Many works in recent years have been focused on developing a portable and less expensive system for diagnosing patients with obstructive sleep apnea (OSA), instead of using the inconvenient and ...expensive polysomnography (PSG). This study proposes a sleep apnea detection system based on a one-dimensional (1D) deep convolutional neural network (CNN) model using the single-lead 1D electrocardiogram (ECG) signals. The proposed CNN model consists of 10 identical CNN-based feature extraction layers, a flattened layer, 4 identical classification layers mainly composed of fully connected networks, and a softmax classification layer. Thirty-five released and thirty-five withheld ECG recordings from the MIT PhysioNet Apnea-ECG Database were applied to train the proposed CNN model and validate its accuracy for the detection of the apnea events. The results show that the proposed model achieves 87.9% accuracy, 92.0% specificity, and 81.1% sensitivity for per-minute apnea detection, and 97.1% accuracy, 100% specificity, and 95.7% sensitivity for per-recording classification. The proposed model improves the accuracy of sleep apnea detection in comparison with several feature-engineering-based and feature-learning-based approaches.
Lung adenocarcinoma has a strong propensity to metastasize to the brain. The brain metastases are difficult to treat and can cause significant morbidity and mortality. Identifying patients with ...increased risk of developing brain metastasis can assist medical decision-making, facilitating a closer surveillance or justifying a preventive treatment. We analyzed 27 lung adenocarcinoma patients who received a primary lung tumor resection and developed metastases within 5 years after the surgery. Among these patients, 16 developed brain metastases and 11 developed non-brain metastases only. We performed targeted DNA sequencing, RNA sequencing and immunohistochemistry to characterize the difference between the primary tumors. We also compared our findings to the published data of brain-tropic and non-brain-tropic lung adenocarcinoma cell lines. The results demonstrated that the targeted tumor DNA sequencing did not reveal a significant difference between the groups, but the RNA sequencing identified 390 differentially expressed genes. A gene expression signature including
could identify 100% of brain-metastasizing tumors with a 91% specificity. However, when compared to the differentially expressed genes between brain-tropic and non-brain-tropic lung cancer cell lines, a different set of genes was shared between the patient data and the cell line data, which include many genes implicated in the cancer-glia/neuron interaction. Our findings indicate that it is possible to identify lung adenocarcinoma patients at the highest risk for brain metastasis by analyzing the primary tumor. Further investigation is required to elucidate the mechanism behind these associations and to identify potential treatment targets.
Background
The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is ...recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings.
Methods
All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute‐and‐chronic group (AANC group) (n = 221) and the chronic group (n = 123). A comparative analysis of the demographic data and perioperative outcomes was performed.
Results
Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC‐to‐LC days of the chronic group were longer than those of the AANC group (73.51 vs 63.00, P < .001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group (P = .040).
Conclusion
In terms of the clinical course and sequential pathological changes in the gallbladder, a 9‐ to 10‐week interval after PC is the optimal timing for LC.
Highlight
Hung and colleagues performed a retrospective study to determine the optimal timing of laparoscopic cholecystectomy following percutaneous cholecystostomy placement for acute cholecystitis. Based on the sequential pathological changes to the gallbladder and the risk of recurrent biliary events, 9‐10 weeks after percutaneous cholecystostomy was considered the optimal timing.
Background
Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube ...removal before definitive cholecystectomy on surgical outcomes.
Methods
From 2012 to 2017, 942 AC patients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography.
Results
The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334–6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182–8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome.
Conclusion
Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
Highlight
Hung and colleagues investigated the impact of percutaneous cholecystostomy tube removal before scheduled laparoscopic cholecystectomy. Removal of the tube was associated with an increased likelihood of emergent cholecystectomy, but not with higher rates of perioperative complications. In addition, routine preoperative cholangiography via a percutaneous cholecystostomy tube may not be necessary.
