lower edge of the patient's tumors and dentate lines was equal to or shorter than 10 cm. Patients who accepted RC radical excision with anal sphincter retained. Patients who volunteered to engage in the research.Exclusion criteria: patients who suffered from temporary or permanent stoma; patients who had anastomotic leak and other severe complications. Patients who got other complicated intestinal functional diseases before surgery, such as irritable bowel syndrome, Crohn's disease, and ulcerative colitis. Patients who took drugs that affected intestinal functions over 3 weeks within 1 month before surgery, such as antidiarrheal agents, laxatives, and morphine. Patients who received the auxiliary treatments of other intestinal functions imaging, such as biofeedback therapy. Patients who received the surgical treatment of other intestinal functions imaging, such as anorectal surgery, pelvic surgery, abdominal surgery, and spinal surgery. Patients who suffered from mental diseases. Patients who suffered from complications of severe heart, lung, kidney, and musculoskeletal diseases.Patients in both groups were offered medication, diet, and life guidance. Besides, they were also provided with anus peripheral skin care, anastomotic stoma expansion, regular defecation training, and other conventional nursing measures. Based on the above guidance and nursing measures, pelvic floor muscle rehabilitation training was carried out 1 week after postoperative defecation. Specific exercise intervention methods were as follows.In the control group, patients were instructed to perform the Kegel motion. Before the exercise, patients were asked to empty their urinary bladders. After that, they needed to take a comfortable position, such as lying on their back or sitting. Patients should try to keep their leg, abdomen, and back muscles as relaxed as possible, and try their best to squeeze perineal muscles upward and inward until pelvic muscles and levator ani muscles were lifted upward. The squeezing action needed to be kept for 5 seconds, and then patients relaxed for 10 seconds. The above steps constituted a group of exercises. A total of 10 groups of exercises needed to be performed for each time. Each single exercise lasted for about 3 minutes and was performed 3 times each day.In the experimental group, the training methods were improved and integrated based on considerable literature and data as well as the advice offered by anorectal surgery experts, rehabilitation therapists, and anorectal surgery nursing staff. The contents of the training included abdominal respiration, abdominal massage, Kegel motion, cross-leg anus lifting motion, and bridging anus lifting motion. Patients' general data included social demography data  and disease-related data .In terms of the anorectum function rating scale, the evaluation contents of the scale included defecation intention, defecation control, defecation sensory functions, defecation times, and defecation time. Each of the above five aspects included 3 levels, and each level was assigned with 0, 1, and 2 points, respectively. The total points for each level ranged from 0 to 10. Based on the general evaluations in five aspects, the anus functions were divided into four levels, including excellent level (9–10 points), good level (7–8 points), intermediate level (5–6 points), and poor level (0–4 points). Besides, excellent and good level rate = (excellent level rate + good level rate)/total number of cases  ×  100%.The quality of life questionnaire for colorectal cancer (EORTC QLQ-CR29) included four aspects of body image: anxiety, weight, and sexual desire. Four aspects included a total of 19 items. In each item, there were four levels of answers which were none, a little, a lot, and quite a lot. The four levels corresponded to 1, 2, 3, and 4 points, respectively. The scoring method was polarization method.A Philips superconductive nuclear magnetic resonance instrument  was adopted with phased-array surface coils. Sagittal, axial, and coronal scanning were performed. The slice thickness was 4 mm without spacing. Before the examination, no intestinal preparation was required. During the examination, patients needed to take a supine position. The center of the surface coil was placed at the pubis symphysis. Besides, the middle axial slice should be kept perpendicular to the anal tubes, and sagittal and coronal slices needed to be balanced with the anorectal axis during the scanning. During the examination, patients needed to breathe calmly and minimize body movement as well. f of the image being M×N was processed, and the image was g. The gray level of the images was determined by the average value of the gray levels of several pixels including the field . The processed image is expressed by the following equation: The denoising process was as follows. The array with x, y = 0, 1, 2, ..., N-1, S denoted the field collection with the point  as the center, and M referred to the total number of coordinate points in S. In terms of multiple images, the original image was set to be f and image noise was n. Then, the noisy image g is expressed by the following equation: In the above equation, If noises were unrelated and the average value was 0, the equation generated is as follows:Eg represented the expected value of g, and M noisy images were averaged to generate the following equations: In the below equation, δn2 were the variances of n at the point .In the above two equations, The equations adopted for the edge detection process are as follows:Wj2d1,f, Wj2d2,f of point  is expressed by the following equation:The membrane value of discrete binary wavelet transform The phase angle is expressed as follows: t-test. The comparison of enumeration data was completed by the chi-square test. P < 0.05 indicated that the differences showed statistical significance.The analysis of all the data was completed by the statistical product and service solution SPSS 19.0. Measurement data were expressed by the mean +standard deviation and tested by an independent sample P > 0.05).P > 0.05).P > 0.05).P > 0.05). The above results indicated that the data of two groups were comparable.P < 0.05).RC is defined as malignant tumors appearing in the intestinal tracts about 15 cm away from the anal edges, and it is one of the main death causes related to cancers at present. Both the incidence and mortality of RC in cities are higher than those in rural areas, and the incidence and mortality of RC among males were higher than those among females as well . In the With the continuous development of adjuvant therapy and anastomat in recent years, anus-preserving surgery can not only radically cure RC but also can retain anus successfully. This surgery addresses the problems with traditional surgical methods and greatly improves patients' living quality . AccordiIn RC diagnosis and therapeutic effect judgment, ERUS, CT, and MRI are all main examination methods. MRI shows a high resolution of soft tissues and multiplane imaging capacity. As a result, it can recognize tumors and peripheral tissues accurately and has become one of the main methods for diagnosing RC. With the continuous improvement of imaging technology, the quality requirements of medical images get higher and higher. Besides, computer technology is also developed widely in medicine, with the processing of medical images as a significant branch . The deeBased on the reference to considerable literature, a comprehensive pelvic floor muscle training plan was proposed, and its therapeutic effects were evaluated by artificial intelligence algorithm-based MRI technology. The results demonstrated that there were obvious differences between MRI image tumors processed by an artificial intelligence algorithm of RC patients and peripheral tissues, and the quality of processed images was remarkably improved compared with that of the images to be processed. The differences revealed that artificial intelligence algorithm-based MRI showed significant application values and prospects in RC diagnosis and therapeutic effect assessment. What's more, the scores of anus functions and living quality of patients in the experimental group were both remarkably improved compared with those of patients in the control group after 3-month treatment.


