A Systematic Review of ChatGPT and Other Conversational Large Language Models in Healthcare.

Background: The launch of the Chat Generative Pre-trained Transformer (ChatGPT) in November 2022 has attracted public attention and academic interest to large language models (LLMs), facilitating the emergence of many other innovative LLMs. These LLMs have been applied in various fields, including healthcare. Numerous studies have since been conducted regarding how to employ state-of-the-art LLMs in health-related scenarios to assist patients, doctors, and public health administrators. Objective: This review aims to summarize the applications and concerns of applying conversational LLMs in healthcare and provide an agenda for future research on LLMs in healthcare. Methods: We utilized PubMed, ACM, and IEEE digital libraries as primary sources for this review. We followed the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) to screen and select peer-reviewed research articles that (1) were related to both healthcare applications and conversational LLMs and (2) were published before September 1st, 2023, the date when we started paper collection and screening. We investigated these papers and classified them according to their applications and concerns. Results: Our search initially identified 820 papers according to targeted keywords, out of which 65 papers met our criteria and were included in the review. The most popular conversational LLM was ChatGPT from OpenAI (60), followed by Bard from Google (1), Large Language Model Meta AI (LLaMA) from Meta (1), and other LLMs (5). These papers were classified into four categories in terms of their applications: 1) summarization, 2) medical knowledge inquiry, 3) prediction, and 4) administration, and four categories of concerns: 1) reliability, 2) bias, 3) privacy, and 4) public acceptability. There are 49 (75%) research papers using LLMs for summarization and/or medical knowledge inquiry, and 58 (89%) research papers expressing concerns about reliability and/or bias. We found that conversational LLMs exhibit promising results in summarization and providing medical knowledge to patients with a relatively high accuracy. However, conversational LLMs like ChatGPT are not able to provide reliable answers to complex health-related tasks that require specialized domain expertise. Additionally, no experiments in our reviewed papers have been conducted to thoughtfully examine how conversational LLMs lead to bias or privacy issues in healthcare research. Conclusions: Future studies should focus on improving the reliability of LLM applications in complex health-related tasks, as well as investigating the mechanisms of how LLM applications brought bias and privacy issues. Considering the vast accessibility of LLMs, legal, social, and technical efforts are all needed to address concerns about LLMs to promote, improve, and regularize the application of LLMs in healthcare.

Prognostic performance of MRI LI-RADS version 2018 features and clinical-pathological factors in alpha-fetoprotein-negative hepatocellular carcinoma.

PURPOSE: To evaluate the role of the magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) version 2018 features and clinical-pathological factors for predicting the prognosis of alpha-fetoprotein (AFP)-negative (≤ 20 ng/ml) hepatocellular carcinoma (HCC) patients, and to compare with other traditional staging systems. METHODS: We retrospectively enrolled 169 patients with AFP-negative HCC who received preoperative MRI and hepatectomy between January 2015 and August 2020 (derivation dataset:validation dataset = 118:51). A prognostic model was constructed using the risk factors identified via Cox regression analysis. Predictive performance and discrimination capability were evaluated and compared with those of two traditional staging systems. RESULTS: Six risk factors, namely the LI-RADS category, blood products in mass, microvascular invasion, tumor size, cirrhosis, and albumin-bilirubin grade, were associated with recurrence-free survival. The prognostic model constructed using these factors achieved C-index of 0.705 and 0.674 in the derivation and validation datasets, respectively. Furthermore, the model performed better in predicting patient prognosis than traditional staging systems. The model effectively stratified patients with AFP-negative HCC into high- and low-risk groups with significantly different outcomes (p < 0.05). CONCLUSION: A prognostic model integrating the LI-RADS category, blood products in mass, microvascular invasion, tumor size, cirrhosis, and albumin-bilirubin grade may serve as a valuable tool for refining risk stratification in patients with AFP-negative HCC.

Dynamic contrast optical coherence tomography (DyC-OCT) for label-free live cell imaging.

Dynamic contrast optical coherence tomography (DyC-OCT), an emerging imaging method, utilizes fluctuation patterns in OCT signals to enhance contrast, thereby enabling non-invasive label-free volumetric live cell imaging. In this mini review, we explain the core concepts behind DyC-OCT image formation and its system configurations, serving as practical guidance for future DyC-OCT users. Subsequently, we explore its applications in delivering high-quality, contrast-enhanced images of cellular morphology, as well as in monitoring changes in cellular activity/viability assay experiments.

