Clinical features and markers to identify pulmonary lesions caused by infection or vasculitis in AAV patients.

OBJECTIVES: Pulmonary lesion is frequently seen in ANCA-associated vasculitis (AAV) patients primarily due to AAV lung involvement or infection, which are hard to differentiate due to their high similarity in clinical manifestations. We aimed to analyze the clinical features of pulmonary lesions consequent to AAV involvement or infection in AAV patients and further identify the markers for differential diagnosis. METHODS: 140 AAV patients who admitted to the Renmin Hospital of Wuhan University from January 2016 to July 2021 were included in this study. According to the nature of lung conditions, these patients were divided into the non-pulmonary lesion group, the lung infection group and the non-pulmonary infection group, and their demographics, clinical symptoms, imaging features, as well as laboratory findings were compared. A receiver operating characteristic (ROC) curve was drawn, and the diagnostic efficacy of single biomarker and composite biomarkers on pulmonary infection was then evaluated. RESULTS: The patients in the lung infection group were significantly older than those in the no lesion group (63.19 ± 14.55 vs 54.82 ± 15.08, p = 0.022). Patients in the lung infection group presented more frequent symptoms and more obvious pulmonary image findings. Compared with patients in the non-pulmonary infection group, patients in the lung infection group showed a higher symptom incidence of fever, chest tightness, cough and expectoration, and hemoptysis (52.94% vs 16.00%, 61.76% vs 40.00%, 72.06% vs 46.00%, 27.94% vs 8.00%, p < 0.05, respectively), and more changes in pulmonary CT scanning images in terms of patched/striped compact opacity, alveolar hemorrhage, bronchiectasis, pleural effusion, as well as mediastinal lymphadenopathy (89.71% vs 52.00%, 11.76% vs 2.00%, 22.06% vs 8.00%, 50.00% vs 20.00%, 48.53% vs 24.00%, p < 0.05, respectively). In addition, patients in the lung infection group had significantly higher levels of serum pro-calcitonin (PCT), C-reactive protein (CRP), amyloid A (SAA), blood neutrophil-to-lymphocyte ratio (NLCR), erythrocyte sedimentation rate (ESR), as well as Birmingham vasculitis activity score (BVAS) than patients in the other two groups (p < 0.05). Among all biomarkers, PCT exhibited the highest diagnostic efficacy (0.928; 95%CI 0.89-0.97) for pulmonary infected AAV patients at a cut-off score of 0.235 ng/ml with 85.3% sensitivity and 84% specificity. Moreover, the composite biomarker of PCT-CRP-NLCR showed more diagnostic efficacy (0.979; 95% CI 0.95-1.00) in distinguishing the infectious and non-infectious lung injuries in AAV patients. CONCLUSIONS: AAV patients with lung infection manifested more clinical symptoms and prominent lung image changes. The PCT and composite biomarker PCT-CRP-NLCR showed high diagnostic efficacy for a lung infection in AAV patients. Pulmonary lesion caused by either infection or AAV involvement is commonly seen and difficult to distinguish. We aim to identify the biomarkers that can be applied in the differentiation diagnosis of pulmonary lesions in AAV patients.

Analysis of the Epidemiologic Characteristics of Children with Hand, Foot and Mouth Disease in China.

Background: We aimed to investigate the epidemiological characteristics of hand, foot and mouth disease (HFMD) and provide recommendations for its control and prevention. Methods: A descriptive epidemiological analysis was designed for HFMD in children through direct network report from 2015 to 2019. Results: From 2015 to 2019, a total 27,395 HFMD cases were reported at Infection Clinic of Shanghai Children's Hospital, Shanghai, China, accounting for 79.24% of the number of reported notifiable infectious disease cases (34,573). The cases number increased since May and reached a peak from June to September, then decreased from October to December with a second small peak in some years. The proportion of cases in boys is higher than in girls (59.7% vs. 40.3%). The cases number of stay-at-home children was higher in 2016 and 2018 (60.07% and 60.95%) than in 2019 (33.47%), and that of kindergarten children and students in 2019 (51.73% and 9.75%) was significantly higher than in other years. Overall, 22606 cases were reported in <5 years group, accounting for 82.52% of the total number of cases during 2015-2019. The proportion of the cases in 5-10 and >10 years groups increased year by year from 2015 to 2019, which is statistically significant. (χ2=71.105, P=0.00; χ2=78.413, P=0.00). Conclusion: The epidemiological characteristics of HFMD had changed during 2015-2019. Analysis of these data can provide helpful evidence to prevention and early treatment of the HFMD, and identification severe cases and handling the outbreaks.

Application of High-Throughput Sequencing Technology in the Pathogen Identification of Diverse Infectious Diseases in Nephrology Departments.