Preoperative evaluation of the mitotic index (MI) of gastrointestinal stromal tumors (GISTs) represents the basis of individualized treatment of patients. However, the accuracy of conventional preoperative imaging methods is limited. The aim of this study was to develop a predictive model based on multiparametric MRI for preoperative MI prediction.n = 81) and test (n = 31) sets based on the time of diagnosis. With the use of T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) map, a convolutional neural network (CNN)-based classifier was developed for MI prediction, which used a hybrid approach based on 2D tumor images and radiomics features from 3D tumor shape. The trained model was tested on an internal test set. Then, the hybrid model was comprehensively tested and compared with the conventional ResNet, shape radiomics classifier, and age plus diameter classifier.A total of 112 patients who were pathologically diagnosed with GIST were enrolled in this study. The dataset was subdivided into the development , area under the precision–recall curve (AUPRC), and accuracy in the test set were 0.947 , 0.964 (95% CI: 0.930–0.978), and 90.8 (95% CI: 88.0–93.0), respectively. With the average probabilities from multiple samples per patient, good performance was also achieved at the patient level, with AUROC, AUPRC, and accuracy of 0.930 (95% CI: 0.828–1.000), 0.941 (95% CI: 0.792–1.000), and 93.6% (95% CI: 79.3–98.2) in the test set, respectively.The deep learning-based hybrid model demonstrated the potential to be a good tool for the operative and non-invasive prediction of MI in GIST patients. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract wall in that they are more common in the stomach and small intestine . It is wThe mitotic index (MI) is an important indicator of GIST risk grading. However, it may be more difficult to perform a preoperative assessment of MI than to obtain morphological information, such as tumor location and size. Pathological examination is still the gold standard to accurately quantify the GIST mitotic index . HoweverMorphological information about tumors can be obtained through endoscopic ultrasonography, computerized tomography (CT), and magnetic resonance imaging (MR); hence, they can be used as a basis to determine the location and size of GIST and indicate the occurrence of rupture or hemorrhage before surgery –14. SomeRadiomics was first proposed by Lambin in 2012. It emphasizes the high-throughput extraction of image information  from medical images and adopts traditional statistical models such as support vector machine, random forest, and XGBoost to achieve tumor segmentation, feature extraction, and model establishment . Using rThis is a retrospective study, and the patients’ information was anonymized. The ethics committee of our hospital approved the study and waived the need for informed consent from the patients.A total of 141 patients who were newly diagnosed with GIST and underwent MR examination in our hospital from January 2013 to May 2022 were initially enrolled. The inclusion criteria were as follows: 1) GIST was confirmed by postoperative pathology after radical resection in our hospital; 2) mitotic index was obtained through postoperative pathological examination; 3) preoperative MR examination is available, including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences. The exclusion criteria were as follows: 1) preoperative MR examination occurred more than 14 days before surgery; 2) two radiologists with 5 years of experience in the diagnosis of abdominal and pelvic MR evaluated the image quality and excluded those whose image quality was too poor to delineate the region of interest due to motion or other artifacts; 3) the patients were treated with imatinib or other tyrosine kinase inhibitors before surgery; 4) the patients were younger than 18 years. The patient inclusion process is shown in All images were scanned using a 1.5T Siemens Avanto MR system  equipped with an eight-channel phased-front coil dedicated to the abdomen. In order to reduce gastrointestinal motion artifacts, the patients were instructed to abstain from water and food for 4 h before the scan. The imaging sequences included coronal fast imaging, employing the steady-state acquisition (FIESTA) sequence, axial fat-suppression T2WI, axial DWI, and axial in-phase and out-of-phase T1-weighted imaging (T1WI). DWI was collected by echo-planar imaging (EPI), with b values of 0 and 800. The respiratory trigger technique was used for T2WI and DWI, and the end-expiratory breath-holding method was used for FIESTA and T1WI scans to reduce respiratory motion artifacts. The images of all patients were downloaded in the digital imaging and communications in medicine (DICOM) format from the picture archiving and communication system (PACS) of our hospital. Apparent diffusion coefficient (ADC) maps were registered to T2WI images using the Statistical Parametric Mapping software v.12 . A radiologist with more than 5 years of experience in abdominal and pelvic MR diagnoses segmented the entire tumor in three dimensions on T2WI images, such that the segmentation was strictly along the edges of the tumor and included areas of necrosis and cystic degeneration. In addition, the maximum diameter of the tumor was measured, and the tumor location was recorded during segmentation. The abovementioned information was confirmed and corrected by another radiologist with 10 years of experience in abdominal and pelvic MR imaging. In case of any disagreement, consultation continued until an agreement was reached.https://www.radiomics.io/pyradiomics.html), which contained 14 features, as follows: mesh volume, voxel volume, surface area, surface area to volume ratio, sphericity, maximum 3D diameter, maximum 2D diameter (slice), maximum 2D diameter (column), maximum 2D diameter (row) major axis length, minor axis length, least axis length, elongation, and flatness. The definitions and calculation methods of each of these features can be found on the package documentation page https://pyradiomics.readthedocs.io/en/latest/features.html#module-radiomics.shape.Shape radiomics features were extracted using the PyRadiomics package (The CNN structure is shown in nth feature and m is the number of samples.where via the target datasets (891 development samples and 531 test samples) to obtain an optimal conventional ResNet model. Then, the weight value of the optimal pretrained conventional ResNet from the initial 7 × 7 convolutional layers to the third layer, and the mixed model was imported and set as untrainable. During the training of the hybrid model, only the weights from the fully connected layers that received shape, age, and maximum diameter as numerical inputs from layer 4 and below were trained to maximize the synergy between the image features from the pretrained weights and numeric inputs. The input images were dynamically enhanced by translation, scaling, rotation, shearing, Gaussian noise, and blur. The Adam optimizer was used to optimize the network , batch size was set to 30, and the maximum training epoch was set to 100, and training was stopped when the lost value of the validation set dropped to a stable level. The resulting model had the lowest validation set loss value. Our CNN model was implemented in PyTorch 1.1.0 (https://pytorch.org) and trained on an NVIDIA Tesla 3080 12 G with a memory of 64 G.The training process of the CNN classifier is discussed in detail below. First, the DICOM image was converted to PNG format, which was used for the training and validation of the CNN model. Since our input data size is 384 × 202, which is bigger than the original residual neural network (224 × 224), the image and mask were resampled. Based on tumor segmentation, all layers of