Upper gastrointestinal cancers (including oesophageal cancer and gastric cancer) are the most common cancers worldwide. Artificial intelligence platforms using deep learning algorithms have made ...remarkable progress in medical imaging but their application in upper gastrointestinal cancers has been limited. We aimed to develop and validate the Gastrointestinal Artificial Intelligence Diagnostic System (GRAIDS) for the diagnosis of upper gastrointestinal cancers through analysis of imaging data from clinical endoscopies.
This multicentre, case-control, diagnostic study was done in six hospitals of different tiers (ie, municipal, provincial, and national) in China. The images of consecutive participants, aged 18 years or older, who had not had a previous endoscopy were retrieved from all participating hospitals. All patients with upper gastrointestinal cancer lesions (including oesophageal cancer and gastric cancer) that were histologically proven malignancies were eligible for this study. Only images with standard white light were deemed eligible. The images from Sun Yat-sen University Cancer Center were randomly assigned (8:1:1) to the training and intrinsic verification datasets for developing GRAIDS, and the internal validation dataset for evaluating the performance of GRAIDS. Its diagnostic performance was evaluated using an internal and prospective validation set from Sun Yat-sen University Cancer Center (a national hospital) and additional external validation sets from five primary care hospitals. The performance of GRAIDS was also compared with endoscopists with three degrees of expertise: expert, competent, and trainee. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of GRAIDS and endoscopists for the identification of cancerous lesions were evaluated by calculating the 95% CIs using the Clopper-Pearson method.
1 036 496 endoscopy images from 84 424 individuals were used to develop and test GRAIDS. The diagnostic accuracy in identifying upper gastrointestinal cancers was 0·955 (95% CI 0·952–0·957) in the internal validation set, 0·927 (0·925–0·929) in the prospective set, and ranged from 0·915 (0·913–0·917) to 0·977 (0·977–0·978) in the five external validation sets. GRAIDS achieved diagnostic sensitivity similar to that of the expert endoscopist (0·942 95% CI 0·924–0·957 vs 0·945 0·927–0·959; p=0·692) and superior sensitivity compared with competent (0·858 0·832–0·880, p<0·0001) and trainee (0·722 0·691–0·752, p<0·0001) endoscopists. The positive predictive value was 0·814 (95% CI 0·788–0·838) for GRAIDS, 0·932 (0·913–0·948) for the expert endoscopist, 0·974 (0·960–0·984) for the competent endoscopist, and 0·824 (0·795–0·850) for the trainee endoscopist. The negative predictive value was 0·978 (95% CI 0·971–0·984) for GRAIDS, 0·980 (0·974–0·985) for the expert endoscopist, 0·951 (0·942–0·959) for the competent endoscopist, and 0·904 (0·893–0·916) for the trainee endoscopist.
GRAIDS achieved high diagnostic accuracy in detecting upper gastrointestinal cancers, with sensitivity similar to that of expert endoscopists and was superior to that of non-expert endoscopists. This system could assist community-based hospitals in improving their effectiveness in upper gastrointestinal cancer diagnoses.
The National Key R&D Program of China, the Natural Science Foundation of Guangdong Province, the Science and Technology Program of Guangdong, the Science and Technology Program of Guangzhou, and the Fundamental Research Funds for the Central Universities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Compared to conventional machining (CM), ultrasonic vibration-assisted machining (UVAM) with high-frequency and small-amplitude has exhibited good cutting performances for advanced materials. In ...recent years, advances in ultrasonic generator, ultrasonic transducer, and horn structures have led to the rapid progress in the development of UVAM. Following this trend, numerous new design requirements and theoretical concepts have been proposed and studied successively, however, very few studies have been conducted from a comprehensive perspective. To address this gap in the literature and understanding the development trend of UVAM, a critical overview of UVAM is presented in this study, covering different vibration-assisted machining styles, device architectures, and theoretical analysis. This overview covers the evolution of typical hardware systems used to achieve vibratory motions from the one-dimensional UVAM to three-dimensional UVAM, the discussion of cutting characteristics with periodic separation between the tools and workpiece and the analysis of processing properties. Challenges for UVAM include ultrasonic vibration systems with high power, large amplitude, and high efficiency, as well as theoretical research on the dynamics and cutting characteristics of UVAM. Consequently, based on the current limitations and challenges, device improvement and theoretical breakthrough play a significant role in future research on UVAM.
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•The evolution of UVAM systems are comprehensively discussed in the paper.•Kinematics are analysed in view of cutting type, including Con-UVAM and R-UVAM.•Cutting characteristics (contact rate, force, surface integrity) are summarized.•Based on advantages and interdisciplinary, directions of development are concluded.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Metal-organic frameworks (MOFs) as solid sorbents for carbon dioxide (CO
) capture face the challenge of merging efficient capture with economical regeneration in a durable, scalable material. ...Zinc-based Calgary Framework 20 (CALF-20) physisorbs CO
with high capacity but is also selective over water. Competitive separations on structured CALF-20 show not just preferential CO
physisorption below 40% relative humidity but also suppression of water sorption by CO
, which was corroborated by computational modeling. CALF-20 has a low enthalpic regeneration penalty and shows durability to steam (>450,000 cycles) and wet acid gases. It can be prepared in one step, formed as composite materials, and its synthesis can be scaled to multikilogram batches.
