Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical ...significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.
The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.
The median time from admission to LUS examinations was 7 days (interquartile range IQR 3-10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days IQR, 10-20 days, 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio HR: 1.05, 95% confidence intervals CI 1.02 ~ 1.08; P < 0.001; Akaike information criterion AIC = 272; C-index = 0.903) or as a categorical variable (HR 10.76, 95% CI 2.75 ~ 42.05; P = 0.001; AIC = 272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC = 286; C-index = 0.866). An LUS score cut-off > 12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.
The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.
Summary Background Human infections with different avian influenza viruses—eg, H5N1, H9N2, and H7N9—have raised concerns about pandemic potential worldwide. We report the first human infection with a ...novel reassortant avian influenza A H10N8 virus. Methods We obtained and analysed clinical, epidemiological, and virological data from a patient from Nanchang City, China. Tracheal aspirate specimens were tested for influenza virus and other possible pathogens by RT-PCR, viral culture, and sequence analyses. A maximum likelihood phylogenetic tree was constructed. Findings A woman aged 73 years presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A novel reassortant avian influenza A H10N8 virus was isolated from the tracheal aspirate specimen obtained from the patient 7 days after onset of illness. Sequence analyses revealed that all the genes of the virus were of avian origin, with six internal genes from avian influenza A H9N2 viruses. The aminoacid motif GlnSerGly at residues 226–228 of the haemagglutinin protein indicated avian-like receptor binding preference. A mixture of glutamic acid and lysine at residue 627 in PB2 protein—which is associated with mammalian adaptation—was detected in the original tracheal aspirate samples. The virus was sensitive to neuraminidase inhibitors. Sputum and blood cultures and deep sequencing analysis indicated no co-infection with bacteria or fungi. Epidemiological investigation established that the patient had visited a live poultry market 4 days before illness onset. Interpretation The novel reassortant H10N8 virus obtained is distinct from previously reported H10N8 viruses. The virus caused human infection and could have been associated with the death of a patient. Funding Emergency Research Project on human infection with avian influenza H7N9 virus, the National Basic Research Program of China, and the National Mega-projects for Infectious Diseases.
Severe side effects of cancer chemotherapy prompt developing better drug delivery systems. Injectable hydrogels are an effective site-target system. For most of injectable hydrogels, once delivered ...in vivo, some properties including drug release and degradation, which are critical to chemotherapeutic effects and safety, are challenging to monitor. Developing a drug delivery system for effective cancer therapy with in vivo real-time noninvasive trackability is highly desired. Although fluorescence dyes are used for imaging hydrogels, the cytotoxicity limits their applications. By using sericin, a natural photoluminescent protein from silk, we successfully synthesized a hydrazone cross-linked sericin/dextran injectable hydrogel. This hydrogel is biodegradable and biocompatible. It achieves efficient drug loading and controlled release of both macromolecular and small molecular drugs. Notably, sericin’s photoluminescence from this hydrogel is directly and stably correlated with its degradation, enabling long-term in vivo imaging and real-time monitoring of the remaining drug. The hydrogel loaded with Doxorubicin significantly suppresses tumor growth. Together, the work demonstrates the efficacy of this drug delivery system, and the in vivo effectiveness of this sericin-based optical monitoring strategy, providing a potential approach for improving hydrogel design toward optimal efficiency and safety of chemotherapies, which may be widely applicable to other drug delivery systems.