The Value of LI-RADS and Radiomic Features From MRI for Predicting Microvascular Invasion in Hepatocellular Carcinoma within 5 cm.

RATIONALE AND OBJECTIVES: To explore and compare the performance of LI-RADS® and radiomics from multiparametric MRI in predicting microvascular invasion (MVI) preoperatively in patients with solitary hepatocellular carcinoma (HCC)< 5 cm. METHODS: We enrolled 143 patients with pathologically proven HCC and randomly stratified them into training (n = 100) and internal validation (n = 43) cohorts. Besides, 53 patients were enrolled to constitute an independent test cohort. Clinical factors and imaging features, including LI-RADS and three other features (non-smooth margin, incomplete capsule, and two-trait predictor of venous invasion), were reviewed and analyzed. Radiomic features from four MRI sequences were extracted. The independent clinic-imaging (clinical) and radiomics model for MVI-prediction were constructed by logistic regression and AdaBoost respectively. And the clinic-radiomics combined model was further constructed by logistic regression. We assessed the model discrimination, calibration, and clinical usefulness by using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision-curve analysis respectively. RESULTS: Incomplete tumor capsule, corona enhancement, and radiomic features were related to MVI in solitary HCC＜5 cm. The clinical model achieved AUC of 0.694/0.661 (training/internal validation). The single-sequence-based radiomic model's AUCs were 0.753-0.843/0.698-0.767 (training/internal validation). The combination model exhibited superior diagnostic performance to the clinical model (AUC: 0.895/0.848 [training/ internal validation]) and yielded an AUC of 0.858 in an independent test cohort. CONCLUSION: Incomplete tumor capsule and corona enhancement on preoperative MRI were significantly related to MVI in solitary HCC＜5 cm. Multiple-sequence radiomic features potentially improve MVI-prediction-model performance, which could potentially help determining HCC's appropriate therapy.

Preoperative prediction of disease-free survival in pancreatic ductal adenocarcinoma patients after R0 resection using contrast-enhanced CT and CA19-9.

OBJECTIVES: To investigate the efficiency of a combination of preoperative contrast-enhanced computed tomography (CECT) and carbohydrate antigen 19-9 (CA19-9) in predicting disease-free survival (DFS) after R0 resection of pancreatic ductal adenocarcinoma (PDAC). METHODS: A total of 138 PDAC patients who underwent curative R0 resection were retrospectively enrolled and allocated chronologically to training (n = 91, January 2014-July 2019) and validation cohorts (n = 47, August 2019-December 2020). Using univariable and multivariable Cox regression analyses, we constructed a preoperative clinicoradiographic model based on the combination of CECT features and serum CA19-9 concentrations, and validated it in the validation cohort. The prognostic performance was evaluated and compared with that of postoperative clinicopathological and tumor-node-metastasis (TNM) models. Kaplan-Meier analysis was conducted to verify the preoperative prognostic stratification performance of the proposed model. RESULTS: The preoperative clinicoradiographic model included five independent prognostic factors (tumor diameter on CECT > 4 cm, extrapancreatic organ infiltration, CECT-reported lymph node metastasis, peripheral enhancement, and preoperative CA19-9 levels > 180 U/mL). It better predicted DFS than did the postoperative clinicopathological (C-index, 0.802 vs. 0.787; p < 0.05) and TNM (C-index, 0.802 vs. 0.711; p < 0.001) models in the validation cohort. Low-risk patients had significantly better DFS than patients at the high-risk, defined by the model preoperatively (p < 0.001, training cohort; p < 0.01, validation cohort). CONCLUSIONS: The clinicoradiographic model, integrating preoperative CECT features and serum CA19-9 levels, helped preoperatively predict postsurgical DFS for PDAC and could facilitate clinical decision-making. CLINICAL RELEVANCE STATEMENT: We constructed a simple model integrating clinical and radiological features for the prediction of disease-free survival after curative R0 resection in patients with pancreatic ductal adenocarcinoma; this novel model may facilitate preoperative identification of patients at high risk of recurrence and metastasis that may benefit from neoadjuvant treatments. KEY POINTS: • Existing clinicopathological predictors for prognosis in pancreatic ductal adenocarcinoma (PDAC) patients who underwent R0 resection can only be ascertained postoperatively and do not allow preoperative prediction. • We constructed a clinicoradiographic model, using preoperative contrast-enhanced computed tomography (CECT) features and preoperative carbohydrate antigen 19-9 (CA19-9) levels, and presented it as a nomogram. • The presented model can predict disease-free survival (DFS) in patients with PDAC better than can postoperative clinicopathological or tumor-node-metastasis (TNM) models.

