During the spring of 2013, a novel avian-origin influenza A (H7N9) virus emerged and spread among humans in China. Data were lacking on the clinical characteristics of the infections caused by this ...virus.
Using medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin influenza A (H7N9) infection through May 10, 2013.
Of the 111 patients we studied, 76.6% were admitted to an intensive care unit (ICU), and 27.0% died. The median age was 61 years, and 42.3% were 65 years of age or older; 31.5% were female. A total of 61.3% of the patients had at least one underlying medical condition. Fever and cough were the most common presenting symptoms. On admission, 108 patients (97.3%) had findings consistent with pneumonia. Bilateral ground-glass opacities and consolidation were the typical radiologic findings. Lymphocytopenia was observed in 88.3% of patients, and thrombocytopenia in 73.0%. Treatment with antiviral drugs was initiated in 108 patients (97.3%) at a median of 7 days after the onset of illness. The median times from the onset of illness and from the initiation of antiviral therapy to a negative viral test result on real-time reverse-transcriptase-polymerase-chain-reaction assay were 11 days (interquartile range, 9 to 16) and 6 days (interquartile range, 4 to 7), respectively. Multivariate analysis revealed that the presence of a coexisting medical condition was the only independent risk factor for the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95% confidence interval, 1.21 to 9.70; P=0.02).
During the evaluation period, the novel H7N9 virus caused severe illness, including pneumonia and ARDS, with high rates of ICU admission and death. (Funded by the National Natural Science Foundation of China and others.).
Lilium is a large genus that includes approximately 110 species distributed throughout cold and temperate regions of the Northern Hemisphere. The species-level phylogeny of Lilium remains unclear; ...previous studies have found universal markers but insufficient phylogenetic signals. In this study, we present the use of complete chloroplast genomes to explore the phylogeny of this genus. We sequenced nine Lilium chloroplast genomes and retrieved seven published chloroplast genomes for comparative and phylogenetic analyses. The genomes ranged from 151,655 bp to 153,235 bp in length and had a typical quadripartite structure with a conserved genome arrangement and moderate divergence. A comparison of sixteen Lilium chloroplast genomes revealed ten mutation hotspots. Single nucleotide polymorphisms (SNPs) for any two Lilium chloroplast genomes ranged from 8 to 1,178 and provided robust data for phylogeny. Except for some of the shortest internodes, phylogenetic relationships of the Lilium species inferred from the chloroplast genome obtained high support, indicating that chloroplast genome data will be useful to help resolve the deeper branches of phylogeny.
Background
Computed tomography (CT) is essential for pulmonary nodule detection in diagnosing lung cancer. As deep learning algorithms have recently been regarded as a promising technique in medical ...fields, we attempt to integrate a well‐trained deep learning algorithm to detect and classify pulmonary nodules derived from clinical CT images.
Materials and Methods
Open‐source data sets and multicenter data sets have been used in this study. A three‐dimensional convolutional neural network (CNN) was designed to detect pulmonary nodules and classify them into malignant or benign diseases based on pathologically and laboratory proven results.
Results
The sensitivity and specificity of this well‐trained model were found to be 84.4% (95% confidence interval CI, 80.5%–88.3%) and 83.0% (95% CI, 79.5%–86.5%), respectively. Subgroup analysis of smaller nodules (<10 mm) have demonstrated remarkable sensitivity and specificity, similar to that of larger nodules (10–30 mm). Additional model validation was implemented by comparing manual assessments done by different ranks of doctors with those performed by three‐dimensional CNN. The results show that the performance of the CNN model was superior to manual assessment.
Conclusion
Under the companion diagnostics, the three‐dimensional CNN with a deep learning algorithm may assist radiologists in the future by providing accurate and timely information for diagnosing pulmonary nodules in regular clinical practices.
Implications for Practice
The three‐dimensional convolutional neural network described in this article demonstrated both high sensitivity and high specificity in classifying pulmonary nodules regardless of diameters as well as superiority compared with manual assessment. Although it still warrants further improvement and validation in larger screening cohorts, its clinical application could definitely facilitate and assist doctors in clinical practice.