Abstract
Interest in low-temperature operation of solid oxide fuel cells is growing. Recent advances in perovskite phases have resulted in an efficient H
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triple-conducting electrode BaCo
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Fe
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3-δ
for low-temperature fuel cells. Here, we further develop BaCo
0.4
Fe
0.4
Zr
0.1
Y
0.1
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3-δ
for electrolyte applications by taking advantage of its high ionic conduction while suppressing its electronic conduction through constructing a BaCo
0.4
Fe
0.4
Zr
0.1
Y
0.1
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-ZnO p-n heterostructure. With this approach, it has been demonstrated that BaCo
0.4
Fe
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Zr
0.1
Y
0.1
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can be applied in a fuel cell with good electrolyte functionality, achieving attractive ionic conductivity and cell performance. Further investigation confirms the hybrid H
+
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conducting capability of BaCo
0.4
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Zr
0.1
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-ZnO. An energy band alignment mechanism based on a p-n heterojunction is proposed to explain the suppression of electronic conductivity and promotion of ionic conductivity in the heterostructure. Our findings demonstrate that BaCo
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is not only a good electrode but also a highly promising electrolyte. The approach reveals insight for developing advanced low-temperature solid oxide fuel cell electrolytes.
Gamma-ray Burst (GRB) collimation has been inferred with the observations of achromatic steepening in GRB light curves, known as jet breaks. Identifying a jet break from a GRB afterglow light curve ...allows a measurement of the jet opening angle and true energetics of GRBs. In this paper, we re-investigate this problem using a large sample of GRBs that have an optical jet break that is consistent with being achromatic in the X-ray band. Our sample includes 99 GRBs from 1997 February to 2015 March that have optical and, for Swift GRBs, X-ray light curves that are consistent with the jet break interpretation. Out of the 99 GRBs we have studied, 55 GRBs are found to have temporal and spectral behaviors both before and after the break, consistent with the theoretical predictions of the jet break models, respectively. These include 53 long/soft (Type II) and 2 short/hard (Type I) GRBs. Only 1 GRB is classified as the candidate of a jet break with energy injection. Another 41 and 3 GRBs are classified as the candidates with the lower and upper limits of the jet break time, respectively. Most jet breaks occur at 90 ks, with a typical opening angle θj = (2.5 1.0)°. This gives a typical beaming correction factor f b − 1 ∼ 1000 for Type II GRBs, suggesting an even higher total GRB event rate density in the universe. Both isotropic and jet-corrected energies have a wide span in their distributions: log(Eγ,iso/erg) = 53.11 with = 0.84; log(EK,iso/erg) = 54.82 with = 0.56; log(Eγ/erg) = 49.54 with = 1.29; and log(EK/erg) = 51.33 with = 0.58. We also investigate several empirical correlations (Amati, Frail, Ghirlanda, and Liang-Zhang) previously discussed in the literature. We find that in general most of these relations are less tight than before. The existence of early jet breaks and hence small opening angle jets, which were detected in the Swfit era, is most likely the source of scatter. If one limits the sample to jet breaks later than 104 s, the Liang-Zhang relation remains tight and the Ghirlanda relation still exists. These relations are derived from Type II GRBs, and Type I GRBs usually deviate from them.
Hydrogen fuel cell vehicle (HFCV) is considered as a promising solution for reducing greenhouse gas (GHG) and air pollutants emissions and improving energy security in the transportation sector. This ...study presents a well-to-wheel (WTW) analysis to estimate the WTW fossil fuel consumption, GHG emission and air pollutants emissions of VOCs, CO, NOx, SOx, PM2.5 and PM10 for HFCV under 12 hydrogen pathways in China for the current (2017) and near future (2030). The results were compared with the gasoline-fueled internal combustion engine vehicle (gasoline-ICEV) and battery electric vehicle (BEV) counterparts. The results show that HFCV can reduce 11–92% fossil fuel consumption compared with gasoline-ICEV in 2017, with one exception that HFCV based on on-site water electrolysis by grid electricity in which fossil fuel consumption increased by 10% instead. Compared with BEV, HFCV based on by-product hydrogen from chlor-alkali process and renewable water electrolysis have the fossil fuel consumption reduction benefits. Regarding GHG emissions, HFCV based on water electrolysis using the renewable electricity performs the best with a value of 31 g CO2-eq/km while that based on on-site water electrolysis using grid electricity performs the worst with a value of 431 g CO2-eq/km in 2017. For air pollutants, HFCV based on all hydrogen pathways can achieve a significant reduction of VOCs and CO emissions on a WTW basis, in comparison with gasoline-ICEV in 2017. In terms of NOx, SOx, PM2.5 and PM10, HFCV based on on-site water electrolysis by grid electricity electrolysis has the highest emissions due to high emission factors of the electricity generation process. Moreover, due to increased share of renewable electricity and improvement in the fuel economy, reductions in WTW fossil fuel consumption and pollutants emissions are excepted by 2030. This study indicates the importance of hydrogen production when considering the energy and environment performance of HFCV to ensure a life cycle low carbon and air pollutants emissions.