Microvascular invasion-negative hepatocellular carcinoma: Prognostic value of qualitative and quantitative Gd-EOB-DTPA MRI analysis.

OBJECTIVES: The purpose of this study was to establish a model for predicting the prognosis of patients with microvascular invasion (MVI)-negative hepatocellular carcinoma (HCC) based on qualitative and quantitative analyses of Gd-EOB-DTPA magnetic resonance imaging (MRI). MATERIALS AND METHODS: Consecutive patients with MVI-negative HCC who underwent preoperative Gd-EOB-DTPA MRI between January 2015 and December 2019 were retrospectively enrolled.In total, 122 patients were randomly assigned to the training and validation groups at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify significant clinical parameters and MRI features, including quantitative and qualitative parameters associated with prognosis, which were incorporated into a predictive nomogram. The end-point of this study was recurrence-free survival. Outcomes were compared between groups using the Kaplan-Meier method with the log-rank test. RESULTS: During a median follow-up period of 58.86 months, 38 patients (31.15 %) experienced recurrence. Multivariate analysis revealed that lower relative enhancement ratio (RER), hepatobiliary phase hypointensity without arterial phase hyperenhancement, Liver Imaging Reporting and Data System category, mild-moderate T2 hyperintensity, and higher aspartate aminotransferase levels were risk factors associated with prognosis and then incorporated into the prognostic model. C-indices for training and validation groups were 0.732 and 0.692, respectively. The most appropriate cut-off value for RER was 1.197. Patients with RER ≤ 1.197 had significantly higher postoperative recurrence rates than those with RER > 1.197 (p = 0.004). CONCLUSION: The model integrating qualitative and quantitative imaging parameters and clinical parameters satisfactorily predicted the prognosis of patients with MVI-negative HCC.

Infants exposed in utero to Hurricane Maria have gut microbiomes with reduced diversity and altered metabolic capacity.

The gut microbiome is a potentially important mechanism that links prenatal disaster exposures with increased disease risks. However, whether prenatal disaster exposures are associated with alterations in the infant's gut microbiome remains unknown. We established a birth cohort study named Hurricane as the Origin of Later Alterations in Microbiome (HOLA) after Hurricane Maria struck Puerto Rico in 2017. We enrolled vaginally born Latino term infants aged 2 to 6 months, including n = 29 infants who were exposed in utero to Hurricane Maria in Puerto Rico and n = 34 infants who were conceived at least 5 months after the hurricane as controls. Shotgun metagenomic sequencing was performed on infant stool swabs. Infants exposed in utero to Hurricane Maria had a reduced diversity in their gut microbiome compared to the control infants, which was mainly seen in the exclusively formula-fed group (P = 0.02). Four bacterial species, including Bacteroides vulgatus, Clostridium innocuum, Bifidobacterium pseudocatenulatum, and Clostridium neonatale, were depleted in the exposure group compared to the control group. Compositional differences in the microbial community and metabolic genes between the exposure and control groups were significant, which were driven by the formula feeding group (P = 0.02 for the microbial community and P = 0.008 for the metabolic genes). Metabolic modules involved in carbohydrate metabolism were reduced in the exposure group. Prenatal maternal exposure to Hurricane Maria was associated with a reduced gut commensal and an altered microbial composition and metabolic potential in the offspring's gut. Breastfeeding can adjust the composition of the gut microbiomes of exposed infants. IMPORTANCE Climate change is a serious issue that is affecting human health. With more frequent and intense weather disasters due to climate change, there is an urgent need to evaluate and understand the impacts of prenatal disaster exposures on the offspring. The prenatal stage is a particularly vulnerable stage for disease origination. However, the impact of prenatal weather disaster exposures on the offspring's gut microbiome has not been evaluated. Our HOLA study starts to fill this knowledge gap and provides novel insights into the microbiome as a mechanism that links prenatal disaster exposures with elevated disease risks. Our major finding that reduced microbial diversity and altered metabolic capacity are associated with prenatal hurricane exposures warrants further studies to evaluate the impact of weather disasters on the unborn.

Determination of prognostic predictors in patients with solitary hepatocellular carcinoma: histogram analysis of multiparametric MRI.

