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, UPCLJ, UPUK, ZAGLJ, ZRSKP
With the rapid development of urban rail transit and underground space development, the occurrence of excavation near existing tunnels is becoming more common. This excavation and unloading will ...inevitably cause soil deformation outside the pit and the tunnel buried therein. This paper presents an investigation into the entire excavation process and the deformation effects on the adjacent subway structure under complex construction environments, including soft soil foundations and adjacent subway intersections, based on measured data of pit construction. The horizontal and vertical displacements of deep soils in two pits were analyzed along with safety management measures to determine the horizontal displacement curve pattern and the lateral displacement development distribution law of deep soils. The analysis of subway deformation data shows that after excavation, the subway tunnel undergoes “lateral expansion” and “vertical compression” type deformation, accompanied by “in-pit” horizontal displacement and “settlement” vertical displacement. Furthermore, a correlation analysis reveals a clear linear relationship between pit deformation and subway structure deformation, which can be used as a prediction method for adjacent structure deformation. Finally, a comparative analysis of existing relevant influence zone models and tunnel deformation prediction formulas is carried out based on the monitoring. The results of this study have significant guiding implications for the excavation construction of soft soil foundations in the vicinity of subway crossings.
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Background: Colorectal cancer is one of the most common malignancies worldwide. Approximately 85% of colorectal cancers are thought to result from adenoma. However, the molecular ...mechanism of adenoma transformation into colorectal cancer is still unclear. Methods: Ninety-nine adenoma patients aged from 25 to 78 years old were enrolled in this study. We collected tissue sample from each patient and 77 matched blood samples. Pathological subtypes included tubular villous adenomas, villous adenomas, tubular adenomas, high-grade intraepithelial neoplasia, and polyps. Eighty-one stage I colorectal cancer patients (CRC I) were also enrolled in this study. All samples underwent Next-generation sequencing with a panel of 405 cancer related genes. Results: Mutational profiles of adenoma and CRC I patients were compared. The top 5 most frequently mutated genes in adenoma were APC (71%), KRAS (41%), ATM (33%), RIF1 (31%), SYNE1 (28%). While in CRC I patients, top 5 mutated genes were APC (78%), TP53 (57%), TTN (35%), KRAS (33%) and TCF7L2 (22%). There were significant differences between TP53 and TTN by chi-square test. The frequency, number and TMB of mutations in stage I colorectal cancer patients were significantly higher than those in various adenoma subtypes. Stage I colorectal cancer patients have more mutated genes enriched in the Wnt and Notch pathways than adenoma patients. We analyzed mutation signatures in CRC I and adenoma patients, and CRC I were more focused on mutation signatures of mismatch repair such as signature 1, signature 6, signature 10, and signature 15. A total of 391 mutations were identified in tissue samples, while 130 mutations were found in plasma cell-free DNA, with 116 mutations shared between them. The two genes with the highest consistency between tissue and blood were PAX7 and KMT2D. Conclusions: TP53 and TTN are associated with the transition from CRC I to adenoma, and Wnt and Notch pathways may also be involved. PAX7 and KMT2D mutations frequently found in adenoma tissue and blood cfDNA demonstrate the diagnostic potential of these two genes in clinic.
Stem cell exosomes are beneficial in accelerating wound repair. However, the therapeutic function is limited due to its rapid clearance in vivo. To improve the functionality of exosomes in cutaneous ...wound healing, a novel hydrogel was designed and fabricated by recombinant human collagen I and carboxymethyl chitosan loaded with exosomes derived from human umbilical cord mesenchymal stem cells (hUCMSCs), named as the rhCol I/CMC-Exos hydrogel.
Exosomes were extracted from hUCMSCs and were characterizated by TEM (Transmission Electron Microscopy), and biomarker detection. The rhCol I hydrogel, rhCol I/carboxymethyl chitosan (rhCol I/CMC) hydrogel and the rhCol I/CMC-Exos hydrogel composites were cross-linked by genipin. These materials were assessed and compared for their physical characteristics, including cross-sectional morphology, porosity, pore distribution, and hydrophilicity. Cell biocompatibility on biomaterials was investigated using scanning electron microscopy and CFDA staining, as well as assessed in vivo through histological examination of major organs in mice. Effects of the hydrogel composite on wound healing were further evaluated by using the full-thickness skin defect mice model.
Successful extraction of hUCMSCs-derived exosomes was confirmed by TEM，Western Blotting and flow cytometry. The synthesized rhCol I/CMC-Exos hydrogel composite exhibited cytocompatibility and promoted cell growth in vitro. The rhCol I/CMC-Exos hydrogel showed sustained release of exosomes. In the mice full skin-defects model, the rhCol I/CMC-Exos-treated group showed superior wound healing efficiency, with 15 % faster wound closure compared to controls. Histological examinations revealed thicker dermis formation and more balanced collagen deposition in wounds treated with rhCol I/CMC-Exos hydrogel. Mechanistically, the application of rhCol I/CMC-Exos hydrogel increased fibroblasts proliferation, alleviated inflammation responses as well as promoted angiogenesis, thereby was beneficial in promoting skin wound healing and regeneration.
Our study, for the first time, introduced recombinant human Collagen I in fabricating a novel hydrogel loaded with hUCMSCs-derived exosomes, which effectively promoted skin wound closure and regeneration, demonstrating a great potential in severe skin wound healing treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
China's diabetes epidemic is getting worse. People with diabetes in China usually have a lower body weight and a different lifestyle profile compared to their counterparts in the United States (US). ...More and more evidence show that certain lifestyles can possibly be spread from person to person, leading some to propose considering social influence when establishing preventive policies. This study developed an innovative agent-based model of the diabetes epidemic for the Chinese population. Based on the risk factors and related complications of diabetes, the model captured individual health progression, quantitatively described the peer influence of certain lifestyles, and projected population health outcomes over a specific time period. We simulated several hypothetical interventions (i.e., improving diet, controlling smoking, improving physical activity) and assessed their impact on diabetes rates. We validated the model by comparing simulation results with external datasets. Our results showed that improving physical activity could result in the most significant decrease in diabetes prevalence compared to improving diet and controlling smoking. Our model can be used to inform policymakers on how the diabetes epidemic develops and help them compare different diabetes prevention programs in practice.