摘要
背景。在肺癌的诊断中，计算机断层扫描 (CT) 对于肺结节的检测必不可少。近几年，随着医学领域逐渐认识到深度学习算法这种技术的价值，本研究试图集成一种训练有素的深度学习算法，对临床 CT 图像中的肺结节进行检测和分类。
材料和方法。本研究使用了开源数据集和多中心数据集。本文设计了一种三维卷积神经网络 (CNN) 来检测肺结节，然后根据病理和实验室证实的结果，判断为恶性或良性结节。
结果。这种训练有素的模型敏感性和特异性分别为 84.4% 95% 可信区间 (CI)， 80.5%‐88.3%和83.0%(95% CI，79.5%‐86.5%)。小结节 (< 10mm) 亚组分析显示的敏感性和特异性显著，与大结节 (10‐30mm) 相似。对比不同级别医生的人工评估结果与三维 CNN 的评估结果，进行了额外的模型验证。结果表明，CNN 模型的表现优于人工评估。
结论。通过伴随诊断可知，加入深度学习算法的三维 CNN 能够提供准确、及时的信息，有助于放射科医生在常规临床实践中的肺结节诊断工作。
实践意义:在对各种直径的肺结节分类中，本文所述的三维卷积神经网络具有较高的敏感性和特异性，与人工评估结果相比具有优越性。虽然仍需在更大的筛选队列中进行进一步改进和验证，但可以肯定的是，临床应用三维卷积神经网络可以促进和协助医生的临床实践工作。
Interest in deep convolutional neural networks (CNN) is growing because of demonstrated accuracy with less manual intervention in computer vision tasks. This article describes efforts to use a pre‐trained CNN model integrating with multi‐centers datasets for detection and classification of pulmonary nodules.
Gas sensors based on metal oxides semiconductor (MOS) have attracted extensive attention from both academic and industry. ZnO, as a typical MOS, exhibits potential applications in toxic gas ...detection, owning to its wide band gap, n‐type transport characteristic and excellent electrical performance. Meanwhile, doping is an effective way to improve the sensing performance of ZnO materials. In this review, the effects of different types of doping on morphology, crystal structure, band gap and depletion layer of ZnO materials are comprehensively discussed. Theoretical analysis on the strategies for enhancing the sensing properties of ZnO is also provided. This review puts forward the reasonable insight for designing efficient n‐type ZnO‐based semiconductor oxide sensing materials.
Gas sensor is still a research hotspot in academia and industry. It is necessary to prepare high‐efficiency sensing material.This review focuses on the influence of doping on the improvement of ZnO sensing performance.
Background
Vessels encapsulating tumor clusters (VETC) pattern is a novel microvascular pattern associated with poor outcomes of hepatocellular carcinoma (HCC). Preoperative estimation of VETC has ...potential to improve treatment decisions.
Purpose
To develop and validate a nomogram based on gadoxetate disodium‐enhanced MRI for estimating VETC in HCC and to evaluate whether the estimations are associated with recurrence after hepatic resection.
Study Type
Retrospective.
Population
A total of 320 patients with HCC and histopathologic VETC pattern assessment from three centers (development cohort:validation cohort = 173:147).
Field Strength/Sequence
A3.0 T/turbo spin‐echo T2‐weighted, spin‐echo echo‐planar diffusion‐weighted, and 3D T1‐weighted gradient‐echo sequences.
Assessment
A set of previously reported VETC‐ and/or prognosis‐correlated qualitative and quantitative imaging features were assessed. Clinical and imaging variables were compared based on histopathologic VETC status to investigate factors indicating VETC pattern. A regression‐based nomogram was then constructed using the significant factors for VETC pattern. The nomogram‐estimated VETC stratification was assessed for its association with recurrence.
Statistical Tests
Fisher exact test, t‐test or Mann–Whitney test, logistic regression analyses, Harrell's concordance index (C‐index), nomogram, Kaplan–Meier curves and log‐rank tests. P value < 0.05 was considered statistically significant.
Results
Pathological VETC pattern presence was identified in 156 patients (development cohort:validation cohort = 83:73). Tumor size, presence of heterogeneous enhancement with septations or with irregular ring‐like structures, and necrosis were significant factors for estimating VETC pattern. The nomogram incorporating these indicators showed good discrimination with a C‐index of 0.870 (development cohort) and 0.862 (validation cohort). Significant differences in recurrence rates between the nomogram‐estimated high‐risk VETC group and low‐risk VETC group were found (2‐year recurrence rates, 50.7% vs. 30.3% and 49.6% vs. 31.8% in the development and validation cohorts, respectively).
Data Conclusion
The nomogram integrating gadoxetate disodium‐enhanced MRI features was associated with VETC pattern preoperatively and with postoperative recurrence in patients with HCC.
Evidence Level
4
Technical Efficacy
Stage 2
The genus Fritillaria comprises approximately 130 perennial herbaceous species. In the Pharmacopoeia of the People's Republic of China, the bulbs of 11 Fritillaria species are used in Chinese herbal ...medicines. However, the traditional methods of morphological classification cannot accurately identify closely related species of Fritillaria. Previous studies have attempted to identify these species with universal molecular markers, but insufficient phylogenetic signal was available. In this study, the complete chloroplast genomes of eight Fritillaria species were compared. The length of the eight Fritillaria chloroplast genomes ranges from 151,009 bp to 152,224 bp. A total of 136 SSR loci were identified, including 124 polymorphic SSR loci. For large repeat sequences, 108 repeat loci and four types of repeats were observed. Ten highly variable regions were identified as potential molecular markers. These SSRs, large repeat sequences and highly variable regions provide important information for the development of genetic markers and DNA fingerprints. Phylogenetic analyses showed that the topological structures of all data sets (except the IR regions) were in complete agreement and well resolved. Overall, this study provides comprehensive chloroplast genomic resources, which will be valuable for future studies of evolution and species identification in Fritillaria.
