Purpose
To demonstrate the efficacy and safety of ranibizumab 0.5 mg pro re nata (PRN) versus laser photocoagulation for the treatment of Chinese patients with visual impairment due to diabetic ...macular edema (DME).
Methods
REFINE was a phase III, 12-month, double-masked, multicenter, laser-controlled study in patients (aged ≥ 18 years) with DME. Patients were randomized 4:1 to receive either ranibizumab 0.5 mg or laser dosing regimen. Efficacy was evaluated as mean average change in best-corrected visual acuity (BCVA) from Months 1 to 12 versus baseline (primary endpoint), anatomical outcomes, treatment exposure, and safety were also assessed.
Results
Ranibizumab was statistically superior (
p
< 0.001) to laser treatment, with a mean average BCVA gain of 6.8 letters (ranibizumab) over 12 months versus 1.1 letters (laser). At Month 12, mean BCVA gain was 7.8 letters (ranibizumab) and 2.5 letters (laser) from baseline. Patients in the ranibizumab arm received a mean number of 7.9 intravitreal injections, whereas those in the laser arm received a mean of 2.1 treatments. There were no new safety signals.
Conclusion
Ranibizumab 0.5 mg PRN demonstrated a statistically significant and clinically meaningful treatment effect versus laser and was well tolerated in Chinese patients with visual impairment due to DME over 12 months.
Iodine is an essential nutrient for the synthesis of thyroid hormones that are critical for brain development. Iodine deficiencies were prevalent in China until the introduction of universal salt ...iodization (USI) in 1995. USI has been considered as the world’s best achievements. This study aims to assess children’s iodine nutrition and goiter status in Zhejiang Province in order to provide reasonable suggestions to the government for policy-making under the USI period. A cross-sectional survey in Zhejiang Province was conducted to children aged 8–10 years by stage cluster random sampling method. Spot urine samples were collected and analyzed. Thyroid ultrasonography examination was performed by special trained technicians using a 7.5-MHz transducer. Fasting venous blood samples were collected and analyzed for thyroid functional status. The median urinary iodine concentration was found to be 173.3 μg/L. The percentage of urine samples with iodine concentration <100 μg/L, 100–300 μg/L, and >300 μg/L was 15.5, 42.0, and 13.3 %, respectively. Goiter prevalence rate with iodine concentration <100 μg/L, 100–300 μg/L, and >300 μg/L was 6.8, 10.0, and 14.9 %, respectively, with no significant difference. Children with goiter have lower serum FT3 and T3 concentrations compared to those without goiter (
p
< 0.05).
Conclusions
: The median urinary iodine concentration of children aged 8–10 years falls in optimal iodine status as recommended by WHO/UNICEF/ICCIDD. Maintaining USI at an appropriate level is an important part of preventing iodine deficiency disorders and should always be based on routine monitoring urinary iodine concentration by the province.
Objectives To evaluate the difference of iodine nutritional status between rural and urban residents under the universal salt iodisation policy. Setting A multistage cluster sampling technique was ...employed in the present cross-sectional study. In total, 3300 rural and 3300 urban households were selected where the investigation was conducted. Participants A total of 8553 rural and 8909 urban residents participated in this provincial survey. Primary and secondary outcome measures Spot urine samples were collected and the iodine concentration in urine was determined by the modified acid-digestion method. Results The median urinary iodine concentration of rural residents was 170.1 μg/L, which was higher than that of urban residents with 153.5 μg/L. For school-aged children, middle-aged people and older people, the median urinary iodine concentration of rural residents was 191.2, 160.2 and 154.0 μg/L, respectively, which was higher than that of urban residents with 166.2, 153.8 and 129.5 μg/L, respectively. Risk factors for urinary concentration of rural residents were age (OR=0.99), terrain (OR=0.83), usual intake of pickled products (OR=1.45) and non-iodised salt intake (OR=0.39), while those for urban residents were age (OR=0.99), terrain (OR=0.83), usual intake of aquatic products (OR=1.24) and non-iodised salt intake (OR=0.27) compared with iodised table salt intake. Conclusions The median urinary iodine concentration of rural residents was higher than that of urban residents although they were both falls in optimal iodine status as recommended by WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders. Iodised salt intake is the major factor which influences the iodine nutritional status mostly for rural and urban residents. The ongoing monitoring of population iodine status remains crucially important.