PURPOSE: To evaluate the histogram parameters of preoperative multiparametric magnetic resonance imaging (MRI) and clinical-radiological (CR) characteristics as prognostic predictors in patients with solitary hepatocellular carcinoma ≤ 5 cm and to determine the optimal time window for histogram analysis. METHODS: We retrospectively included 151 patients who underwent preoperative MRI between January 2012 and December 2017. All patients were randomly separated into training and validation cohorts (n = 105 and 46). Eight whole-lesion histogram parameters were extracted from T2-weighted images, apparent diffusion coefficient maps, and dynamic contrast-enhanced images. Univariate and multivariate logistic regression analyses were performed to evaluate these histogram parameters and CR variables related to early recurrence (ER) and recurrence-free survival. A nomogram was derived from the clinical-radiological-histogram (CRH) model that incorporated these risk factors. Kaplan-Meier survival analysis was performed to evaluate the prognostic performance of the CRH model. RESULTS: In total, 151 patients (male: female, 130: 21; median age, 54.46 ± 9.09 years) were evaluated. Multivariate logistic regression analysis revealed that the significant risk factors of ER were Mean Absolute Deviation and Minimum in the histogram analysis of the delayed phase images, as well as three important CR variables: albumin-bilirubin grade, microvascular invasion, and tumor size. The nomogram built by incorporating these risk factors showed satisfactory predictive ability in the training and validation cohorts with AUC values of 0.747 and 0.765, respectively. Furthermore, the prognostic nomogram can effectively classify patients into high- and low-risk groups (p < 0.05). CONCLUSION: Multiparametric MRI-derived histogram parameters provide additional value in predicting patient prognosis. The CRH model may be a useful and noninvasive method for achieving prognostic stratification and personalized disease management.

[Comparation on the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old].

OBJECTIVE: To compare the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old. METHODS: A prospective study was conducted. The febrile infants with less than 90 days old hospitalized in the department of pediatrics of Xuzhou Central Hospital from August 2019 to November 2021 were enrolled. The basic data of the infants were recorded. The infants with high risk or low risk of bacterial infection was evaluated by the step-by-step approach and the lab-score method, respectively. The step-by-step approach was based on clinical manifestations, age, blood neutrophil absolute value or C-reactive protein (CRP), urine white blood cells, blood venous blood procalcitonin (PCT) or interleukin-6 (IL-6) to gradually assess the high risk or low risk of bacterial infection in infants with fever. The lab-score method was based on the levels of laboratory indicators such as blood PCT, CRP and urine white blood cells, which were assigned different scores to evaluate the high risk or low risk of bacterial infection in febrile infants according to the total score. Using clinical bacterial culture results as the "gold standard", the negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio, positive likelihood ratio, sensitivity, specificity, and accuracy of the two methods were calculated. The consistency of the two evaluation methods was tested by Kappa. RESULTS: A total of 246 patients were enrolled in the analysis, and ultimately confirmed by bacterial culture as non-bacterial infections in 173 cases (70.3%), bacterial infection in 72 cases (29.3%), and unclear in 1 case (0.4%). There were 105 cases with low risk evaluated by the step-by-step approach, and 98 cases (93.3%) were ultimately confirmed as non-bacterial infection; 181 cases with low risk evaluated by the lab-score method, and 140 cases (77.4%) were ultimately confirmed as non-bacterial infection. The consistency of the two evaluation methods was poor (Kappa value = 0.253, P < 0.001). The ability of the step-by-step approach in early identification of non-bacterial infection in febrile infants with less than 90 days old was superior to the lab-score method (NPV: 0.933 vs. 0.773, negative likelihood ratio: 5.835 vs. 1.421), but the sensitivity of the former was lower than that of the latter (0.566 vs. 0.809). The ability of the step-by-step approach in early identification of bacterial infection in febrile infants with less than 90 days old was similar to the lab-score method (PPV: 0.464 vs. 0.484, positive likelihood ratio: 0.481 vs. 0.443), but the specificity of the former was higher than that of the latter (0.903 vs. 0.431). The overall accuracy of the step-by-step approach and the lab-score method was similar (66.5% vs. 69.8%). CONCLUSIONS: The ability of the step-by-step approach in early identification of non-bacterial infections in febrile infants with less than 90 days old is superior to the lab-score method.

Rational design of NiO/NiSe2@C heterostructure as high-performance anode for Li-ion battery.

