A deep learning-based algorithm for pulmonary tuberculosis detection in chest radiography.

In tuberculosis (TB), chest radiography (CXR) patterns are highly variable, mimicking pneumonia and many other diseases. This study aims to evaluate the efficacy of Google teachable machine, a deep neural network-based image classification tool, to develop algorithm for predicting TB probability of CXRs. The training dataset included 348 TB CXRs and 3806 normal CXRs for training TB detection. We also collected 1150 abnormal CXRs and 627 normal CXRs for training abnormality detection. For external validation, we collected 250 CXRs from our hospital. We also compared the accuracy of the algorithm to five pulmonologists and radiological reports. In external validation, the AI algorithm showed areas under the curve (AUC) of 0.951 and 0.975 in validation dataset 1 and 2. The accuracy of the pulmonologists on validation dataset 2 showed AUC range of 0.936-0.995. When abnormal CXRs other than TB were added, AUC decreased in both human readers (0.843-0.888) and AI algorithm (0.828). When combine human readers with AI algorithm, the AUC further increased to 0.862-0.885. The TB CXR AI algorithm developed by using Google teachable machine in this study is effective, with the accuracy close to experienced clinical physicians, and may be helpful for detecting tuberculosis by CXR.

Reversal of Pulmonary Fibrosis: Human Umbilical Mesenchymal Stem Cells from Wharton's Jelly versus Human-Adipose-Derived Mesenchymal Stem Cells.

Pulmonary fibrosis (PF) is a progressive, non-reversible illness with various etiologies. Currently, effective treatments for fibrotic lungs are still lacking. Here, we compared the effectiveness of transplantation of human mesenchymal stem cells from umbilical cord Wharton's jelly (HUMSCs) versus those from adipose tissue (ADMSCs) in reversing pulmonary fibrosis in rats. Bleomycin 5 mg was intratracheally injected to establish a severe, stable, single left lung animal model with PF. On Day 21 post-BLM administration, one single transplantation of 2.5 × 107 HUMSCs or ADMSCs was performed. Lung function examination of Injury and Injury+ADMSCs rats displayed significantly decreased blood oxygen saturation and increased respiratory rates, while Injury+HUMSCs rats showed statistical amelioration in blood oxygen saturation and significant alleviation in respiratory rates. Reduced cell number in the bronchoalveolar lavage and lower myofibroblast activation appeared in the rats transplanted with either ADMSCs or HUMSCS than that in the Injury group. However, ADMSC transplantation stimulated more adipogenesis. Furthermore, matrix-metallopeptidase-9 over-expression for collagen degradation, and the elevation of Toll-like receptor-4 expression for alveolar regeneration were observed only in the Injury+HUMSCs. In comparison with the transplantation of ADMSCs, transplantation of HUMSCs exhibited a much more effective therapeutic effect on PF, with significantly better results in alveolar volume and lung function.

Efficacy of HEPA Air Cleaner on Improving Indoor Particulate Matter 2.5 Concentration.

High-efficiency particulate air (HEPA) filters is a potential tool used to remove fine particles and improve indoor air quality. This study aims to analyze the real-world efficacy of portable HEPA air cleaners in a household environment. Laser light dispersion PM2.5 sensors are used to continuously monitor the indoor and outdoor PM2.5 level before and after HEPA air cleaner filtration. Overall, HEPA air cleaners significantly reduce the indoor PM2.5 level (33.5 ± 10.3 vs. 17.2 ± 10.7 µg/m3, mean difference (MD) = -16.3 µg/m3, p < 0.001) and indoor/outdoor PM2.5% (76.3 ± 16.8 vs. 38.6 ± 19.8%, MD = -37.7%, p < 0.001). The efficacy to reduce PM2.5 is strongest in three machines with medium-flow setting group (indoor PM2.5 MD: -26.5 µg/m3, indoor/outdoor PM2.5 percentage MD: -56.4%). Multiple linear regression demonstrates that outdoor PM2.5, machine number, airflow speed, and window ventilation are significant factors associated with indoor PM2.5 concentrations (R = 0.879) and percentage of the indoor/outdoor PM2.5 ratio (R = 0.808). HEPA air cleaners can effectively improve indoor PM2.5 air pollution. Adequate air cleaner machine numbers, appropriate airflow, and window ventilation limitations are important to achieve the best efficacy of the HEPA air cleaner.

Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan.

Patients in critical care medicine are ageing. There is limited literature evaluating long-term outcomes and prognostic factors for the growing number of elderly patients with acute respiratory failure (ARF) receiving invasive mechanical ventilation (IMV). Data on elderly patients (≧ 65 years old) with ARF receiving intubation and IMV during 2003-2012 were retrospectively collected from the national health database in Taiwan. We included 7,095 elderly patients. The 28-day mortality was 33%, the 60-day mortality was 47.5%, and the 1-year mortality was 70.4%. Patients were divided into groups: young-old (65-74 years), middle-old (75-84 years), and oldest-old (≧ 85 years). Patients in the oldest-old and middle-old groups had higher 1-year mortality than the young-old group (p < 0.001). The multivariate logistic regression revealed 9 significant factors associated with 1-year mortality, and these factors were used to develop a prognostic nomogram. The present study showed that the long-term prognosis of elderly patients with ARF and IMV is very poor. This nomogram can help physicians estimate the 1-year mortality of elderly patients in the early stage of ARF and assist in clinical decision making.

Synthesis of Multiporous Carbons from the Water Caltrop Shell for High-Performance Supercapacitors.

In this study, an economic, sustainable, and green synthesis method of multiporous carbons from agricultural waste, water caltrop shell (denoted as WCS), was presented. To prepare the WCS biochar, the dried WCS was first carbonized to a microporous carbon with a surface area of around 230 m2 g-1 by using a top-lit-updraft method. Then, the microporous WCS biochar was directly mixed with an appropriate amount of ZnO nanoparticles and KOH as activating agents via a solvent-free physical blending route. After further activation at 900 °C, the resulted carbons possess both micropores and mesopores that were named as WCS multiporous carbons. The carbon yield of the prepared WCS multiporous carbons with high surface area in the range of 1175-1537 m2 g-1 is up to 50%. Furthermore, the micropore/mesopore surface area ratio can be simply tuned by controlling the ZnO content. For supercapacitor applications, the as-prepared WCS multiporous carbon electrodes showed high specific capacitance (128 F g-1 at 5 mV s-1) with a good retention rate at 500 mV s-1 scan rate (>60% compared to the capacitance at 5 mV s-1) and low Ohmic resistance in a 1.0 M LiClO4/PC electrolyte. In addition to the ZnO nanoparticles, CaCO3 nanoparticles with low environmental impact were also used to prepare the WCS multiporous carbons. The assembled supercapacitors also demonstrate high specific capacitance (102 F g-1 at 5 mV s-1) and good retention rate (∼70%).

Association of iron deficiency anemia with tuberculosis in Taiwan: A nationwide population-based study.

BACKGROUND: Iron deficiency is associated with decreased cellular immunity, which may predispose patients with iron deficiency anemia (IDA) to increased risk of developing tuberculosis (TB). This study investigated the relationship between newly diagnosed IDA and TB infection in Taiwan. METHODS: The study included data on 21,946 patients with incident IDA and 87,555 non-IDA controls from a national database covering the period 2000-2012. IDA and non-IDA subjects were matched 1:4 on age, gender, and index year. The follow-up period was defined as the time from the initial IDA diagnosis to the date of developing TB or 31 December 2013. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, with the control group as the reference. RESULTS: The adjusted hazard ratio of TB for the IDA group was 1.99 (95% confidence interval, 1.77-2.25) compared with the control group. The subgroup analysis showed that for both genders, all age groups, and patients with diabetes mellitus, hyperlipidemia, hypertension, cancer, chronic obstructive pulmonary disease, and hepatitis B virus infection, the IDA group had significantly higher TB incidence. The association was significantly stronger within the 5 years after new IDA diagnosis for both genders and all age groups. CONCLUSIONS: Higher TB incidence was discovered in the IDA group, especially for patients with comorbidities.

Trends in the incidence of thymoma, thymic carcinoma, and thymic neuroendocrine tumor in the United States.