•Well-to-wheel analysis of hydrogen fuel cell vehicle under various H2 pathways in China.•Fossil fuel consumption, GHG and criteria air pollutants emission are examined.•Hydrogen pathways are critical for emission reduction.•Air pollutants mitigation characteristics are identified.•Highlight the importance of incorporating well-to-tank stage into the comparison.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
The number of sensing data are often imbalanced across data classes, for which oversampling on the minority class is an effective remedy. In this paper, an effective oversampling method called ...evolutionary Mahalanobis distance oversampling (EMDO) is proposed for multi-class imbalanced data classification. EMDO utilizes a set of ellipsoids to approximate the decision regions of the minority class. Furthermore, multi-objective particle swarm optimization (MOPSO) is integrated with the Gustafson-Kessel algorithm in EMDO to learn the size, center, and orientation of every ellipsoid. Synthetic minority samples are generated based on Mahalanobis distance within every ellipsoid. The number of synthetic minority samples generated by EMDO in every ellipsoid is determined based on the density of minority samples in every ellipsoid. The results of computer simulations conducted herein indicate that EMDO outperforms most of the widely used oversampling schemes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Multimodality treatment provides modest survival benefits for patients with locally advanced (stage III) non-small-cell lung cancer (NSCLC). Nevertheless, preoperative immunotherapy has continuously ...been shown to be promising in treating resectable NSCLC.This phase 2 trial enrolled patients with AJCC-defined stage IIIA or T3-4N2 IIIB NSCLC deemed surgically resectable. Patients received three cycles of neoadjuvant treatment with intravenous PD-1 inhibitor toripalimab (240 mg), carboplatin (area under the curve 5), and pemetrexed (500 mg/m
2
for adenocarcinoma) or nab-paclitaxel (260 mg/m
2
for other subtypes) on day 1 of each 21-day cycle. Surgical resection was performed 4-5 weeks afterward. The primary endpoint was major pathological response (MPR), defined as less than 10% residual tumor remaining at the time of surgery.Thirty-three patients were enrolled, of whom 13 (39.4%) had T3-4N2 stage IIIB disease. Thirty (90.9%) patients underwent resection and all except one (96.7%) achieved R0 resection. Twenty patients (60.6%) in the intention-to-treat population achieved an MPR, including 15 patients (45.5%) who achieved a pathological complete response (pCR). The MPR and pCR rates in the per-protocol population were 66.7% and 50.0%, respectively. The surgical complications included three cases of arrhythmias, one case of a prolonged air leak, and one case of chylothorax. The most common grade 3 treatment-related adverse event (TRAE) was anemia (2, 6.1%). Severe TRAEs included one (3.0%) case of grade 3 peripheral neuropathy that resulted in surgical cancellation.Toripalimab plus platinum-based doublet chemotherapy yields a high MPR rate, manageable toxicity, and feasible resection in stage III NSCLC.Trial ClinicalTrials.gov (NCT04304248)
Abstract
Background
Frailty is a common condition in older adults that is characterized by transitions between frailty states in both directions (progression and reversion) over time. Loneliness has ...been reported to be associated with the incidence of frailty, but few studies have explored the impact of persistent loneliness over time on frailty. In this study, we aimed to whether and how two different types of loneliness, transient and chronic, were associated with changes in frailty status in older adults.
Methods
The analytic sample contained 2961 adults aged ≥ 60 years who completed interviews for both the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. The logistic regression model was used to examine the relationship between transient and chronic loneliness and progression and reversion of frailty. Demographics (age, sex, education level, marital status, urban–rural residence), living alone, chronic conditions, physical function, and depressive symptoms from the 2011 wave were adjusted.
Results
After four years, 21% of the studied sample reported progression, 20% reported reversion in frailty, 31% reported transient loneliness, and 14% reported chronic loneliness. There was no significant difference in participants who reported transient loneliness (OR = 1.10, 95% CI 0.89,1.37), or chronic loneliness (OR = 1.14, 95% CI 0.84,1.57) on the progression of frailty, compared with no report of loneliness. Participants reporting chronic loneliness (OR = 0.68, 95% CI 0.50,0.93) were less likely to report reversion in their level of frailty compared to participants who did not report loneliness but not transient loneliness (OR = 0.87, 95% CI 0.70,1.08).
Conclusions
Roughly the same percentage, a fifth, of older Chinese adults progressed or reversed in frailty status without active intervention. Chronic loneliness was related to a lower probability of reversion in the frail group than in the no loneliness group, but not in the transient loneliness group. More attention should be given to older adults with chronic loneliness.
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