Biphasic or multiphase heterostructures have promising futures in advanced electrode materials for energy-related applications because of their desirable synergistic effects. Here we prepared a rational NiO/NiSe2@C heterostructure microsphere through carbonization, selenization, and oxidation using Ni-MOF as a precursor. Electrochemical studies were conducted to examine the Li+ storage characteristics, and density functional theory (DFT) was utilized to comprehend the underlying mechanism. When employed as the anode for LIBs, the NiO/NiSe2@C showed a high specific capacity and long-term cyclic stability, with a specific capacity of 992 mAh g-1 for 600 cycles at a current density of 0.2 A g-1. The NiO/NiSe2@C exhibits a significantly enhanced lithium-ion diffusion coefficient ( [Formula: see text] ) value. The DFT results show that an electron-rich area forms at the NiO/NiSe2 heterointerface, where the metalloid selenium transfers electrons to the oxygen atoms. The lithiation reactions were improved dramatically by redistributing interfacial charges, which can trigger a built-in electric field that dramatically promotes the capacitance contribution of electrode materials, enhances the lithium storage capacity, and accelerates the ion/electron transmission. The rational synthesis of NiO/NiSe2@C heterostructure can provide an idea for designing novel heterostructure anode materials.

Risk stratification of solitary hepatocellular carcinoma ≤ 5 cm without microvascular invasion: prognostic values of MR imaging features based on LI-RADS and clinical parameters.

OBJECTIVES: To estimate the potential of preoperative MR imaging features and clinical parameters in the risk stratification of patients with solitary hepatocellular carcinoma (HCC) ≤ 5 cm without microvascular invasion (MVI) after hepatectomy. METHODS: The study enrolled 166 patients with histopathological confirmed MVI-negative HCC retrospectively. The MR imaging features were evaluated by two radiologists independently. The risk factors associated with recurrence-free survival (RFS) were identified by univariate Cox regression analysis and the least absolute shrinkage and selection operator Cox regression analysis. A predictive nomogram was developed based on these risk factors, and the performance was tested in the validation cohort. The RFS was analyzed by using the Kaplan-Meier survival curves and log-rank test. RESULTS: Among the 166 patients with solitary MVI-negative HCC, 86 patients presented with postoperative recurrence. Multivariate Cox regression analysis indicated that cirrhosis, tumor size, hepatitis, albumin, arterial phase hyperenhancement (APHE), washout, and mosaic architecture were risk factors associated with poor RFS and then incorporated into the nomogram. The nomogram achieved good performance with C-index values of 0.713 and 0.707 in the development and validation cohorts, respectively. Furthermore, patients were stratified into high- and low-risk subgroups, and significant prognostic differences were found between the different subgroups in both cohorts (p < 0.001 and p = 0.024, respectively). CONCLUSION: The nomogram incorporated preoperative MR imaging features, and clinical parameters can be a simple and reliable tool for predicting RFS and achieving risk stratification in patients with solitary MVI-negative HCC. KEY POINTS: • Application of preoperative MR imaging features and clinical parameters can effectively predict RFS in patients with solitary MVI-negative HCC. • Risk factors including cirrhosis, tumor size, hepatitis, albumin, APHE, washout, and mosaic architecture were associated with worse prognosis in patients with solitary MVI-negative HCC. • Based on the nomogram incorporating these risk factors, the MVI-negative HCC patients could be stratified into two subgroups with significant different prognoses.

Revealing the practical strategies for promoting Chinese migrant workers' health and well-being: Organizational empowerment perspective.

The health and well-being of migrant workers struggling to make ends meet are being compromised, especially with the uncertainty of the COVID-19 pandemic. The aim is to analyze how organizational empowerment promotes health and well-being from an applied psychological perspective, taking into account the shaping role of individual vulnerability. Links between theory and practice will be established to achieve equitable health and well-being. The underlying mechanism by which organizational empowerment mitigated workplace-induced adverse outcomes was validated in the analysis of construction workers (n = 966). In addition, individual characteristics, namely, excitability, low perceptual threshold, control, and knowledge, attitude, and practice, were identified as critical factors, as well-being consequences vary from person to person. Moderating effect analysis showed that high excitability enhanced the association between work environment exposure and health and well-being. Control and knowledge, attitude, and practice have opposite effects. Moreover, the dual effects of the low perception threshold are verified, that is, facing the work environment produces more negative consequences, whereas perceiving more resources stimulates more positive consequences. Overall, the research provides a clearer dialectical view of vulnerability, contributing wisdom toward accurate management based on empowerment theory, which lays a solid foundation for bridging gaps in health and well-being.