This study aimed to identify the trends in the incidence of thymic cancer, i.e., thymoma, thymic carcinoma, and thymic neuroendocrine tumor, in the United States. Data from the United States Cancer Statistics (USCS) database (2001-2015) and those from the Surveillance, Epidemiology, and End Results (SEER) database (SEER 9 [1973-2015], SEER 13 [1992-2015], and SEER 18 [2000-2015]) were used in this study. All incidences were per 100,000 population at risk. The trends in incidence were described as annual percent change (APC) using the Joinpoint regression program. Data from the USCS (2001-2015) database showed an increase in thymic cancer diagnosis with an APC of 4.89% from 2001 to 2006, which is mainly attributed to the significant increase in the incidence of thymoma and thymic carcinoma particularly in women. The incidence of thymic cancer did not increase from 2006 to 2015, which may be attributed to the increase in the diagnosis of thymic carcinoma from 2004 to 2015, with a concomitant decrease in thymoma from 2008 to 2015. Before declining, the age-specific incidence of thymic cancer peaked at ages 70-74 years, with a peak incidence at 1.06 per 100,000 population, and decreased in older age groups. The incidence of thymic cancer was higher in men than in women. Asian/Pacific Islanders had the highest incidence of thymoma, followed by black and then white people. The incidence of thymic carcinoma increased from 2004 to 2015, with a concomitant decrease in thymoma from 2008 to 2015. Asian/Pacific Islanders had the highest incidence of thymoma than other races.

The factors influence compatibility of pulse-pulse intervals with R-R intervals.

Cardiac autonomic dysfunction assessed by power spectral analysis of electrocardigographic (ECG) R-R intervals (RRI) is a useful method in clinical research. The compatibility of pulse-pulse intervals (PPI) acquired by photoplethysmography (PPG) with RRI is equivocal. In this study, we would like to investigate factors influence the compatibility. We recruited 25 young and health subjects divided into two groups: normal subjects (Group1, BMI < 24, n=15) and overweight subjects (Group2, BMI >/= 24, n=10). ECG and PPG were measured for 5 minutes. Used cross-approximate entropy (CAE) and Fast Fourier transform (FFT) to obtained compatibility between RRI and PPI. The CAE value in Group1 were significantly lower than in Group2 (1.71 ± 0.12 vs. 1.83 ± 0.11, P = 0.011). A positive linear relationship between CAE value and risk factors of metabolic syndrome. No significantly difference between LFP/HFP ratio of RRI (LHRRRI) and LFP/HFP ratio of PPI (LHRPPI) in Group1 (1.42 ± 0.19 vs. 1.38 ± 0.17, P = 0.064), LHRRRI significantly higher than LHRPPI in Group2 (2.18 ± 0.37 vs. 1.93 ± 0.30, P = 0.005). It should be careful that using PPI to assess autonomic function in the obese subjects or the patients with metabolic syndrome.

Assessing spontaneous baroreflex in aged with pulse-pulse intervals and pulse amplitudes.

Cardiac autonomic dysfunction is a serious condition in the elder subjects. Baroreflex sensitivity (BRS) by measuring pulse intervals and blood pressure has been proven as an effective indicator. This paper proposes a novel index by substitution blood pressure with amplitudes of pressure pulse. We recruited 61 subjects divided into two groups: healthy young subjects (Group1, n=33), healthy elders (Group2, n=28). The wrist pulse pressures of each subject were measured for 5 minutes to obtain pulse-pulse intervals and amplitudes then applied within the spontaneous sequence technique to calculate the pulse-pulse interval and amplitude ratio (PAR). We verified the reproducibility of PAR and agreement with spectral analysis of heart rate variability in group1 participants. We discovered significant differences between different groups in PAR (Group1 vs. Group2: 0.90 ± 0.42 vs. 0.62 ± 0.27, P=0.010). In contrast with measurements of BRS, this study proposes a simple approach without the necessity of blood pressure calibration or professional expertise to conduct measurements, thereby providing a convenient method for assessing autonomic function at home.

Projected fringe profilometry using a liquid-crystal spatial light modulator to extend the depth measuring range.

An approach using a liquid-crystal spatial light modulator (LC-SLM) to enlarge the depth measuring range of the projected fringe profilometry is presented. This approach is especially applicable to detect dynamic objects with micro-scale sizes. Compared with a typical 2D image system, the LC-SLM provides a better performance for a 3D shape sensing system. The main advantages include (1) a much higher allowance to increase in the depth measuring range, (2) easiness to compensate perspective distortion and geometric distortion, (3) very high accuracy (in the micron-range) and (4) only one phase measurement needed for operation.