The widely used alkyd resin suffers not only the flammability but also the autoignition of resin waste. Its autoignition should result from the air-drying exothermic effect due to autoxidation and ...conversion of double bond. However, the air-drying exothermic effect is seldom studied. In this study, five soybean oil-based alkyd resins were synthesized. The content of double bond measured by the titration method increased linearly with increasing the molar fraction of maleic anhydride. After air-drying, the infrared spectroscopy absorption peak for the double bond disappeared. Considering that the curing originated from the conversion of chemical bonds, the exothermic effect was theoretically analyzed to be 1163–1455 kJ mol
−1
double bond based on the air-drying mechanisms and the differences among chemical bond energies. According to thermodynamics principles, the air-drying exothermic effect was also derived from the measured heat of combustion. When the content of double bond increased from 2.19 mol kg
−1
resin to 2.56 mol kg
−1
resin, the exothermic effect linearly increased from 1352 kJ mol
−1
double bond or 2.96 kJ g
−1
resin to 2508 kJ mol
−1
double bond or 6.42 kJ g
−1
resin. The steady and unsteady autoignition theoretical analyses implied that due to the air-drying exothermic effect the alkyd resin waste with a certain thickness would catch fire within one working day.
•We conducted the first large scale research for AI-based LUS analysis of COVID-19 and built an effective framework for COVID-19 diagnosis.•We designed a DSA-MIL module to combine the heterogeneous ...LUS images and videos.•We proposed a MA-CLR module to align the feature of LUS data and clinical information for patient severity prediction.•We learned the framework following an SRT pipeline to explore discriminative features gradually from different level.
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The outbreak of COVID-19 around the world has caused great pressure to the health care system, and many efforts have been devoted to artificial intelligence (AI)-based analysis of CT and chest X-ray images to help alleviate the shortage of radiologists and improve the diagnosis efficiency. However, only a few works focus on AI-based lung ultrasound (LUS) analysis in spite of its significant role in COVID-19.
In this work, we aim to propose a novel method for severity assessment of COVID-19 patients from LUS and clinical information. Great challenges exist regarding the heterogeneous data, multi-modality information, and highly nonlinear mapping. To overcome these challenges, we first propose a dual-level supervised multiple instance learning module (DSA-MIL) to effectively combine the zone-level representations into patient-level representations. Then a novel modality alignment contrastive learning module (MA-CLR) is presented to combine representations of the two modalities, LUS and clinical information, by matching the two spaces while keeping the discriminative features. To train the nonlinear mapping, a staged representation transfer (SRT) strategy is introduced to maximumly leverage the semantic and discriminative information from the training data.
We trained the model with LUS data of 233 patients, and validated it with 80 patients. Our method can effectively combine the two modalities and achieve accuracy of 75.0% for 4-level patient severity assessment, and 87.5% for the binary severe/non-severe identification. Besides, our method also provides interpretation of the severity assessment by grading each of the lung zone (with accuracy of 85.28%) and identifying the pathological patterns of each lung zone. Our method has a great potential in real clinical practice for COVID-19 patients, especially for pregnant women and children, in aspects of progress monitoring, prognosis stratification, and patient management.
Abstract Background Despite transarterial chemoembolization (TACE) was recommended as first line therapy for intermediate hepatocellular carcinoma (HCC), the efficacy of transarterial embolization ...(TAE) has not been widely recognized. This work was to determine whether TAE was as effective and safe as TACE for unresectable HCC. Methods We performed a systematic search of electronic databases and other sources for randomized controlled studies (RCTs) comparing TAE with TACE for unresectable HCC. Results were expressed as Hazard Ratio (HR) for survival and Odds Ratio (OR) for dichotomous outcomes using RevMan 5.4.1. Results We included 6 trials with 683 patients. The risk of bias of included RCTs was from unclear to high risk. There were no significant differences between TACE and TAE for progression-free survival (HR 0.83, 95% CI 0.45–1.55; p = 0.57), overall survival (HR 1.10, 95% CI 0.90–1.35; p = 0.36), and objective response rate (OR 1.17, 95% CI 0.80–1.71; p = 0.42) without obvious publication bias. Sensitivity analyses confirmed the robustness of the results. TAE group reported similar or less adverse effects than TACE group in all the studies. Conclusions Our study demonstrated that TAE was as effective as TACE. Since TAE was simpler, cheaper and had less adverse effects than TACE, TAE should be a better choice in most cases where TACE was indicated for unresectable HCC.