The salivary and nasopharyngeal microbiomes are associated with SARS-CoV-2 infection and disease severity.

Emerging evidence suggests the oral and upper respiratory microbiota may play important roles in modulating host immune responses to viral infection. As the host microbiome may be involved in the pathophysiology of coronavirus disease 2019 (COVID-19), we investigated associations between the oral and nasopharyngeal microbiome and COVID-19 severity. We collected saliva (n = 78) and nasopharyngeal swab (n = 66) samples from a COVID-19 cohort and characterized the microbiomes using 16S ribosomal RNA gene sequencing. We also examined associations between the salivary and nasopharyngeal microbiome and age, COVID-19 symptoms, and blood cytokines. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status, but not COVID-19 severity, was associated with community-level differences in the oral and nasopharyngeal microbiomes. Salivary and nasopharyngeal microbiome alpha diversity negatively correlated with age and were associated with fever and diarrhea. Oral Bifidobacterium, Lactobacillus, and Solobacterium were depleted in patients with severe COVID-19. Nasopharyngeal Paracoccus was depleted while nasopharyngeal Proteus, Cupravidus, and Lactobacillus were increased in patients with severe COVID-19. Further analysis revealed that the abundance of oral Bifidobacterium was negatively associated with plasma concentrations of known COVID-19 biomarkers interleukin 17F and monocyte chemoattractant protein-1. Our results suggest COVID-19 disease severity is associated with the relative abundance of certain bacterial taxa.

Changes in physical activity and sedentary time among children with asthma during the COVID-19 pandemic and influencing factors.

OBJECTIVE: Regular physical activity is essential for asthma control in children, but it remains understudied within the context of COVID-19. Physical activity and sedentary time levels before and during the COVID-19 pandemic among children with asthma were documented and differences by characteristics were explored. METHODS: This was a cross-sectional self-administered online survey study of 5- to 17-year-old children with asthma from the United States between December 2020 and April 2021. RESULTS: This study included 68 children with asthma. Although only 4.6% of the children were fully inactive before the pandemic, this number increased to 24.6% during the survey period (p < 0.001). Children spent significantly less time outdoors and more time in front of screens during the pandemic versus before (p < 0.001). The variety of activities in which children with asthma engaged in during the pandemic was lower than what they used to do prior to the COVID-19 crisis. Boys, Hispanic children, those of low-income households, and those not attending school in-person were significantly associated with less participation in physical activity during the pandemic. Ethnicity remained significantly associated after adjusting for multiple comparisons. CONCLUSIONS: During the COVID-19 pandemic, children with asthma were less active and spent more time in front of screens and less time outdoors. Subgroup analyses revealed individual, parental, and organizational characteristics being associated with differential participation in physical activity, highlighting disparities in opportunities for children with asthma of different circumstances to remain active and healthy during the pandemic. Additional, more robust longitudinal studies are needed to confirm these results.

[Role of platelets aggregation in the process of ductus arteriosus closure of newborn pups].