each patient’s tumor were selected as independent samples; this approach might have a better effect on data enhancement than image flipping or rotation. In this way, our convolutional residual neural network and our CNN classifier obtained 891 development samples and 531 test samples. To train our model, the transfer learning method was used, which is widely used in computer vision, for efficient training and accurate classification performance. A weight file obtained by training an ResNet50 network was used on the large ImageNet dataset to extract the features of target datasets, and the model parameters were fine-tuned To generalize the reliability of the networks, threefold cross-validation was performed on the 111 subjects by randomly shuffling the dataset and distributing it into three groups by stratified randomization . During each fold of the cross-validation procedure, two of the three groups of subjects were combined as the internal training set, and the remaining group was used as the internal validation set. The internal validation set helped improve network performance during training. Note that each fold of the cross-validation procedure represents a new training phase on a unique combination of the three groups. Network performance was reported on the internal validation set for each fold.n_estimators = 400. In order to evaluate whether the hybrid model achieved better diagnostic efficiency, the DeLong test was used to compare AUROC values  and the area under the precision–recall curve (AUPRC). In addition to the hybrid and conventional ResNet models, a traditional shape radiomics feature-based classifier was established in this study; the random forest (RF) algorithm was used in the development set, and the 10-fold cross-validation was performed to evaluate the model, with each fold repeated three times using X&Y software  based on the R language. The RF algorithm selected and ranked the parameters according to their importance. The constructed “forest” represents the integration of decision trees (DTs) and was trained with the “bagging” method. Bagging methods involve randomly selecting samples of the derivation dataset with replacement, building classifiers, and finally combining the learned models to increase overall performance. In this study, the number of trees in the RF model was 400, with the variables leading to the minimum “out-bagging” error in the model selected as the optimal model. The feature importance was derived from the mean decrease in impurity (MDI). When the RF model has the best effect, the hyperparameters are set as follows: max_depth = 400, max_features = 4, min_sample_leaf = 1, min_sample_split = 2, and C values . A p-valThe clinical characteristics of 112 patients are summarized in After the image was provided as an input, the conventional ResNet was pretrained for 30 epochs. Among the 14 shape features, the following four features were screened out by the RF algorithm: Elongation, Maximum 2D Diameter row, Sphericity, and Surface Volume Ratio. The variable importance of the shape features and their different distributions according to MI are shown in The performance evaluation results of conventional ResNet, shape radiomics classifier, and prediction using age plus diameter are shown in The comparison results of AUROCs and accuracies between the hybrid model and age plus diameter, shape radiomics classifier, and conventional ResNet are shown in The results of the ablation analysis are discussed in detail in n = 112). In the internal validation set, the mean AUROC was 0.910  and 0.903  in the hybrid model (per slice) and hybrid model (per patient), respectively  without additional feature extraction operations; thus, no additional error occurs in the analysis due to feature calculation, and the effectiveness of the feature is only related to the segmentation quality , 36. At Researchers have begun to explore the application of DL in the diagnosis and evaluation of GIST. Previously, a DL model for predicting the mitotic index of GIST was preliminarily established by providing venous images as input into CNN. The results showed that the image-based DL model could evaluate the MI of GIST before surgery . HoweverResNet50 CNN was selected as the basic model in this study. ResNet50 is a network framework of residual learning that solves the degradation problem of decreasing accuracy caused by increasing the network depth. Compared with previous models, the residual network is easier to optimize and can derive accuracy from a significantly increased depth . Many prIn addition to the multi-modal image input, the construction process of the proposed hybrid model proposed was different from that of the image-based CNN model reported in previous studies . While tThe hybrid model fuses the 3D tumor morphology and mitotic-related clinical indicators (age and tumor size) with the CNN model, thus producing an enhanced model performance compared with image-based CNN alone. Previous studies showed that age and tumor size are independent risk factors for prognosis in GIST patients . In thisThis study used radiomics and deep learning analysis based on MR plain scan images to predict mitosis in GIST. However, due to the limited time resolution, MR is highly susceptible to respiratory movement and intestinal peristalsis during abdominal imaging, which limits its application in GIST assessment. Compared with MR, CT is more widely used in the preoperative evaluation of GIST in clinical at present, which has the advantages of low cost, short examination time, and low susceptibility to motion artifacts . HoweverThis study has some limitations that merit discussion. First, the sample size of this study is small, so future studies should continue the data collection and use a larger sample size. Second, this study is a single-center study. Although internal verification has been performed, the repeatability and generalization ability of the model should be further verified by external datasets. Finally, because GIST is irregular in shape and may occur in any part of the digestive tract and its adjacent tissues and organs are complex, it is difficult to achieve automatic segmentation of the tumors. In this study, manual segmentation was adopted, which is more difficult but more accurate.In conclusion, we developed a deep learning-based model that used radiomics and clinical features to reliably predict the MI status in GIST based on conventional, unenhanced MR images. Our model is expected to serve as a practical tool for the non-invasive characterization of GIST to support personalized treatment plans.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by The Ethics Committee of the First Hospital of Qinhuangdao. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Written informed consent was not obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.DL, ZW, LL, and YC designed and coordinated the study. LY, DD, TZ, HY, JD, and YF carried out the experiment and data processing and drafted the manuscript. All authors gave the final approval for the publication.The research leading to these results has received funding from the National Science Foundation of China (81871029).