The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine ...aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty‐one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1–4), bridging fibrosis (F0–2 vs F3–4) and liver cirrhosis (F0–3 vs F4) was 0.80 (95% CI: 0.68–0.92), 0.87 (95% CI: 0.82–0.93) and 0.93 (95% CI: 0.89–0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis.
The SARS-CoV-2 virus emerged in December 2019 and has caused a worldwide pandemic due to the lack of any pre-existing immunity. Accurate serology testing is urgently needed to help diagnose ...infection, determine past exposure of populations and assess the response to a future vaccine. The landscape of antibody responses to SARS-CoV-2 is unknown. In this study, we utilized the luciferase immunoprecipitation system to assess the antibody responses to 15 different SARS-CoV-2 antigens in patients with COVID-19. We identified new targets of the immune response to SARS-CoV-2 and show that nucleocapsid, open reading frame (ORF)8 and ORF3b elicit the strongest specific antibody responses. ORF8 and ORF3b antibodies, taken together as a cluster of points, identified 96.5% of COVID-19 samples at early and late time points of disease with 99.5% specificity. Our findings could be used to develop second-generation diagnostic tests to improve serological assays for COVID-19 and are important in understanding pathogenicity.
Purpose: This study set out to quantify the fatigue-related changes in surface electromyographic (sEMG) activities of the perilaryngeal muscles following a vocal loading task. Method: Thirty-six ...young healthy participants (Msubscript age = 22.4 years) with normal voice performed karaoke singing for at least 100 min. Before the singing task, all participants underwent the sEMG measure and completed a Perceived Vocal Fatigue Score (P-VFS) questionnaire. After the singing task, all participants were immediately measured with the P-VFS again. Half of the participants were then measured for their sEMG immediately after their karaoke singing task, and the other half were given 20 min of rest before undertaking the sEMG measure. The P-VFS and the median frequency (MDF) of the sEMG signals collected from the suprahyoid, infrahyoid, and sternocleidomastoid muscles before and after the singing task were compared using a linear mixed-effects model. Results: All participants reported a perceived vocal fatigue after singing, with a significantly increased P-VFS. Compared with the presinging baseline, the MDF of the sEMG signals in perilaryngeal muscles was significantly lower immediately after the singing task. Such a significant difference was also found after 20 min following the singing task. Conclusions: The MDF analysis of the sEMG signals could identify and quantify the performance vocal fatigue contributed by perilaryngeal muscles following a vocal loading task. The findings also showed that such fatigue in perilaryngeal muscles, as far as sEMG activities are concerned, can last for at least 20 min.
Nasopharyngeal carcinoma (NPC) is highly sensitive to both radiotherapy (RT) and chemotherapy. This randomized phase III trial compared concurrent cisplatin-RT (CRT) with RT alone in patients with ...locoregionally advanced NPC.
Patients with Ho's N2 or N3 stage or N1 stage with nodal size > or = 4 cm were randomized to receive cisplatin 40 mg/m(2) weekly up to 8 weeks concurrently with radical RT (CRT) or RT alone. The primary end point was progression-free survival (PFS).
Three hundred fifty eligible patients were randomized. Baseline patient characteristics were comparable in both arms. There were significantly more toxicities, including mucositis, myelosuppression, and weight loss in the CRT arm. There were no treatment-related deaths in the CRT arm, and one patient died during treatment in the RT-alone arm. At a median follow-up of 2.71 years, the 2-year PFS was 76% in the CRT arm and 69% in the RT-alone arm (P =.10) with a hazards ratio of 1.367 (95% confidence interval CI, 0.93 to 2.00). The treatment effect had a significant covariate interaction with tumor stage, and a subgroup analysis demonstrated a highly significant difference in favor of the CRT arm in Ho's stage T3 (P =.0075) with a hazards ratio of 2.328 (95% CI, 1.26 to 4.28). For T3 stage, the time to first distant failure was statistically significantly different in favor of the CRT arm (P =.016).
Concurrent CRT is well tolerated in patients with advanced NPC in endemic areas. Although PFS was not significantly different between the concurrent CRT arm and the RT-alone arm in the overall comparison, PFS was significantly prolonged in patients with advanced tumor and node stages.