Ipomoea pes-caprae
is a plant of sand coasts and it can tolerate stresses, such as high salinity, strong wind and sand movements and lack of nutrients. It plays an important role in coast protection ...and preventing erosion. Fungal endophytes show high biodiversity and have a strong influence on the survival of plants under different stress factors. Although this plant is important for sand coast ecosystems, little is known about the associated fungi. In this study, we isolated and identified endophytic fungi of
Ipomoea pes-caprae
, a dominant plant along the shore of Taiwan. The dataset contains 896 records, which correspond to 177 species. The geographical scope of the dataset covers the northern subtropical area of the main island of Taiwan, with its sand coasts in New Taipei, Taoyuan, Hsinchu and Taichung and two botanical gardens in Taipei and Taichung. The detailed original data of fungal diversity are rarely publicly shared under strictly formalised and, thus, reusable standards. As an example for such an approach, the complete occurrence dataset was made available in the Darwin Core Archive format via the Global Biodiversity Information Facility (GBIF) under Version 1.13, Taiwan Biodiversity Information Facility (TaiBIF) https://doi.org/10.15468/9h9rcg. In this first data paper on endophytic fungi, the scientific name and associated DNA sequence in the dataset were directly linked to other free online resource (Index Fungorum, GenBank), which shows the potential of GBIF for linking together different online data repositories.
We describe a dataset, in which the diversity of endophytic fungi of the sand coast plant
Ipomoea pes-caprae
in Taiwan was investigated.
The present study examined the effects of dietary lipid levels on growth performance, lipid deposition, oxidative stress and liver morphological changes in giant grouper, Epinephelus lanceolatus. ...Five isonitrogenous diets containing graded lipid levels (100, 125, 150, 175 and 200 g/kg diet) were applied to triplicate groups of grouper (mean weight: 17.59 ± 0.14 g) in a seawater recirculation system for 56 days. Dietary lipid levels from 100 to 200 g/kg exhibited no influence on weight gain, specific growth rate, protein efficiency ratio and feed efficiency of the fish. Grouper whole‐body and hepatic total lipid content, intraperitoneal fat ratio and oxidative stress (malondialdehyde content) increased linearly (p < 0.05) with escalating dietary lipid levels, reaching the highest values for a fish fed diet with 200 g/kg lipid content. In comparison with the observations in the liver of 100–125 g/kg lipid groups, the liver sections from the 175–200 g/kg lipid groups showed more numerous and larger vacuoles and the presence of round or elliptical hepatocytes. The results indicated that giant grouper could tolerate dietary lipid levels of up to 200 g/kg without exhibiting any negative impacts on growth performance in the 56‐day feeding trial. According to the results of intraperitoneal fat, hepatic lipid content, oxidative stress and liver morphology, a dietary lipid level no higher than 150 g/kg is recommended for this species.
A variety of feature extraction and classification approaches have been proposed using electrocardiogram (ECG) and ECG-derived signals for improving the performance of detecting apnea events and ...diagnosing patients with obstructive sleep apnea (OSA). The purpose of this study is to further evaluate whether the reduction of lower frequency P and T waves can increase the accuracy of the detection of apnea events. This study proposed filter bank decomposition to decompose the ECG signal into 15 subband signals, and a one-dimensional (1D) convolutional neural network (CNN) model independently cooperating with each subband to extract and classify the features of the given subband signal. One-minute ECG signals obtained from the MIT PhysioNet Apnea-ECG database were used to train the CNN models and test the accuracy of detecting apnea events for different subbands. The results show that the use of the newly selected subject-independent datasets can avoid the overestimation of the accuracy of the apnea event detection and can test the difference in the accuracy of different subbands. The frequency band of 31.25-37.5 Hz can achieve 100% per-recording accuracy with 85.8% per-minute accuracy using the newly selected subject-independent datasets and is recommended as a promising subband of ECG signals that can cooperate with the proposed 1D CNN model for the diagnosis of OSA.