To explore the association of body mass index (BMI) with the risk of developing acute kidney injury after cardiac surgery (CS-AKI) and for AKI requiring renal replacement therapy (AKI-RRT) after ...cardiac surgery.
Clinical data of 8,455 patients undergoing cardiac surgery, including demographic preoperative, intraoperative, and postoperative data were collected. Patients were divided into underweight (BMI <18.5), normal weight (18.5≤ BMI <24), overweight (24≤ BMI <28), and obese (BMI ≥28) groups. The influence of BMI on CS-AKI incidence, duration of hospital, and intensive care unit (ICU) stays as well as AKI-related mortality was analyzed.
The mean age of the patients was 53.2 ± 13.9 years. The overall CS-AKI incidence was 33.8% (
= 2,855) with a hospital mortality of 5.4% (
= 154). The incidence of AKI-RRT was 5.2% (
= 148) with a mortality of 54.1% (
= 80). For underweight, normal weight, overweight, and obese cardiac surgery patients, the AKI incidences were 29.9, 31.0, 36.5, and 46.0%, respectively (
< 0.001). The hospital mortality of AKI patients in the 4 groups was 9.5, 6.0, 3.8, and 4.3%, whereas the hospital mortality of AKI-RRT patients in the 4 groups was 69.2, 60.8, 36.4, and 58.8%, both significantly different (
< 0.05). Hospital and ICU stay durations were not significantly different in the 4 BMI groups.
The hospital prognosis of AKI and AKI-RRT patients after cardiac surgery was best when their BMI was in the 24-28 range.
BackgroundTo investigate the common etiologies, characteristics, and management of ureteric injury. MethodsA nationwide study was performed in 38 medical centers from Mar 2017 to Mar 2019. The data ...of patients with ureteric injury were retrospectively collected. ResultsOverall, 294 patients were included in this study. Ten cases (3.4%) were due to abdominal injuries, and 284 cases (96.6%) were due to iatrogenic injuries, including 48.6% from urological procedures, 41.9% from gynecological procedures, 6.3% from general surgery, and 3.2% from other treatments. Most urological injuries (79.7%) were caused by endourological procedures. Injury occurred in the distal ureter in 178 cases (60.5%), the mid-ureter in 31 cases (10.5%), and the proximal ureter in 85 cases (28.9%). Only 51 patients (17.3%) were diagnosed immediately during primary surgery. Immediate ureter reconstruction was performed in 30 patients (58.8%), while delayed urinary diversion was performed in 148 patients (60.9%) in the delayed diagnosis group. The side and the location of the injury were different between the urological and nonurological injury groups (P<0.001). Ureteric injuries were diagnosed timelier in the urological group than in the nonurological group (P=0.037). ConclusionsIatrogenic injury was the most common cause of ureteric injury. The majority of iatrogenic injuries were caused by urological procedures and were primarily due to aggressive endourological techniques. Depending on the condition of the patient, the time of diagnosis, and the location and length of the ureteric injury, different management strategies should be applied.
Equal channel angular pressing (ECAP) is applied to investigate the microstructural evolution and mechanical properties of Cu-8 wt pct Ag alloy subjected to one to four passes via four different ...routes (A, B
A
, B
C
, and C). It is demonstrated that better mechanical properties, a higher fraction of high-angle boundaries, and a smaller grain size can be obtained most rapidly with route A, whereas the specimen processed by route B
C
contains relatively inhomogeneous microstructure and has poor mechanical properties. The ultimate tensile stress (UTS) of the Cu-Ag alloy processed by route B
C
saturates after four passes; in contrast, the UTS of the Cu-Ag alloy processed by route A increases continuously in relation to the number of ECAP passes. Based on the experimental results, the strengthening mechanisms of the Cu-8 wt pct Ag alloy processed by different routes as well as the efficiency of different routes in refining the binary alloy are discussed.
The objectives of this study were to determine species distribution and in vitro antifungal susceptibility of Candida isolates identified in the multicentre China-SCAN study of invasive Candida ...infection (ICI) in intensive care units (ICUs) across China.
Candida isolates from patients in the China-SCAN study with documented ICI were evaluated by a central laboratory. Species were identified using chromogenic culture media or the API 20C AUX kit. Susceptibility to fluconazole, voriconazole, itraconazole, caspofungin and amphotericin B was determined using the CLSI broth microdilution method (M27-A3) and updated clinical breakpoints or epidemiological cut-off values.