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Web-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version.The aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep.A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]).In all groups, users experienced high levels of depressive symptoms . Moderate levels of satisfaction  and acceptability  were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep , whereas among PUs, older respondents , those with paid work , those who had not been in therapy , and those who had not attempted suicide  showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work , those who had not been in therapy , those without disability , and those who had not attempted suicide  showed higher acceptability.HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence. The World Health Organization  has rankInternet- or web-based interventions represent effective, accessible, and low-cost means to treat and prevent depressive disorders, and they can be broadly disseminated ,5. UnguiWeb-based interventions for common mental health problems, such as depression, have a long history and have evolved rapidly in high-income countries, but they are at an earlier stage of development and are less common in LMICs -12. Web-The initial version of HDep (2009-2013) was modeled after a face-to-face psychoeducational intervention in Mexico to prevent depression in women, based on multimodal and cognitive behavioral principles  16]. Th. Th16]. A use/usability analysis of the first version of HDep showed that 15.6% of the users were men [The lack of adequate mental health services for most of the population of Mexico and other Latin American countries means that very few people receive even minimally adequate treatment for depression . In thisSince 2014, the revised version of HDep has had around 2956 visits each month from individuals who answered the depression scale (CES-D) and received feedback based on their scores. At the same time, there is a high rate of attrition, which is consistent with data from a scoping review in Latin America . To imprThe aim of this study is to assess the acceptability of and satisfaction with the updated version of HDep, considering both types of users separately: HPUs and PUs. This was an exploratory study, with the underlying hypothesis that PUs would show greater acceptance and satisfaction than HPUs, as they were receiving a higher dose of the intervention.A retrospective cross-sectional design was used in this study. The population corresponds to people who visited HDep: HPUs and PUs from January to December 2018  and answered the initial depressive symptoms questionnaire (CES-D), which is accessible on the home page. The sample size was determined according to the procedure of Lemeshow et al . The minData retrieved from HDep databases: email, sex, age, marital status, occupation, education, depressive symptoms (CES-D), disability during the previous month owing to depressive symptoms, psychological or psychiatric treatment for depression, suicide attempt in the last 6 months, alcohol and drug use, and medication .Depressive symptoms are assessed with the CES-D , which hHDep was used instead of service. The CSQ-8 is reliable across a variety of ethnic contexts, including Hispanic groups, and the Spanish version is as reliable as the English version (Cronbach α=.90) [α of .95.Satisfaction with HDep is measured with the short version of the Client Satisfaction Questionnaire-8 (CSQ-8)  (Spanishh α=.90) . The CroIs there something additional that helped you that is not listed here? and Are there any additional comments you would like to add?). The first five questions were related to general acceptability: Is the home page persuasive? Is the page layout of the modules inviting? Does HDep seem useful for managing depression? Did HDep meet your expectations? and Is the website user friendly? Respondents were asked to answer the questions on a 4-point Likert scale (1=low to 4=high acceptability). The Cronbach coefficient for these 5 questions in the sample was a Cronbach α of .89. In all, 2 questions rated the HDep content and design on a scale of 1 to 10, with a space to provide open-ended elaboration. The final eight questions scored the following elements of HDep on a scale of 1 to 10: module information, sample cases, activities, forums, chats, thought charts, audio, and depressive symptom assessment and feedback. The Cronbach coefficient for the scale in the sample was a Cronbach α of .95. Except for the depressive symptoms assessment and feedback, these questions were analyzed only for users who registered for the program (PUs), as these elements are part of the program modules.As in many studies ,28, an aThe link to the web survey was delivered via email (using the Mail Chimp and Google Forms platforms), including a cover letter explaining the objectives of the study and why users were being contacted. A follow-up email was sent 1 month later to those who had not answered. As a token of appreciation, those who responded to the survey were sent a list of 10 positive thoughts to reinforce HDep activities and improve mood.The survey was designed to be user friendly; it was configured to prevent users from leaving questions unanswered.The study was approved by the Ethics Committee of the National Institute of Psychiatry, Mexico (CEI/C/050/2018). The terms of use on the HDep home page explain that some of the data provided by users may be used for scientific reports and publications but that participant confidentiality will be maintained. An informed consent letter was included with the survey, underscoring the guarantee of confidentiality.t tests. The same procedure was followed to evaluate the elements of acceptability  of HDep overall and for each component. Logistic regression analyses were conducted to assess the characteristics of users who were satisfied with the HDep program among the HPUs and PUs. For these analyses, the acceptability and satisfaction scales were dichotomized: the cutoff points were defined at the 75th percentile for each scale . Finally, a qualitative thematic analysis was conducted on the responses to the 2 open-ended questions regarding design and content.The percentages of sociodemographic characteristics and the means and SDs of the overall satisfaction scale and for individual items were obtained for HPUs and PUs and compared using chi-square and 2-tailed χ21=6.22; P=.01) and aged 20 years  or aged 21-30 years .Of the 13,207 emailed invitations, 191 (1.45%) were completed questionnaires; 67  were from HPUs and 124  from PUs. Most were women . Questions on mental health problems were answered only by PUs; 70  PUs reported disability associated with depressive symptoms, 20  PUs reported psychological or psychiatric treatment for depression, 21  PUs reported a previous suicide attempt, 27  PUs reported excessive alcohol use, 15  PUs reported excessive drug use, and 39  PUs had received drug treatment  experienced high levels of depressive symptoms (CES-D>16), with no significant difference between PUs  and HPUs  for HPUs and 21.1  for PUs. No significant difference was found in the overall level of satisfaction among types of users  for HPUs and 13.97  for PUs, with no significant difference among types of users  were more satisfied with HDep, whereas among PUs, older participants , those with paid work , those who had not been in therapy , and those who had not attempted suicide  showed higher satisfaction . There wt189=0.16; P=.87). The design was also evaluated positively, with means of 7 and 7.5 , with no significant difference among types of users  to 6.88 (SD 3.14). Forums  and chats  had the lowest acceptability. Depressive symptom assessment and feedback, evaluated by both types of users, had the highest acceptability , with no significant difference between the 2 user types .Responses to open-ended questions fell into one of three categories: (1) Liked it, (2) Had other expectations, or (3) Did not like it. The fourth category included those who did not respond . ExampleThe three categories were as follows:Liked the content—approximately half of the users liked the content: 52% (35/67) of the HPUs and 43.5% (54/124) of the PUs, with no significant difference observed between the 2 groups . HPUs coHad other expectations—a significantly greater number of PUs had other expectations  than