Metabolic syndrome is associated with non-alcoholic steatohepatitis and cryptogenic cirrhosis. Whether metabolic syndrome affects the severity of chronic hepatitis B (CHB) is unclear.
We aimed to ...study the relationship between metabolic syndrome and the risk of liver cirrhosis in patients with CHB.
We prospectively recruited patients with CHB from primary care and hospital clinics for liver stiffness measurement (LSM) with transient elastography to diagnose early cirrhosis. Probable cirrhosis was defined as LSM >or=13.4 kPa. We analysed a subgroup of patients with paired LSM and liver biopsies to validate the accuracy of LSM.
1466 patients had reliable LSM and 134 (9%) patients had adequate liver biopsy. 188 (13%) patients had metabolic syndrome. Histological liver cirrhosis was present in 32/134 (24%) patients. Histological liver cirrhosis was more common among patients who had metabolic syndrome (38%) versus those who did not (11%, p<0.001). The specificity of probable cirrhosis on LSM for histological cirrhosis was 94%. Probable cirrhosis was present in 187 (13%) patients. Metabolic syndrome was more prevalent in patients with probable cirrhosis (24%) than those without cirrhosis (11%, p<0.001). After adjustment for anthropometric, biochemical and virological factors, metabolic syndrome remained an independent factor associated with probable cirrhosis (odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.6). The odds ratios of probable cirrhosis were 1.4 (95% CI, 0.9 to 2.3), 2.6 (95% CI, 1.7 to 4.3), 4.1 (95% CI, 2.4 to 7.1), 4.0 (95% CI, 1.9 to 8.4) and 5.5 (95% CI, 1.8 to 16.7) in patients with one, two, three, four and five components of metabolic syndrome, respectively.
Metabolic syndrome is an independent risk factor of liver cirrhosis in CHB.
Triaging and prioritising patients for RT-PCR test had been essential in the management of COVID-19 in resource-scarce countries. In this study, we applied machine learning (ML) to the task of ...detection of SARS-CoV-2 infection using basic laboratory markers. We performed the statistical analysis and trained an ML model on a retrospective cohort of 5148 patients from 24 hospitals in Hong Kong to classify COVID-19 and other aetiology of pneumonia. We validated the model on three temporal validation sets from different waves of infection in Hong Kong. For predicting SARS-CoV-2 infection, the ML model achieved high AUCs and specificity but low sensitivity in all three validation sets (AUC: 89.9-95.8%; Sensitivity: 55.5-77.8%; Specificity: 91.5-98.3%). When used in adjunction with radiologist interpretations of chest radiographs, the sensitivity was over 90% while keeping moderate specificity. Our study showed that machine learning model based on readily available laboratory markers could achieve high accuracy in predicting SARS-CoV-2 infection.
Radio observations of stars trace the plasma conditions and magnetic field properties of stellar magnetospheres and coronae. Depending on the plasma conditions at the emitter site, radio emission in ...the metre- and decimetre-wave bands is generated via different mechanisms, such as gyrosynchrotron, electron cyclotron maser instability, and plasma radiation processes. The ongoing LOFAR Two-metre Sky Survey (LoTSS) and VLA Sky Survey (VLASS) are currently the most sensitive wide-field radio sky surveys ever conducted. Because these surveys are untargeted, they provide an opportunity to study the statistical properties of the radio-emitting stellar population in an unbiased manner. Here we perform an untargeted search for stellar radio sources down to sub-mJy level using these radio surveys. We find that the population of radio-emitting stellar systems is mainly composed of two distinct categories: chromospherically active stellar (CAS) systems and M dwarfs. We also seek to identify signatures of a gradual transition within the M-dwarf population, from chromospheric or coronal acceleration close to the stellar surface similar to that observed on the Sun to magnetospheric acceleration occurring far from the stellar surface similar to that observed on Jupiter. We determine that radio detectability evolves with spectral type, and we identify a transition in radio detectability around spectral type M4, where stars become fully convective. Furthermore, we compare the radio detectability versus spectra type with X-ray and optical flare (observed by TESS) incidence statistics. We find that the radio efficiency of X-ray and optical flares, which is the fraction of flare energy channelled into radio-emitting charges, increases with spectral type. These results motivate us to conjecture that the emergence of large-scale magnetic fields in CAS systems and later M dwarfs leads to an increase in radio efficiency.
