To develop an artificial intelligence-based approach with multi-labelling capability to identify both ST-elevation myocardial infarction (STEMI) and 12 heart rhythms based on 12-lead ...electrocardiograms (ECGs).
We trained, validated, and tested a long short-term memory (LSTM) model for the multi-label diagnosis of 13 ECG patterns (STEMI + 12 rhythm classes) using 60 537 clinical ECGs from 35 981 patients recorded between 15 January 2009 and 31 December 2018. In addition to the internal test above, we conducted a real-world external test, comparing the LSTM model with board-certified physicians of different specialties using a separate dataset of 308 ECGs covering all 13 ECG diagnoses. In the internal test, the area under the curves (AUCs) of the LSTM model in classifying the 13 ECG patterns ranged between 0.939 and 0.999. For the external test, the LSTM model for multi-labelling of the 13 ECG patterns evaluated by AUC was 0.987 ± 0.021, which was superior to those of cardiologists (0.898 ± 0.113,
< 0.001), emergency physicians (0.820 ± 0.134,
< 0.001), internists (0.765 ± 0.155,
< 0.001), and a commercial algorithm (0.845 ± 0.121,
< 0.001). Of note, the LSTM model achieved an accuracy of 0.987, AUC of 0.997, and precision, recall, and
score of 0.952, 0.870, and 0.909, respectively, in detecting STEMI.
We demonstrated the usefulness of an LSTM model in the multi-labelling detection of both rhythm classes and STEMI in competitive testing against board-certified physicians. This AI tool exceeding the cardiologist-level performance in detecting STEMI and rhythm classes on 12-lead ECG may be useful in prioritizing chest pain triage and expediting clinical decision-making in healthcare.
To examine whether the serial measurement of plasma cytokine levels can assist in the early recognition of AIDS/tuberculosis patients with poor response to anti-tuberculosis treatment.
Longitudinal, ...prospective cohort study.
A university hospital, the largest centre for HIV/AIDS patients in Taiwan.
Between January 1997 and September 1998, 25 consecutive patients with advanced HIV infection and suspected tuberculosis were enrolled in the study. Plasma samples were obtained on day 1 (baseline), 3, 7 and 14 of anti-tuberculosis treatment and the levels of tumour necrosis factor-alpha (TNF-alpha) were measured. Patients were classified as either responders or non-responders according to the results of assessment of symptoms and follow-up cultures during the sixth and eighth week of anti-tuberculosis treatment. Thirty consecutive HIV-negative tuberculosis patients were also enrolled in the study.
The data of a total of 16 AIDS patients (median CD4 cell count 16 x 10(6)/l; 12 responders and four non-responders) and 21 HIV-negative patients (16 responders and five non-responders), whose tuberculosis was culture-proven, were included for analysis. In responders, TNF-alpha levels declined remarkably within the first week of anti-tuberculosis treatment; however, the decline of TNF-alpha levels in non-responders was significantly less the median ratio of TNF-alpha level on day 7 to that at baseline was 0.32 versus 0.85 (P < 0.001) in AIDS patients; 0.34 versus 0.80 (P = 0.001) in HIV-negative patients). The lack of a > or = 50% reduction in pre-treatment TNF-alpha levels during the first week of treatment was strongly associated with a poor response to anti-tuberculosis treatment (P = 0.001 in AIDS patients; P < 0.001 in HIV-negative patients).
Serial measurement of plasma TNF-alpha levels may help to assess the response to anti-tuberculosis treatment in AIDS patients, in spite of very low CD4 cell counts. Failure of TNF-alpha levels to decline by > or = 50 % of pre-treatment levels in the first week of treatment may be an early surrogate marker of a poor response.
The photocatalytic process using TiO2 and coupled semiconductor in the photodegradation reaction of 4-chlorophenol (4-CP) was investigated. Nanosized titanium dioxide powder was synthesized via the ...sol-gel procedure and modified via the coupled photocatalysts. The microstructural and chemical properties of TiO2 and coupled CdSe/TiO2 were also examined. For CdSe/TiO2 samples, the specific surface area was 7.0m2/g and the deposition proportion of CdSe was approximately 27.6%. In the photocatalysis results, higher photodegradation efficiency of 4-CP was observed at higher pH values. In the UV 254nm system, the degradation efficiency of 4-CP and TOC with sol-gel produced TiO2 (TiO2(SG)) powder was higher than with commercial TiO2(RdH) powder. For the coupled semiconductor system (CdSe/TiO2), the apparent first-order rate constants were 1.35 X 10-2, 4.33 X 10-2, 2.0 X 10-3 and 1.9 X 10-3min-1 at the conditions of pH 7 (254nm), pH 11 (254nm), pH 7 (365nm), and pH 11 (365nm). The disappearance of 4-CP under CdSe/TiO2(RdH) photoreaction at pH 7 and 365nm condition is better than that of TiO2(RdH) system, with 30% versus 22% 4-CP reduction in 180min. In the same condition, CdSe/TiO2(RdH) provided more photomineralization efficiency than that of TiO2(RdH) in terms of TOC reduction. Both 4-CP and TOC reduction were significant for systems illuminated at 254nm. Considering the direct photolysis effect at 254nm where 4-CP reduction is near 100% and TOC removal is nil, CdSe/TiO2(RdH) exhibits a 50% photomineralization efficiency and a nearly four times faster reaction rate than the single TiO2(RdH) semiconductor.