HPUs  of HPUs and 16.9% (21/124) of PUs . HPUs thpressed” .Open responses regarding the HDep design were also organized into 3 categories, plus one for nonrespondents . ExampleThe three categories were as follows:Liked the design—more than half of the users liked the design, with no significant difference between HPUs and PUs . HPUs said they did not receive the expected response or care for their symptoms and had no improvement; PUs believed that the web program, by its nature, reinforced the causes of their depression, not because of problems with its design, but simply because it was a website, meaning that it did not provide contact with a professional, which led to feelings of abandonment .Did not like the design—significantly more PUs disliked the design  than HPUs . HPUs noted that HDep was only readable on a computer screen, and it was not encouraging; from their perspective, it should have fewer bright colors and simpler graphics .This study explored the satisfaction and acceptability of the updated version of the internet-based preventive intervention, HDep  and founOf the survey respondents, 52% (35/67) of HPUs and 43.5% (54/124) of PUs reported liking the HDep content; 12% (8/67) and 25% (31/124), respectively, had other expectations, and 12% (8/67) and 16.9% (21/124), respectively, did not like it. With respect to the design, 52% (35/67) of HPUs and 58.9% (73/124) of PUs reported liking it; 5% (3/67) and 3.2% (4/124), respectively, had other expectations, and 13% (9/67) and 25.8% (32/124), respectively, did not like it. Thus, there was no evidence that PUs were more satisfied or indicated a higher degree of acceptability than HPUs, as was hypothesized, based on the fact that the latter received a smaller portion of the intervention. It may be that there is self-selection of users to the dose of the intervention they need. For some, the home page information and feedback about their symptoms seem to be sufficient, whereas others seem to need the entire intervention.The satisfaction level was above the scale mean, suggesting that users were more satisfied than dissatisfied, to the degree that they “would recommend it to someone in need” or “would use it again if depressed.” Less satisfied participants believed that HDep did not meet their needs. This finding may reflect the high levels of depressive symptoms reported by almost all participants, as well as possible psychopathologies in PUs. Such participants were not the target population of the intervention design, but they were the ones seeking help. Muñoz et al  found thConsistent with this notion, higher satisfaction was observed in PUs with less disability owing to depression, no suicidal ideation, and no experience with psychotherapy. According to Rost et al , the sevFindings from the World Mental Health Survey show that in Mexico, 58.3% of people with a diagnosis of major depressive disorder who felt they needed treatment, only 6.4% received treatment that was minimally adequate  also fouThe general acceptability ratings of HDep were above the mean, suggesting that users considered it acceptable but with room for improvement. Some of the features they valued were its user-friendliness and usefulness in managing their depression, but it did not fully meet their expectations. Regarding the content, more than half of the respondents described it as good, meaningful, and helpful in making them feel better, friendly, systematic, well-paced, and encouraging reflection. More than half of the respondents liked the design, describing it as easy to understand, well organized, attractive, user friendly, colorful, intuitive, and entertaining.The test for depressive symptoms and feedback regarding results had the highest acceptability ratings, whereas forums and chats had the lowest ratings . Some stIt is noteworthy that forums received low ratings, although it has previously been observed that forums allow for meaningful social exchange of experiences . One posjust a platform, and lacking professionals to support, advise, and track people’s progress. Other studies have also found that participants in automated programs are concerned about their being too impersonal [Three major areas were found to be lacking in the design and content of HDep. These were described as (1) not being sufficiently persuasive, dynamic, motivating, or appealing; (2) not meeting users’ expectations; and (3) being cold, being personal . Therapepersonal . Not meepersonal  reportedpersonal  concludepersonal .The content deficiency perceived by HDep users was the need for professional help or specialized guidance. This issue has often been reported in the literature on unguided interventions ,15, and Overall, HDep showed moderate levels of satisfaction and acceptability and high levels for more than half of its participants, despite a level of depressive symptoms high enough to suggest a major depressive episode. HPUs and PUs rated satisfaction and acceptability similarly, contrary to our hypothesis that the latter, having received a larger portion of the intervention, would be more satisfied. Respondents’ ratings on satisfaction and acceptability may be related to their ability to choose how much of the program they want to do: whether they just want an overview from the home page or want to work on the intervention modules. They considered the content culturally sensitive, reflecting their everyday experiences; they found the design to be friendly, with tools that were well organized, simple, and motivating. The main limitations were the lack of contact with a professional, and in some cases, content that did not motivate and was not encouraging. Users who responded to the survey provided abundant suggestions on feasible ways to alleviate some of the deficiencies. Some of these deficiencies coincide with those observed in other web-based interventions for depression ,27,35,38the dominant individualized focus of Euro-American cultural orientation compared to a more collectivist and relational Latin American cultural orientation [This study has the strength of being based in a real-world setting, not in a confined research environment, so that it reflects more closely what real participants do. However, this feature also makes it more difficult to implement strict methodological control. HDep is the first web-based self-help intervention for depression in Latin America and has been in operation for 11 years. It is a promising and cost-effective tool that can contribute to reducing the treatment gap for depression in Mexico . It has entation .Although there are many effective internet-based interventions for depression, there are far fewer with open access for general use . Web-basA major limitation of this study was its response rate of 1.45% . This response implied a CI of 95% and a margin of error of 7%. Low response rates are an important concern that affects the validity of web surveys . In a meParticipants who did not respond may have been less satisfied and less positive than those who did . The levTo estimate other possible sources of bias, the characteristics of the study sample were compared with those of a previous study on HDep , which o