Studies on the relationship between lifetime body mass index (BMI) trajectory and colorectal premalignant precursor lesions are limited. This study aimed to assess the relationship between ...prediagnostic adulthood BMI trajectory and the risk of colorectal adenomas using data from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial.
In total, 39,824 participants in the intervention arm of the prospective PLCO cohort, who have undergone at least one colonoscopy or sigmoidoscopy examination with a confirmed diagnosis of colorectal adenomas, were enrolled and divided into four groups (underweight, normal weight, overweight, and obese) according to BMI during each age period. SAS Proc Traj was used to establish the BMI trajectory model. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Compared with normal weight, overweight or obesity significantly increased colorectal adenomas risk in each age period after 30 years. Specifically, obesity in the 50s was most closely related to colorectal adenomas risk HR: 1.32, 95% CI: (1.22, 1.43). BMI gain from the age of 40 to 50 HR: 1.25, 95% CI: (1.11, 1.42) showed the strongest correlation with an increased incidence of colorectal adenomas, followed by that from the age of 30 to 50 HR: 1.19, 95% CI: (1.10, 1.29), the age of 20 to 50 HR: 1.16, 95% CI: (1.10, 1.24), the age of 20 to 40 HR: 1.14, 95% CI: (1.05, 1.23), and the age of 20 to 30 HR: 1.13, 95% CI: (1.02, 1.26). Additionally, compared with those who maintained normal weight throughout adulthood, those who progressed from normal weight to obesity HR: 1.15, 95% CI: (1.06, 1.25), or from overweight to obesity HR: 1.33, 95% CI: (1.11, 1.61), had a higher risk of colorectal adenomas.
Overweight and obesity increased the risk of colorectal adenomas, and this risk increased with advancing age.
Business modeling and Business components designing have lots of construction methods which have been proved insufficient in lots of cases. According to this problem, this paper presents a business ...model description method which is descripted by UML and consists of a business entity view and a business control view. Besides, it offers a transformation mechanism from UML model to Petri. At the same time, on the basis of semantic analysis of business model, the clustering algorithm formula which is introduced to divide the process of business component more effectively between classes is given. Then this paper builds up an Inventory Management business model of an enterprise for discussing business component identification, analysis and designing in practical using.
The objective of this study is to quantitatively evaluate Tropical Rainfall Measuring Mission （TRMM） data with rain gauge data and further to use this TRMM data to drive a Dis- tributed Time-Variant ...Gain Model （DTVGM） to perform hydrological simulations in the semi-humid Weihe River catchment in China. Before the simulations, a comparison with a 10-year （2001-2010） daily rain gauge data set reveals that, at daily time step, TRMM rainfall data are better at capturing rain occurrence and mean values than rainfall extremes. On a monthly time scale, good linear relationships between TRMM and rain gauge rainfall data are found, with determination coefficients R2 varying between 0.78 and 0.89 for the individual stations. Subsequent simulation results of seven years （2001-2007） of data on daily hydro- logical processes confirm that the DTVGM when calibrated by rain gauge data performs better than when calibrated by TRMM data, but the performance of the simulation driven by TRMM data is better than that driven by gauge data on a monthly time scale. The results thus suggest that TRMM rainfall data are more suitable for monthly streamfiow simulation in the study area, and that, when the effects of recalibration and the results for water balance components are also taken into account, the TRMM 3B42-V7 product has the potential to perform well in similar basins.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In areas with topographic heterogeneity, land use change is spatially variable and influenced by climate, soil properties, and topography. To better understand this variability in the high-sediment ...region of the Loess Plateau in which soil loss is most severe and sediment diameter is larger than in other regions of the plateau, this study builds some indicators to identify the characteristics of land use change and then analyze the spatial variability as it is affected by climate, soil property, and topography. We build two indicators, a land use change intensity index and a vegetation change index, to characterize the intensity of land use change, and the degree of vegetation restoration, respectively. Based on a subsection mean method, the two indicators are then used to assess the spatial variability of land use change affected by climatic, edaphic, and topographic elements. The results indicate that： 1） Land use changed significantly in the period 1998-2010. The total area experiencing land use change was 42,302 km2, accounting for 22.57%of the study area. High-coverage grassland, other woodland, and forest increased significantly, while low-coverage grassland and farmland decreased in 2010 compared with 1998.2） Land use change occurred primarily west of the Yellow River, between 35 and 38 degrees north latitude. The four transformation types, including （a） low-coverage grassland to medium-coverage grassland, （b） medium-coverage grassland to high-coverage grassland, （c） farmland to other woodland, and （d） farmland to medium-coverage grassland, were the primary types of land use change, together constituting 60% of the area experiencing land use change. 3） The spatial variability of land use change was significantly affected by properties of dryness/wetness, soil conditions and slope gradient. In general, land use changed dramatically in semi-arid regions, remained relatively stable in arid regions, changed significantly in clay-rich soil, remained relatively stable in clay-poor soil, changed dramatically in steeper slopes, and remained relatively stable in tablelands and low-lying regions. The increase in vegetation coincided with increasing changes in land use for each physical element. These findings allow for an evaluation of the effect of the Grain to Green Program, and are applicable to the design of soil and water conservation projects on the Loess Plateau of China.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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