OBJECTIVE: To investigate the role of platelets aggregation in the developing process of ductus arteriosus closure of newborn pups, and the effect of platelet membrane glycoprotein IIb-IIIa (GPIIb-IIIa) receptor antagonist (tirofiban). METHODS: Four 24-month-old Beagle bitches were selected and numbered 1, 2, 3, and 4 respectively, and their pups were removed by cesarean section in two batches 1-2 days before the expected date of delivery. Bitches 1 and 2 were the first batch. Eighteen newborn pups were removed after cesarean section as the control group. They were divided into three subgroups: 1-hour subgroup, 4-hour subgroup, and 12-hour subgroup according to postnatal time point, with 6 pups in each subgroup. The newborn pups were injected with normal saline 10 mL/kg via jugular vein immediately after birth. Bitches 3 and 4 were the second batch. Nineteen newborn pups were removed by cesarean section as tirofiban group. They were also divided into three subgroups: 1-hour subgroup (n = 6), 4-hour subgroup (n = 6), and 12-hour subgroup (n = 7) according to the postnatal time point. The newborn pups were injected with tirofiban hydrochloride injection 10 mL/kg (10 mL injection including 2.5 mg of tirofiban) via jugular vein immediately after birth. The diameter of ductus arteriosus was measured by echocardiography. Ductus arteriosus was removed by surgical dissection and divided into two parts. Western blotting and immunohistochemistry were used to detect the expression of platelet membrane GPIIb-IIIa, respectively. RESULTS: In the control group, 1 newborn pup died at 0.5 hour after birth in the 1-hour subgroup. The experiment was completed by 19 in the tirofiban group. Ductus arteriosus of all pups were not closed in 1-hour subgroups of the two groups, and there was no significant difference in the diameter of ductus arteriosus between the control group and the tirofiban group (mm: 1.72±0.08 vs. 1.70±0.11, P > 0.05). Ductus arteriosus of 1 newborn pup in 4-hour subgroup of the control group was closed, but the ductus arteriosus of all the newborn pups in 4-hour subgroup of the tirofiban group were not closed. The diameter of ductus arteriosus of the tirofiban group was significantly larger than that of the control group (mm: 1.52±0.15 vs. 0.95±0.48, P < 0.05). Ductus arteriosus of all pups were closed in 12-hour subgroup of the control group, but the ductus arteriosus of 2 pups of the tirofiban group were still not closed, with the diameter of ductus arteriosus of 1.0 mm and 1.1 mm, respectively. Western blotting showed that at 1-hour, 4-hour and 12-hour after birth, the expression of platelet membrane GPIIb-IIIa was gradually increased in ductus arteriosus of newborn pups of the two groups. The expression of GPIIb-IIIa in 1-hour subgroup of the tirofiban group was significantly lower than that in the control group (GPIIb-IIIa/ß-actin: 0.67±0.07 vs. 0.84±0.16, P < 0.05). The expression of GPIIb-IIIa in 4-hour and 12-hour subgroups of the tirofiban group were slightly lower than those in the control group (GPIIb-IIIa/ß-action: 0.85±0.12 vs. 0.95±0.11 in 4-hour subgroup, 1.04±0.16 vs. 1.09±0.17 in 12-hour subgroup, both P > 0.05). Immunohistochemistry showed that the change trend of platelet membrane GPIIb-IIIa in ductus arteriosus of newborn pups in both groups was similar to the results of Western blotting. CONCLUSIONS: The ductus arteriosus of newborn pups begin to close 1-4 hours after birth, and all closed at 12 hours after birth. The expression of platelet membrane GPIIb-IIIa in ductus arteriosus increase gradually after birth, and the platelet aggregation may participate in and promote ductus arteriosus closure to some extent. Tirofiban, a platelet membrane GPIIb-IIIa receptor antagonist, may delay ductus arteriosus closure of newborn pups to some extent by inhibiting platelet aggregation.

Daytime Radiative Cooling Coating Based on the Y2O3/TiO2 Microparticle-Embedded PDMS Polymer on Energy-Saving Buildings.

Daytime radiative cooling technology can release heat into outer space without consuming any electricity during the day while reflecting as much solar radiation as possible. This characteristic gives radiative cooling materials considerable application potential in the fields of energy-saving buildings, fabrics, and photovoltaic cells. The radiative cooling coating (RC coating) applied to a building should cover a large area of the building surface, so a RC coating was prepared by spraying. The RC coating consisted of highly near-infrared reflective yttrium oxide (Y2O3), titanium dioxide (TiO2), and polydimethylsiloxane (PDMS). The RC coating could reach a high solar reflectance of 92.2% and a high atmospheric window emissivity of 94.9%. The complementary reflectivity of TiO2 and Y2O3 was the key to obtaining high reflectivity for RC coatings. The results of field tests showed that the cavity where the RC coating is cooled was 7.7 °C lower than the ambient temperature under direct sunlight. Moreover, the average radiative cooling power of the RC coating was 72.5 W/m2 on a hot summer day. In addition, the RC coating has good stability and thus can be used in various conditions, such as on outdoor buildings.

Whole-liver enhanced CT radiomics analysis to predict metachronous liver metastases after rectal cancer surgery.