The World Health Organization in recent years has emphasized reducing the possibility of unnecessary interventions in natural childbirth, but little is known about the accuracy of non-invasive methods when assessing the progress of labor. This paper presents a literature review to assess strategies that support non-invasive methods for labor during the first stage. It evaluates the available evidence to provide the most suitable assessments and predictions that objectively identify the progress of low-risk labor during the first stage of labor.A search for relevant literature was conducted using the electronic databases of PubMed, CINAHL, Web of Sciences, the Cochrane Library, Scopus, Medline (OVID), and CEPS, with publications up to November 2021. Records were screened against pre-specified inclusion/exclusion criteria and the potential papers from Google Scholar were examined to identify additional papers that may have been missed. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to appraise the methodological quality of the included studies. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Two independent investigators extracted the review’s characteristics, and discrepancies were resolved by consensus. This review calculated individual and pooled sensitivity, specificity, and positive predictive values, which were exported to STATA  to represent the performance of diagnostic testing.Our search returned 2283 reports of which 13 fulfilled the inclusion criteria, accounting for 2594 women. The subjects were divided into groups according to the diagnostic tests used to assess the progress of their labor, including appearance assessment and sonographic imaging parameters . HPD pooled sensitivity was 0.74 (0.65–0.82), and specificity was 0.77 (0.69–0.84). The pooled diagnostic odds ratio (DOR) was 8.21 (4.67–14.41) and 10.34 (5.02–21.27), respectively. The results of subgroup analysis showed that the summary sensitivity and specificity were of medium accuracy overall. The quality of evidence as assessed with GRADE was low.Vaginal examination is an intrinsic element in the use of the partogram, while transperineal ultrasound can also be used as an auxiliary tool. However, the presence of publication bias within the parameters of ultrasound indicates that the diagnostic performance may be overestimated. Thus, randomized controlled trials or large-scale prospective cohort studies are necessary.The online version contains supplementary material available at 10.1186/s12884-022-04938-y. Assessing labor progress is performed during intrapartum care to monitor that labor and childbirth progresses as expected and to identify deviations from the norm as early as possible, so as to intervene to minimize or avoid maternal or fetal problems . HoweverIn clinical practice, VE is a standard method to evaluate labor progression. However, there are also several methods for assessing the progress of labor, including the frequency and quality of uterine contractions, fetal descent by abdominal palpation, or sonographic assessment , 9. ChanDespite the various techniques described above for assessing labor progress, the evidence for these methods remains unclear. Healthcare providers are challenged by the lack of less-invasive procedures to establish a correct assessment of the labor progress. Thus, this systematic review aims to evaluate and compare the available evidence on the accuracy of different methods, in order to help doctors, midwives, and other healthcare providers choosing the best suitable assessments for the objective identification of the labor progress in women during the first stage of labor, especially the active phase.This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was registered in PROSPERO . The search was done through electronic databases up until November 8, 2021. The search was conducted in seven databases, PubMed, CINAHL, Web of Sciences, the Cochrane Library, Scopus, Medline (OVID), and CEPS , to identify eligible studies based on pre-determined criteria. The main search was conducted using a search string  AND  AND . The reference list and Google scholar were also searched to identify any additional relevant studies.This review used the study characteristics as the criteria, including participants, settings, index testing, and reference standards. The participants were low-risk women aged 18 or older during the first stage of labor. The settings included hospital delivery rooms. Index testing refers to the purple line, behavior observations, uterine contractions, verbal expressions, electrohysterography, and intrapartum ultrasound, covering the parameters of sensitivity, specificity, and positive predictive value. Detection evaluation was conducted on the labor progress, cervical dilatation, and fetal descent. The reference standard was vaginal examinations. For this review, the exclusion criteria are: doctor or midwife experience, an abnormal first stage of labor, tool development, and psychometric testing.The titles and abstracts of the studies were initially screened for eligibility. After the removal of duplicates, the titles and abstracts were screened by one reviewer [Pan]. Relevant full-text studies were then obtained and screened. Manuscripts that were potentially eligible for inclusion were discussed, and the two authors (Pan and Gau) must both agree on their inclusion or exclusion. The search was limited to studies published in peer-reviewed journals. A full flowchart of the study selection process using the PRISMA 2020 flowchart is illustrated in Fig. There is currently no widely accepted checklist to assess the quality of non-invasive methods of assessment in labor progression. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool to assess the quality of included studies. QUADAS-2 includes four key domains: patient selection, index tests, reference standard, and flow and timing. In addition, the first three items were also rated according to their applicability to the research question. The domains were rated as high, low, or unclear risk . The GraI2) [I2 (which ranges from 0 to 100%) was used to examine the heterogeneity of results and to determine the analytical model [fixed-effects model or random-effects model].The meta-analysis was performed by calculating pooled estimates of sensitivity, specificity, positive predictive value, true positives, true negatives, false positives, and false negatives, which can be extracted from all included studies. They were either reported directly or calculated from published studies. Heterogeneity was determined using both Cochran’s Q test and inconsistency index (I2) . Here, II2 value of > 50% and Cochran's Q test with a p value < 0.05 were defined as inter-study heterogeneity and were assessed by a random-effects model [An ts model . Next, tts model  curve win = 4), did not cover the normal labor process (n = 14), was not an assessment of the first stage of labor (n = 42), or did not use sensitivity and specificity on the diagnostic of labor (n = 7), all of which would have compromised the quality assessment process. The reference list search and Google scholar strategies identified 9 additional studies.Among all 2283 articles identified with the first search strategy, 893 overlapped , and these records were exported to EndNote X8. Seven additional articles were identified by reviewing the reference lists of the existing relevant references. After screening the titles and abstracts, a total of 1390 studies was excluded. Except for 6 reports that were not retrieved, the text of 70 studies was retrieved for review. A further 60 studies were excluded because the full text was not available  for HPD and AOP were 0.74 (0.65–0.82) and 0.78 (0.66–0.86), respectively, the specificities and 95% CIs were 0.77 (0.69–0.84) and 0.75 (0.67–0.82), respectively, while AUC for HPD and AOP were 0.83 and 0.81. The HSROC curve was obtained by using the hierarchical regression model to present an overall summary of HPD and AOP and lies to the left of the diagonal  and 0.23 (p = 0.53). Meta-analysis executed the pooling of odds ratios using the random-effects inverse-variance model. The pooled DOR of HPD and AOP were 8.21  and 10.34 , respectively. There was significant heterogeneity of AOP  and AOP .Given the small number of included studies, the forest plots were just from HPD and AOP, in which the summary from nine data subsets of