The aim of this study was to assess the anxiolytic effect of berberine (abbrev. BER) using two experimental anxiety models in the mouse. In the black and white test of anxiety, berberine (100, 500 ...mg/kg) produced an increase in the first time entry, time spent in the white section, and total changes between two compartments. On the other hand, in the elevated plus-maze test, berberine (100, 500 mg/kg) produced an increase in the time spent and arm entries in the open arms, and a decrease in the time spent and arm entries in the closed arms. Berberine (500 mg/kg) decreased locomotor activity in mice. Furthermore, BER at 100, 500 mg/kg decreased concentrations of NE, DA and 5-HT, and increased the concentrations of VMA, HVA and 5-HIAA in the brain stem. BER also attenuated the anxiogenic effect of WAY-100635, 8-OH DPAT and DOI and enhanced the anxiolytic effect of BUS, p-MPPI and RIT in the elevated plus-maze. These results suggested that berberine at 100 mg/kg had a significant anxiolytic-like effect, which was similar to that observed with 1 mg/kg diazepam and 2 mg/kg buspirone. The anxiolytic mechanism of BER might be related to the increase in turnover rates of monoamines in the brain stem and decreased serotonergic system activity. Moreover, BER decreased serotonergic system activity via activation of somatodendritic 5-HT1A autoreceptors and inhibition of postsynaptic 5-HT1A and 5-HT2 receptors.
Children with heterotaxy syndrome frequently have complex cardiac and noncardiac malformations requiring detailed diagnostic evaluation for management planning. Direct delineation of these structures ...by electron beam computed tomography (EBCT) is validated as a means of diagnosis. From July 1995 to March 1997, 32 patients (16 girls, 16 boys) with clinically impressed heterotaxy syndrome were enrolled in this study. After evaluation by echocardiography, EBCT studies were performed. Interpretation of cardiac anomalies was performed by sequential analysis based on these cross-sectional images. The diagnoses were subsequently confirmed by angiocardiography and surgical findings. Twenty-eight patients had bilateral trifurcated bronchi, and most of these (24 of 28) did not have a spleen. Four patients had bilateral bifurcated bronchi, 2 patients had polysplenia, and the other 2 patients had a lobulated single spleen. We found that laterality could be identified by EBCT in all patients. Comparison of diagnostic yield between echocardiography, catheterization, and EBCT showed that EBCT is superior to echocardiography and catheterization in demonstration of pulmonary venous anatomy and presence of a very small rudimentary ventricle. In addition, associated visceral, bronchopulmonary, mediastinal, and intracardiac anomalies could all be clearly delineated by EBCT at the same time. Thus, EBCT is a promising complementary modality for an overall understanding of heterotaxy syndrome.
This study describes the process of growing densely distributed metallic seeds of sizes ∼4
nm on SiO
2 dielectric layers by sequential treatment in N
2–H
2 vacuum plasma (to activate the surfaces) ...and an aqueous solution of metallic salt (to adsorb metallic seeds). After the plasma treatment, the metallic seeds can be densely adsorbed onto the SiO
2 dielectric layers, thus facilitating Co–P barrier layers of thickness only ∼10
nm to be grown using electroless plating. Conversely, for the SiO
2 dielectric layers without the plasma pre-treatment, the population density of the metallic seeds is significantly reduced by one order and thus can only initiate the growth of a relatively thick (∼40
nm) barrier layer by the identical seeding and electroless plating conditions. Improvement in seeding by the plasma pre-treatment is discussed based on surface bonding modification.
Guided by the analogy with the Rayleigh-Plesset dynamics of multielectron bubbles in superfluid He-4, we consider the cosmological FLRW evolution equation with additional cubic and sixth powers of ...the inverse of the scale factor of the universe. For the barotropic parameter w=2/3 (coasting universe), along with zero cosmological constant in the absence of viscous terms, by using the Sundman time as evolution parameter, we present parametric solutions for the scale factor of the universe in terms of rational expressions of Weierstrass elliptic functions and their particular cases thereof. For other values of the equation of state parameter w, such as w=-1, but also the same coasting case, we present a more standard discussion in the conformal time variable using solutions obtained by numerical integration.
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