BACKGROUND: To develop a radiomics model based on pretreatment whole-liver portal venous phase (PVP) contrast-enhanced CT (CE-CT) images for predicting metachronous liver metastases (MLM) within 24 months after rectal cancer (RC) surgery. METHODS: This study retrospectively analyzed 112 RC patients without preoperative liver metastases who underwent rectal surgery between January 2015 and December 2017 at our institution. Volume of interest (VOI) segmentation of the whole-liver was performed on the PVP CE-CT images. All 1316 radiomics features were extracted automatically. The maximum-relevance and minimum-redundancy and least absolute shrinkage and selection operator methods were used for features selection and radiomics signature constructing. Three models based on radiomics features (radiomics model), clinical features (clinical model), and radiomics combined with clinical features (combined model) were built by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of models, and calibration curve and the decision curve analysis were performed to evaluate the clinical application value. RESULTS: In total, 52 patients in the MLM group and 60 patients in the non-MLM group were enrolled in this study. The radscore was built using 16 selected features and the corresponding coefficients. Both the radiomics model and the combined model showed higher diagnostic performance than clinical model (AUCs of training set: radiomics model 0.84 (95% CI, 0.76-0.93), clinical model 0.65 (95% CI, 0.55-0.75), combined model 0.85 (95% CI, 0.77-0.94); AUCs of validation set: radiomics model 0.84 (95% CI, 0.70-0.98), clinical model 0.58 (95% CI, 0.40-0.76), combined model 0.85 (95% CI, 0.71-0.99)). The calibration curves showed great consistency between the predicted value and actual event probability. The DCA showed that both the radiomics and combined models could add a net benefit on a large scale. CONCLUSIONS: The radiomics model based on preoperative whole-liver PVP CE-CT could predict MLM within 24 months after RC surgery. Clinical features could not significantly improve the prediction efficiency of the radiomics model.

Prenatal exposure to Hurricane Maria is associated with an altered infant nasal microbiome.

Background: Prenatal adverse exposures have been associated with increased risks of development of respiratory diseases in children. The infant nasal microbiome is an important mechanism and indicator. Objective: Our aim was to characterize and compare the nasal microbiome of infants who were in utero and exposed to Hurricane Maria in Puerto Rico during 2017 with that of infants who were conceived at least 5 months after the hurricane as controls. Methods: We recruited 63 vaginally born infants, 29 of whom were in the exposure group and 34 of whom were in the control group. Nasal swab samples were collected and analyzed by using 16S ribosomal RNA gene sequencing at the community and taxon levels, respectively. Results: Infants in the exposure group were more likely to harbor a Staphylococcus-Streptococcus-dominant microbial community in their nose. The richness and diversity of the microbiome was significantly higher in the exposure group than in the control group. In the exposure group, the bacterial genera Rhodocista, Azospirillum, Massilia, Herbaspirillum, Aquabacterium, and Pseudomonas were enriched, whereas Corynebacterium and Ralstonia were depleted. Food insecurity due to Hurricane Maria was associated with an increase in Pseudomonas in the infant nasal microbiome. Conclusion: Infants who were exposed to Hurricane Maria during gestation had an altered nasal microbiome, with a higher prevalence of environmental bacteria. More research is needed to evaluate the long-term impacts of extreme weather events occurring in the prenatal stage on a child's nasal microbiome and respiratory health.

Diagnostic value of whole-tumor apparent diffusion coefficient map radiomics analysis in predicting early recurrence of solitary hepatocellular carcinoma ≤ 5 cm.

PURPOSE: To evaluate the role of whole-tumor radiomics analysis of apparent diffusion coefficient (ADC) maps in predicting early recurrence (ER) of solitary hepatocellular carcinoma (HCC) ≤ 5 cm and compare the diagnostic efficiency of whole-tumor and single-slice ADC measurements. METHODS: One hundred and seventy patients with primary HCC were randomly divided into the training set (n = 119) and the test set (n = 51). The diagnostic efficiency was compared between the whole-tumor and single-slice ADC measurements. The clinical-radiological model was established by selected significant clinical characteristics and qualitative imaging features. The radiomics model was constructed using the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm. The significant clinical-radiological risk factors and radiomics features were integrated to develop the combined model. Receiver operating characteristic (ROC) curves were used for evaluating the predictive performance. RESULTS: Cirrhosis, age, and albumin were significantly associated with ER in the clinical-radiological model selected by the random forest classifier. The diagnostic efficiency of the whole-tumor ADC measurements was slight higher than that of the single-slice (AUC = 0.602 and 0.586, respectively). The clinical-radiological model (AUC = 0.84 and 0.82 in the training and test sets, respectively) showed better diagnostic performance than the radiomics model (AUC = 0.70 and 0.69 in the training and test sets, respectively) in predicting ER. The combined model showed optimal predictive performance with the highest AUC values of 0.88 and 0.85 in the training and test sets, respectively. CONCLUSIONS: The whole-tumor ADC measurements performed better than the single-slice ADC measurements. The clinical-radiological model performed better than the radiomics model for predicting ER in patients with solitary HCC ≤ 5 cm.