eight studies and ten data subsets of nine studies are shown in Figs. p value = 0.02) and AOP  indicated publication bias was present , indirectness, and inconsistency   and 0.78 (0.66–0.86) and specificities 0.77 (0.69–0.84) and 0.75 (0.67–0.82) compared with VE as the current clinical gold standard. The pooled DOR was 8.21and 10.34, indicating that the HPD and AOP were classified as having good normal birth progress tool parameters. However, significant heterogeneity was found between the studies. The quality of evidence assessed with GRADE was low to very low.For the purple line subgroup, the quality of the trial was very low according to GRADE, although accurately this should be, and only two studies reporting on the purple line studies were included. Although past research has found the purple line positively correlated with cervical dilatation and fetal head descent in labor , 34, 35,Eleven of the included 13 studies compared transabdominal and/or transperineal ultrasound, and several different ultrasound measurements have been proposed. Most studies used the AOP and HPD parameters. because they were easy to perform . HoweverMore and more information about the use of ultrasound for the assessment of labor progress has been accumulated in recent years, and it has become a relatively new way of assessing childbirth . TranspeThere are limitations to this study. The very low to low quality of the evidence is of major concern mainly due to selection bias as well as verification bias. First, the aim of the paper was to achieve a synthesis of the sensitivity, specificity, positive predictive value, and negative predictive value, which may limit the analyses of the different research methods adopted. Next, in this review, there are eight studies from the same African country, and because there are different healthcare institutions, ultrasound systems and observers in conducting births may have contributed to the variability of the results , 44. Mor. Therefore, in clinical practice, HPD and AOP parameters can be combined with VE, which will help to estimate the progress of low-risk normal birth.The contribution of this systematic review is that clinical practice could consider including ultrasound as an adjunct to assessing labor progress during labor. In addition to being non-invasive, previous studies have found that evaluating labor progress through VE remains one of the most challenging skills for younger midwives or midwifery students . This reThe results of this meta-analysis support the international recommendations of WHO and confirmed that the HPD and AOP parameters are promising methods for use in transperineal ultrasound for decreased vaginal examination in the first stage of labor. Although these studies are not randomized controlled trial designs, they demonstrated that the benefits to women and healthcare givers are unequivocally clear. Due to publication bias in this study, future research is suggested to employ randomized controlled trials or large-scale prospective cohort studies, and focus on test combinations with VE in order to improve the predictive accuracy in normal labor progress.Additional file 1. Search strategy.Additional file 2. Study Quality of Evidence According to Guidelines.Additional file 3. Sensitivity and specificity row data.


The pathological type of non–small cell lung cancer is considered to be an important factor affecting the treatment and prognosis. The purpose of this study was to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in determining efficacy to distinguish adenocarcinoma (AC) and squamous cell carcinoma (SC), and their combined diagnostic efficacy was also analyzed.This is a single-center prospective study, and we collected 70 patients with lung SC and 127 patients with lung AC confirmed by histopathological examination. Morphological parameters, plain scan CT value, biphasic enhanced CT value, and spectral parameters were calculated. The diagnostic efficiency of morphological parameters, spectral parameters, and spectral parameters combined with morphological parameters was obtained by statistical analysis.p < 0.05). In the arterial phase and the venous phase, the spectral parameters of AC were higher than those of SC . When conducting multivariate analysis combining CT features and DLCT parameters with the best diagnostic efficacy, the independent predictors of AC were distribution on peripheral , presence of air bronchogram , and presence of vacuole sign . Receiver operating characteristic curves of the SC and AC showed that VP-λ had the best diagnostic performance, with an area under the curve (AUC) of 0.864 and sensitivity and specificity rates of 85.8% and 74.3%, respectively; the AUC was increased to 0.946 when morphological parameters were combined, and sensitivity and specificity rates were 89.8% and 87.1%, respectively.In univariate analysis, seven morphological CT features differed significantly between SC and AC: tumor location (distribution), lobulation, spicule, air bronchogram, vacuole sign, lung atelectasis and/or obstructive pneumonia, and vascular involvement (all The quantitative parameters of the DLCT spectrum are of great value in the diagnosis of SC and AC, and the combination of morphological parameters and spectral parameters is helpful to distinguish SC from AC. Lung cancer is a disease that seriously affects human health. Approximately 85% of patients are non–small cell lung cancer (NSCLC), of which adenocarcinoma (AC) and squamous cell carcinoma (SC) are the most common subtypes , 2. HistChest CT is the preferred imaging examination for the diagnosis of lung cancer. Traditional CT can evaluate the benign and malignant lesions according to their morphological features, intensity, and lymph node metastasis. However, it is difficult to evaluate the pathological subtypes of lung cancer because of the lack of quantitative indicators. If morphological criteria did not help to distinguish benign from malignant lung lesions, then it is strongly dependent on invasive pathologic examination or follow-up studies . As a noPrevious studies on energy spectrum CT in SC and AC are insufficient and controversial. Fehrenbach et al.  considerThis study improves the above issues. The purpose of this study was to investigate the diagnostic value of spectral parameters of DLCT in determining efficacy to distinguish AC and SC, and their combined diagnostic efficacy was also analyzed.A prospective study was conducted in our hospital between 1 August 2020 and 31 March 2021; a total of 656 consecutive patients who were diagnosed with lung cancer, confirmed by histopathological examination, were enrolled for the present study. To ensure the reliability of the results, all patients were required to conduct DLCT scan within 7 days before treatment. Inclusion criteria were as follows: (1) patients who underwent dual-layer detector spectral CT before treatment; (2) imaging, clinical, and pathological data were complete; (3) the short diameter of the tumor was greater than 2.0 cm; (4) no clinical antineoplastic treatment was given before enrollment; (5) patients can undergo the CT scan with the breath-holding; and (6) no other cancer history. Exclusion criteria were as follows: (1) patients with hyperthyroidism were not cured; (2) history of allergy to iodine contrast medium; and (3) complication of the heart, liver, kidney, and other important organ damage. The flow diagram of the present study is shown in This single-center prospective study was approved by the Hospital Institution Review Committee [no. 2020(KY-E-30)], and written informed consent was obtained from all of the participants.via an antecubital vein at an intended flow rate of 3.0 ml/s with a high-pressure syringe, followed by 30 ml of saline, injected at the same flow