The prognosis of liver cancer was inferior among tumors. New medicine treatments are urgently needed. In this study, a novel exopolysaccharide EPS364 was purified from
364, which was isolated from a ...deep-sea cold seep of the South China Sea. Further research showed that EPS364 consisted of mannose, glucosamine, gluconic acid, galactosamine and arabinose with a molar ratio of 5:9:3.4:0.5:0.8. The relative molecular weight of EPS364 was 14.8 kDa. Our results further revealed that EPS364 was a β-linked and phosphorylated polysaccharide. Notably, EPS364 exhibited a significant antitumor activity, with inducing apoptosis, dissipation of the mitochondrial membrane potential (MMP) and generation of reactive oxygen species (ROS) in Huh7.5 liver cancer cells. Proteomic and quantitative real-time PCR analyses indicated that EPS364 inhibited cancer cell growth and adhesion via targeting the FGF19-FGFR4 signaling pathway. These findings suggest that EPS364 is a promising antitumor agent for pharmacotherapy.
miR-148a has been shown to regulate inflammation, immunity and the growth of certain tumors, but its roles in colitis and colorectal tumorigenesis remain largely undetermined. Here we found ...miR-148a-deficient mice to be more susceptible to colitis and colitis-associated tumorigenesis. Both were associated with increased nuclear factor κB (NF-κB) and signal transducer and activator of transcription 3 (STAT3) signaling. Bone marrow- and non-bone marrow-derived miR-148a contributed to colitis and colitis-associated tumorigenesis. miR-148a loss of heterozygosity exacerbated Apc
colon and small intestinal spontaneous tumor development. Restoring miR-148a expression prevented both spontaneous and carcinogen-induced colon tumor development. miR-148a was downregulated in human inflammatory bowel disease (IBD) and colorectal cancer patient tissues. This correlated with a high degree of miR-148a promoter methylation mediated by a complex comprised of P65 and DNA methyltransferase 3 alpha (DNMT3A). miR-148a directly targets several well-accepted upstream regulators of NF-κB and STAT3 signaling, including GP130, IKKα, IKKβ, IL1R1 and TNFR2, which leads to decreased NF-κB and STAT3 activation in macrophages and colon tissues. Our findings reveal that miR-148a is an indirect tumor suppressor that modulates colitis and colitis-associated tumorigenesis by suppressing the expression of signaling by NF-κB and STAT3 and their pro-inflammatory consequences.
Background
Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC), and it should be performed within 72 h of symptoms onset if possible. In many undesired ...situations, LC was performed beyond the golden 72 h. However, the safety and feasibility of prolonged LC (i.e., performed more than 72 h after symptoms onset) are largely unknown, and therefore were investigated in this study.
Methods
We retrospectively enrolled the adult patients who were diagnosed as AC and were treated with LC at the same admission between January 2015 and October 2018 in an emergency department of a tertiary academic medical center in China. The primary outcome was the rate and severity of adverse events, while the secondary outcomes were length of hospital stay and costs.
Results
Among the 104 qualified patients, 70 (67.3%) underwent prolonged LC and 34 (32.7%) underwent early LC (< 72 h of symptom onset). There were no differences between the two groups in mortality rate (none for both), conversion rates (prolonged LC 5.4%, and early LC 8.8%,
P
= 0.68), intraoperative and postoperative complications (prolonged LC 5.7% and early LC 2.9%,
P
≥ 0.99), operation time (prolonged LC 193.5 min and early LC 198.0 min,
P
= 0.81), and operation costs (prolonged LC 8,700 Yuan, and early LC 8,500 Yuan,
P
= 0.86). However, the prolonged LC was associated with longer postoperative hospitalization (7.0 days versus 6.0 days,
P
= 0.03), longer total hospital stay (11.0 days versus 8.0 days,
P
< 0.01), and subsequently higher total costs (40,400 Yuan versus 31,100 Yuan,
P
< 0.01).
Conclusions
Prolonged LC is safe and feasible for patients with AC for having similar rates and severity of adverse events as early LC, but it is also associated with longer hospital stay and subsequently higher total cost.
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