Objective: The purpose of this study was to explore the clinical applications of high-throughput sequencing (HTS) in the identification of pathogens in patients with urinary tract infection (UTI), peritoneal dialysis-associated peritonitis (PDAP), central venous catheter related blood infections (CRBIs), and lung infections in the nephrology department. Methods: Midstream urine samples from 112 patients with UTI, peritoneal fluid samples from 67 patients with PDAP, blood samples from 15 patients with CRBI, and sputum specimens from 53 patients with lung infection were collected. The HTS and ordinary culture methods were carried out in parallel to identify the pathogens in each sample. Pathogen detection positive rate and efficacy were compared between the two methods. Results: The pathogen positive detection rates of HTS in UTI, PDAP, CRBI, and lung infection were strikingly higher than those of the culture method (84.8% vs. 35.7, 71.6% vs. 23.9%, 75% vs. 46.7%, 84.9% vs. 5.7%, p < 0.05, respectively). HTS was superior to the culture method in the sensitivity of detecting bacteria, fungi, atypical pathogens, and mixed microorganisms in those infections. In patients who had empirically used antibiotics before the test being conducted, HTS still exhibited a considerably higher positive rate than the culture method (81.6% vs. 39.0%, 68.1% vs. 14.9%, 72.7% vs. 36.4%, 83.3% vs. 4.2%, p < 0.05, respectively). Conclusions: HTS is remarkably more efficient than the culture method in detecting pathogens in diverse infectious diseases in nephrology, and is particularly potential in identifying the pathogens that are unable to be identified by the common culture method, such as in cases of complex infection with specific pathogens or subclinical infection due to preemptive use of antibiotics.

Dose prediction using a deep neural network for accelerated planning of rectal cancer radiotherapy.

PURPOSE: To apply a deep neural network to predict dose distributions of rectal cancer patients for accelerated volume modulated arc technique (VMAT) planning. MATERIALS AND METHODS: Computed tomography scans and approved VMAT plans together with Doseapproved of 187 patients treated from February 2018 to April 2019 were randomly selected for this retrospective study. The deep neural network DeepLabv3+ was applied for dose distribution prediction. A prior dose information-aided planning scheme was introduced. Prediction precision was evaluated by mean square error (MSE), normalized dose difference (δD), and dose-volume histogram (DVH) indices using a paired t test. Information-aided and experienced replanning were performed by 1-year and 6-year experienced dosimetrists, respectively. Replanning time and DVH indices were evaluated by two-way variance analysis. RESULTS: The DeepLabv3+ prediction results (DoseDeepLabv3+) were all clinically acceptable. Taking Doseapproved as the baseline, the MSE was 0.001 and mean δD was 0.40% with an inter-quartile range of 0.079%-0.30% for DoseDeepLabv3+. No significant differences were found for the planning target volume quantitative parameters between Doseapproved and DoseDeepLabv3+, except for the conformality index. For the two-way variance analysis, a significantly different replanning time was found between the information-aided and experienced replanning with maximum time-saving of 15.76 min. Information-aided replans had the advantage of lower maximum dose, higher minimum dose, and lower homogeneity index, and the disadvantage of lower conformality index and higher machine unites with significant differences. CONCLUSION: DeepLabv3+ successfully predicted rectal cancer dose distribution, and the predicted prior information helped save planning times for multi-level experienced dosimetrists.

Consensus of a class of discrete-time nonlinear multi-agent systems in the presence of communication delays.

In this paper, we study the consensus problem for a class of discrete-time nonlinear multi-agent systems. The dynamics of each agent is input affine and the agents are connected through a connected undirected communication network. Distributed control laws are proposed and consensus analysis is conducted both in the absence and in the presence of communication delays. Both theoretical analysis and numerical simulation show that our control laws ensure state consensus of the multi-agent system.

[Detection the pathogens and analysis the clinical characteristics in children with hand, foot and mouth disease in Shanghai during 2009-2011].

OBJECTIVE: To investigate the epidemic characteristics of etiological agents and analyze the clinic differences in children with hand, foot and mouth diseases in Shanghai. METHODS: Collection 551 specimens including vesicle fluid, stool and throat swabs to detect the pathogens. The positive rates were tested by RT-PCR assay with Enterovirus consensus primer and specific primer for Enterovirus 71 (EV71) and Coxsackie A16 (CoxA16), respectively. RESULTS: Out of 357 patients, the overall positive rate was 79.7%. CoxA16 infection was mainly popular in 2009, EV71 was mainly popular in 2011. The epidemic characteristics of enterovirus infection within 2009-2011 had significant differences (P = 0.005). The positive rate of vesicle fluid was highest. The concurrent rate of fever and tendency to be frightened had significant differences in three patients' groups. The count of the peripheral white blood cells and the ratio of the neutrophil in the patients with EV71 infection was higher than that in the patients with CoxA16 or PE infection. CONCLUSION: HFMD showed alternant epidemic characteristics at different times of enterovirus infection in Shanghai. Analyzing the differences of clinic characteristic of EV71 and CoxA16 infection is helpful to prevent and control EV71 infection.

QSAR study of Akt/protein kinase B (PKB) inhibitors using support vector machine.

A three-class support vector classification (SVC) model with high prediction accuracy for the training, test and overall data sets (95.2%, 88.6% and 93.1%, respectively) was developed based on the molecular descriptors of 148 Akt/protein kinase B (PKB) inhibitors. Then, support vector regression (SVR) method was applied to set up a more accurate model with good correlation coefficient (r(2)) for the training, test and overall data sets (0.882, 0.762 and 0.840, respectively). Enrichment factors (EF) and receiver operating curves (ROC) studies of database screening were also performed either using the SVR model alone or assisted with the SVC model, the results of which demonstrated that the established models could be useful and reliable tools in identifying structurally diverse compounds with Akt inhibitory activity.