rate. Scans were performed using the bolus chase method. The region of interest (ROI) was located in the descending aorta with a trigger threshold of 150 Hu. AP was started at 6 s after contrast agent injection, and VP was performed at 36 s after contrast agent injection. Parameters included tube voltages of 120 kVp, spectral CT adaptive current, collimator width of 64 × 0.625 mm, pitch of 1.234, rotation time of 0.27 s, and matrix of 512 × 512. After the scans were completed, the data obtained in the enhanced double phases were reconstructed by projected spatial-spectral reconstruction . The image reconstruction image thickness was 1 mm, and the image spacing was 1 mm.All scans were performed using the IQon Spectral CT device . The scans included routine CT plain film and AP and VP enhancement scan of the lung. The field of vision ranges from apex to diaphragm level. The contrast agent iophorol  was administered aorta. The slope of the spectral curve was defined as the difference of the CT value at 40 and 60 keV divided by the energy difference (60 − 40) according to the following formula: λ = [CT(40) − CT(60)]/(60 − 40).The images were sent to the Philips Spectral Diagnostic Suite 9.0  workstation, and all data were processed and analyzed by two radiologists with more than 5 years of chest CT diagnosis experience. They were blinded to any patient’s clinical data to mitigating potential cognitive biases. Three consecutive image sections containing the maximum cross section of the tumor and the adjacent upper and lower levels were chosen for measurement; the round or oval ROI was drawn as large as possible  to minimize the influences of noise and the partial volume effect. Two radiologists first sketched the ROI on the conventional CT enhanced and unenhanced images, and the morphological parameters  of the tumor were evaluated. The ROI was placed on solid regions of the tumor, avoiding areas with vessels, calcification, cystic, and necrotic change. They then obtained data from other parameter images , and copy/paste functions were used to ensure the consistency of the size, shape, and position of the ROIs. Enhancement value was defined as the difference of the CT value (AP/VP) and plain CT value according to the following formula: enhancement value (AP/VP) = CT value (AP/VP) − plain CT value. To minimize the influence of the individual circulation status and scanning times, the ID values of lung lesions were normalized to that of the aorta in the aortopulmonary window level to calculate the NID: NID = ID/IDTumor specimens were analyzed by a pathologist with 14 years of immunohistochemical staining experience. Without knowing clinical information and spectral CT results, the pathologist numbered and evaluated all sections and analyzed and recorded their pathological types. The histologic criteria used for diagnosis were in accordance with the World Health Organization Classification of Lung Tumors , 13.p < 0.05 on univariate analysis were used as the input variables for multiple logistic regression analysis, with the final model selected with the forward selection; model I , model II , model III , and model IV  were established respectively. Finally, the ROC curves of the above models are drawn, and their diagnostic efficiency is analyzed. In the case of two-tailed p-value < 0.05, the difference was considered statistically significant.Kappa and Intraclass correlation coefficient (ICC) tests were used to test the consistency of the measurement results of the two radiologists, with Kappa > 0.8 or ICC > 0.7 indicating satisfaction. All parameters were finally averaged over the measurements made by the two physicians. The normal distribution of all measured data was tested by the Shapiro–Wilk test. Measurements that follow a normal distribution were expressed as mean (standard deviation). In addition, the counting data were expressed by n (%). Independent sample t-test was adopted for all measurement parameters, and the chi-square test was adopted for counting data. For parameters that were significantly different, the results of the pathological examination were used as the gold standard, receiver operating characteristic (ROC) curves were drawn, and the diagnostic efficiency of each parameter is analyzed. First, univariate analysis regression model was established to analyze the correlation between morphological parameters and SC and AC. Then, multivariate logistic regression analyses were applied to identify independent predictors of SC or AC, with the model of CT features alone and CT features combined with optimal spectral parameters; factors with All data were analyzed using SPSS 21.0.0 , and graphics were drawn using GraphPad Prism version 9.0.2 .a priori power analysis to test the adequacy of our sample size to independent sample t-test using G*Power  resulted in a reported power of 0.917 to detect a medium effect (f = 0.50) with an alpha level of 0.05.We conducted an  G*Power . We specEleven patients with poor image quality, 45 patients with lymph nodes and/or distant metastases, 32 patients with focal necrosis greater than one-half of the maximum cross-sectional area, and 60 patients without pathological findings or with previous treatment were excluded. Finally, a total of 197 patients met the inclusion criteria, including 70 patients with SC  and 127 patients with AC patients . The clinical data are shown in p < 0.05). AC was more frequently found in the periphery, and the lobulation, spicule, air bronchogram, and vacuole sign were more likely to be observed among AC. Tumors with lung atelectasis and/or obstructive pneumonia and vascular involvement were more likely to be observed among SC. When it came to other CT features, no significant differences were noted between AC and SC. Univariate analysis revealed that seven CT features differed significantly between SC and AC in As shown in Because spectral quantitative parameters have statistically significant differences between SC and AC in the AP and the VP, diagnostic capacity was assessed using ROC curves in In multivariate analysis, after adjusting for other confounding factors, models of distribution, air bronchus, vacuole sign, and VP-λ are associated with AC Figure 3As shown in p > 0.05).For all the given parameters, the Kappa and ICC tests found that the measurement results were found to be consistent between the two radiologists  because of the small sample size, this study failed to stratify the degree of differentiation of tumors; (2) unenhanced spectral parameters were not included in the study; (3) not all pathological sections were matched with imaging ROI; and (4) some patients’ unenhanced images were replaced by virtual unenhanced images, which may affect our results.In summary, the combination of morphological features and DLCT spectral parameters improved the diagnostic efficiency in distinguishing SC from AC. This may help clinicians develop initial treatment strategy and prognostic predictions. Although relatively accurate pathological diagnosis can be obtained by invasive methods, complications or patient intolerance still exist.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Nanxishan Hospital of Guangxi Zhuang Autonomous Region Institution Review Committee [NO.2020(KY-E-30)]. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.First author: RM. Co-author: ZM; ZG. Other authors: XQ; GH; XY; HJ; PY; MD; XDZ. Guarantor and correspondent: XQZ. All authors contributed to the article and approved the submitted version.The authors thank the dedicated this project participants, their loved ones, and the devoted staff and trainees who contributed to recruitment, screening, and enrollment of the cohort.Author XZ is employed by Philips China Investment Co.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.