•We developed an integrative model of construction workers’ safety behavior.•We surveyed 215 workers of New Zealand construction industry.•Eight competing models were tested using structural equation ...modeling (SEM).•An understanding of how safety climate factors affect safety behavior is improved.
This study develops and tests an integrative model of construction workers’ safety behavior with an attempt to better understand the mechanisms by which key safety climate factors (i.e., management safety commitment, social support, and production pressure) and individual factors (i.e., safety knowledge and safety motivation) influence workers’ safety behavior. Data were collected from 215 construction workers in New Zealand using a questionnaire. Eight competing models were tested using structural equation modeling (SEM). The results showed that management safety commitment was significantly related to social support and production pressure. Production pressure was identified as a critical factor that has direct and significant effects on safety motivation, safety knowledge, safety participation and safety compliance. Furthermore, social support was found to have the same paths to influence safety behavior as production pressure, except that the effect on safety participation was insignificant. Safety knowledge and safety motivation were significantly and positively related to safety participation. The integrative model suggests a combination of “a safe organization”, “safe groups” and “safe workers” strategies to reduce unsafe behavior on sites.
Abstract Objectives The present study aims to investigate the synergistic effects of cognitive remediation training (CRT) on Integrated Supported Employment (ISE). ISE blends individual placement ...support service with work-related social skills training for Chinese people suffering from schizophrenia or schizoaffective disorder. Method Ninety participants with schizophrenia or schizoaffective disorders were recruited from two psychiatric outpatient services in Hong Kong. They were randomly assigned into the ISE + CRT ( n = 45) and ISE ( n = 45) conditions. Blinded assessments on vocational, clinical, psychological, and neurocognitive outcomes were conducted by independent assessors. The two groups were followed up at 7 and 11 months. Results Both groups yielded similar improvements across several outcome domains assessed immediately after the interventions and at 7 and 11 month follow-ups, but no significant group differences were found. Significant positive trends over time in vocational, clinical and cognitive outcomes consistently favored the ISE + CRT condition. Conclusion While both the ISE + CRT and ISE groups demonstrated improvement in vocational, clinical, psychological, and neurocognitive outcomes, there was no evidence to show that cognitive remediation facilitated further improvement in these domains beyond gains associated with ISE alone. Further investigation is needed to fully exploit the synergistic potential of ISE combined with CRT, and to better understand which individuals experience a maximal benefit from the specific rehabilitation program components.
Background: To evaluate the efficacy and toxicity of combination gemcitabine plus cisplatin (GC) chemotherapy in metastatic or recurrent nasopharyngeal carcinoma (NPC). Patients and methods: ...Forty-four patients of Chinese ethnicity with metastatic or recurrent NPC received ambulatory GC chemotherapy every 28 days (gemcitabine 1000 mg/m2 days 1, 8 and 15; cisplatin 50 mg/m2 days 1 and 8). There were 40 male and four female patients with a mean age of 47.4 years. More than half (54.5%) of the patients had received either prior platinum-based chemotherapy and/or radiotherapy to target lesions. Results: There were nine complete responses and 23 partial responses in the 44 patients, achieving an overall response rate of 73% (78% for the 41 assessable patients). The mean duration of response was 5.3 months. Improved subjective symptom-control scores were found in 78% of patients with pre-existing symptoms, while 64% of patients experienced improved general well-being scores. Toxicity was mainly hematological: grade III/IV anemia, granulocytopenia and thrombocytopenia were found in 11, 37 and 16% of cycles, respectively. With a median follow-up of 17.2 months, 62% survived 1 year while 36% were alive and progression free. Conclusions: Gemcitabine plus cisplatin chemotherapy offers a satisfactory overall response rate, subjective patient improvement and safety profile for metastatic and recurrent NPC.
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