A total of 389 isolates from 244 patients were analysed. Species identified most frequently were Candida albicans (40.1%), Candida parapsilosis (21.3%), Candida tropicalis (17.2%) and Candida glabrata (12.9%). Rarer species such as Lodderomyces elongisporus and Candida ernobii were also identified. Fluconazole susceptibility was evident in 85.9% (134/156) of C. albicans, 62.7% (42/67) of C. tropicalis and 48.2% (40/83) of C. parapsilosis isolates. Susceptibility to voriconazole was ≥ 90% among all species. All isolates were susceptible to amphotericin B and caspofungin except C. glabrata 86.0% (43/50) susceptible to caspofungin. Cross-resistance between fluconazole and voriconazole was observed for C. parapsilosis and C. glabrata.
Although C. albicans was the predominant single species, non-albicans species constituted >50% of isolates. Fluconazole susceptibility was lower in most non-albicans species, indicating that fluconazole resistance should be closely monitored. Susceptibility to voriconazole, amphotericin B and caspofungin is encouraging. Differences between these data and those from other regions emphasize the importance of assessing regional variations.
Thoracic spinal stenosis is a relatively common disorder causing paraplegia in the population of China. Until nowadays, the clinical management of thoracic spinal stenosis is still demanding and ...challenging with lots of questions remaining to be answered. A clinical guideline for the treatment of symptomatic thoracic spinal stenosis has been created by reaching the consensus of Chinese specialists using the best available evidence as a tool to aid practitioners involved with the care of this disease. In this guideline, many fundamental questions about thoracic spinal stenosis which were controversial have been explained clearly, including the definition of thoracic spinal stenosis, the standard procedure for diagnosing symptomatic thoracic spinal stenosis, indications for surgery, and so on. According to the consensus on the definition of thoracic spinal stenosis, the soft herniation of thoracic discs has been excluded from the pathological factors causing thoracic spinal stenosis. The procedure for diagnosing thoracic spinal stenosis has been quite mature, while the principles for selecting operative procedures remain to be improved. This guideline will be updated on a timely schedule and adhering to its recommendations should not be mandatory because it does not have the force of law.
Multi-modal 3D object detection has received growing attention as the information from different sensors like LiDAR and cameras are complementary. Most fusion methods for 3D detection rely on an ...accurate alignment and calibration between 3D point clouds and RGB images. However, such an assumption is not reliable in a real-world self-driving system, as the alignment between different modalities is easily affected by asynchronous sensors and disturbed sensor placement. We propose a novel {F}usion network by {B}ox {M}atching (FBMNet) for multi-modal 3D detection, which provides an alternative way for cross-modal feature alignment by learning the correspondence at the bounding box level to free up the dependency of calibration during inference. With the learned assignments between 3D and 2D object proposals, the fusion for detection can be effectively performed by combing their ROI features. Extensive experiments on the nuScenes dataset demonstrate that our method is much more stable in dealing with challenging cases such as asynchronous sensors, misaligned sensor placement, and degenerated camera images than existing fusion methods. We hope that our FBMNet could provide an available solution to dealing with these challenging cases for safety in real autonomous driving scenarios. Codes will be publicly available at https://github.com/happinesslz/FBMNet.
We present the design, implementation and engineering experience in building and deploying MegaScale, a production system for training large language models (LLMs) at the scale of more than 10,000 ...GPUs. Training LLMs at this scale brings unprecedented challenges to training efficiency and stability. We take a full-stack approach that co-designs the algorithmic and system components across model block and optimizer design, computation and communication overlapping, operator optimization, data pipeline, and network performance tuning. Maintaining high efficiency throughout the training process (i.e., stability) is an important consideration in production given the long extent of LLM training jobs. Many hard stability issues only emerge at large scale, and in-depth observability is the key to address them. We develop a set of diagnosis tools to monitor system components and events deep in the stack, identify root causes, and derive effective techniques to achieve fault tolerance and mitigate stragglers. MegaScale achieves 55.2% Model FLOPs Utilization (MFU) when training a 175B LLM model on 12,288 GPUs, improving the MFU by 1.34x compared to Megatron-LM. We share our operational experience in identifying and fixing failures and stragglers. We hope by articulating the problems and sharing our experience from a systems perspective, this work can inspire future LLM systems research.
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