In this paper, we introduce an anonymous batch authenticated and key agreement (ABAKA) scheme to authenticate multiple requests sent from different vehicles and establish different session keys for ...different vehicles at the same time. In vehicular ad hoc networks (VANETs), the speed of a vehicle is changed from 10 to 40 m/s (36-144 km/h); therefore, the need for efficient authentication is inevitable. Compared with the current key agreement scheme, ABAKA can efficiently authenticate multiple requests by one verification operation and negotiate a session key with each vehicle by one broadcast message. Elliptic curve cryptography is adopted to reduce the verification delay and transmission overhead. The security of ABAKA is based on the elliptic curve discrete logarithm problem, which is an unsolved NP-complete problem. To deal with the invalid request problem, which may cause the batch verification fail, a detection algorithm has been proposed. Moreover, we demonstrate the efficiency merits of ABAKA through performance evaluations in terms of verification delay, transmission overhead, and cost for rebatch verifications, respectively. Simulation results show that both the message delay and message loss rate of ABAKA are less than that of the existing elliptic curve digital signature algorithm (ECDSA)-based scheme.
Purpose
Percutaneous cholecystostomy (PC) is an important modality for acute cholecystitis and has been applied for other clinical scenarios as well. In the present study, we aimed to investigate an ...alternative use of PC for obstructive jaundice.
Methods
From January 2012 to December 2018, eligible subjects were selected from patients undergoing PC in our institute. The characteristics, spectrum of underlying disease, indication for PC performance, details of the procedure, and treatment effect were all investigated.
Results
During the study period, 1364 patients underwent PC. Seventy patients fulfilled the defined inclusion criteria. While 47 patients were diagnosed with malignant biliary obstruction with or without cholangitis, 23 patients were diagnosed with nonmalignant biliary obstruction and acute cholangitis. There were 63 patients (90%) diagnosed with acute cholangitis. Pancreatic cancer (
n
= 24, 51%) and advanced malignancy (
n
= 28, 59%) were noted mostly in the group with malignant biliary obstruction. Treatment effects were proven by laboratory data, including the white blood cell count, C-reactive protein level, and hepatic function.
Conclusion
PC can temporize definitive therapies and serve as an alternative treatment for patients with nonmalignant conditions. For patients with advanced malignancy, PC can serve as a palliative procedure that has a high success rate and low complication rate and effectively relieves biliary obstruction.
Acute‐on‐chronic liver failure (ACLF) is a fatal condition, and liver transplantation (LT) is a vital option for these patients. However, the result of living donor LT (LDLT) for ACLF is not well ...investigated. This study investigated the outcomes of LDLT in patients with ACLF compared with patients without ACLF. This was a single‐center, retrospective, matched case‐control study. From July 2002 to March 2017, a total of 112 patients with ACLF who underwent LDLT were enrolled according to the consensus of the Asian Pacific Association for the Study of the Liver. A total of 224 patients were selected for control comparison (non‐ACLF) with demographic factors (sex, age, and body mass index) matched (1:2). Patients with ACLF were stratified into ACLF 1, 2, and 3 categories according to the number of organ failures based on the Chronic Liver Failure–Sequential Organ Failure Assessment score. Survival and surgical outcomes after LDLT were analyzed. The Model for End‐Stage Liver Disease and Child‐Turcotte‐Pugh scores in the ACLF group were significantly higher than those in the non‐ACLF group (P < 0.001). The 90‐day, 3‐year, and 5‐year survival rates in the ACLF and non‐ACLF groups were 97.3%, 95.5%, 92.9%, respectively, and 96.9%, 94.2%, and 91.1%, respectively (P = 0.58). There was more intraoperative blood loss in the ACLF group than in the non‐ACLF group (P < 0.001). The other postoperative complications were not significantly different between the groups. A total of 20 patients (17.9%) in the ACLF group presented with 3 or more organ system dysfunctions (ACLF 3), and the 90‐day, 3‐year, and 5‐year survival rates were comparable with those of ACLF 1 and ACLF 2 (P = 0.25). In carefully selected patients, LDLT gives excellent outcomes in patients with ACLF regardless of the number of organs involved. Comprehensive perioperative care and timely transplantation play crucial roles in saving the lives of patients with ACLF.
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