Clean environment is essential to human health. The world is facing formidable challenges in meeting rising requirement to clean environment. Recently, persistent organic pollutants (POPs), heavy ...metals, etc. pollutants in water and soil are the key factors which make the environment worse. Even trace pollutants can enter human body and do harm to human health. Trace detection and treatment of these pollutants become an eagerly solved problem. Nanomaterials and nanotechnology provide a powerful method for detection and treatment of trace pollutants in the environment. This article reviews the recent progress of detection and treatment of POPs and heavy metal by using nanomaterials and analytical nanotechnology. And the application of nanomaterials and nanotechnology through enhancement of Raman scattering, surface plasmon resonance, fluorescent detection and electrochemical detection were described. We highlight recent advances on the development of novel nanomaterials and nanostructures and processes for treatment of POPs and heavy metals in water and soil. We also discussed the mechanisms of POPs degradation and heavy metal treatment.
Abstract
Sepsis is a common complication of combat injuries and trauma, and is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is also one of ...the significant causes of death and increased health care costs in modern intensive care units. The use of antibiotics, fluid resuscitation, and organ support therapy have limited prognostic impact in patients with sepsis. Although its pathophysiology remains elusive, immunosuppression is now recognized as one of the major causes of septic death. Sepsis-induced immunosuppression is resulted from disruption of immune homeostasis. It is characterized by the release of anti-inflammatory cytokines, abnormal death of immune effector cells, hyperproliferation of immune suppressor cells, and expression of immune checkpoints. By targeting immunosuppression, especially with immune checkpoint inhibitors, preclinical studies have demonstrated the reversal of immunocyte dysfunctions and established host resistance. Here, we comprehensively discuss recent findings on the mechanisms, regulation and biomarkers of sepsis-induced immunosuppression and highlight their implications for developing effective strategies to treat patients with septic shock.
Hybrid manganese halide has attracted much attention in the field of environment friendly ferroelectric and photo‐responsive multifunctional materials. Here, the highly efficient photoluminescent ...inorganic framework MnBr42− is utilized to conceive and synthesize a series of hybrid manganese bromide compounds RQ2MnBr4 by introducing precisely designed quasi‐spherical cations RQ+ (R = H, Me, Et, FEt, Q = quinuclidine). The accurate and effective modification of cations not only achieves the satisfactory ferroelectricity, but also enhances the photoluminescence quantum yield from 38.7% to 83.65%. Moreover, FEtQ2MnBr4 shows a highly efficient X‐ray scintillator performance, including a large range of linear response to X‐ray dose rate from 0.3 to 414.2 μGyair s−1, a high light yield of 34 438 photons per MeV, and a low detection limit of 258 nGyair s−1. This work provides an efficient strategy for the preparation of hybrid manganese halide ferroelectrics with highly efficient light‐emission and X‐ray detection.
By coupling the design for high Curie temperature ferroelectrics and the modulation of photo‐responsive properties through precise modification of spherical cations, an A2MnBr4‐type hybrid ferroelectric with a high photoluminescence quantum yield of 83.65% is obtained. Moreover, the eco‐friendly crystal is promising for high performance X‐ray detectors compared with commercially available scintillators such as bismuth germanium oxide and lutetium yttrium oxyorthosilicate.
There is a discrepancy between west and east on the relationship between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). This study aimed to find out the possible reason ...for this and to clarify the association between NAFLD and CKD by analyzing two population-based datasets from the US and China.
Two health examination datasets from China and the US were used. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m
or and/or abnormal albuminuria and/or overt proteinuria. Binary logistic regression was used to examine the association between NAFLD and CKD.
A total of 60,965 participants were analyzed, including 11,844 from the US and 51,229 from China. The prevalence of NAFLD was 27.12% in the Chinese population and 36.08% in the US population (p < 0.001). The proportions of CKD and late stage CKD (stages 3-5) were higher in the US population than the Chinese one. NAFLD was independently associated with an increased risk of CKD in Chinese population, whereas in the US population, the NAFLD was not an independent risk factor of CKD. In subgroup analyses which excluded late stages CKD (stages 3-5), the risks of mild renal function decline became consistent: NAFLD was associated with early stages of CKD but not the late stages of CKD in both populations.
NAFLD increased the risk of early stages of CKD in both Chinese and the US population. The conflicting results reported by previous studies might result from the different proportion of late stages of CKD.
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