Randomized Assessment of the Optimal Time Interval Between Programmed Intermittent Epidural Boluses When Combined With the Dural Puncture Epidural Technique for Labor Analgesia.

BACKGROUND: The dural puncture epidural (DPE) and programmed intermittent epidural bolus (PIEB) techniques are recent advances in neuraxial labor analgesia. Previous studies have investigated the PIEB optimal interval for effective analgesia when a standard epidural technique is used to initiate labor analgesia. However, it is unknown whether these findings are applicable when DPE is used. METHODS: Patients were randomized into 1 of 5 groups with PIEB intervals of 35, 40, 45, 50, or 55 minutes. Labor analgesia was initiated on request with a DPE technique by epidural injection over 2 minutes of 15 mL of ropivacaine 0.1% with sufentanil 0.5 µg/mL after a dural puncture with a 25-gauge Whitacre needle. Effective analgesia was defined as no additional requirement for a patient-controlled bolus during the first stage of labor. The PIEB interval that was effective in 50% of patients (EI50) and 90% of patients (EI90) was estimated using probit regression. RESULTS: One hundred laboring parturients received the DPE technique of whom 93 proceeded to have analgesia maintained with PIEB using 10 mL boluses of ropivacaine 0.1% and sufentanil 0.5 µg/mL. Totals of 89.5% (17/19), 84.2% (16/19), 82.4% (14/17), 52.6% (11/19), and 36.8% (7/19) of patients in groups 35, 40, 45, 50, and 55, respectively, received effective PIEB analgesia. The estimated values for EI50 and EI90 were 52.5 (95% CI, 48.4-62.6) minutes and 37.0 (95% CI, 28.4-40.9) minutes, respectively. CONCLUSION: The estimate of the PIEB optimal interval for effective analgesia after the DPE technique was comparable to that reported in previous studies when analgesia was initiated using a conventional epidural technique.

Analysis of the close contact management mode and epidemiological characteristics of COVID-19 in Chengdu, China.

With the development of the novel coronavirus disease 2019 (COVID-19) epidemic and the increase in cases, as a potential source of infection, the risk of close contact has gradually increased. However, few studies have analyzed the tracking and management of cross-regional personnel. In this study, we hope to understand the effectiveness and feasibility of existing close contact management measures in Chengdu, so as to provide a reference for further prevention and control of the epidemic. The close contact management mode and epidemiological characteristics of 40,425 close contacts from January 22, 2020, to March 1, 2022, in Chengdu, China, were analyzed. The relationship with index cases was mainly co-passengers (57.58%) and relatives (7.20%), and the frequency of contact was mainly occasional contact (70.39%). A total of 400 (0.99%) close contacts were converted into cases, which were mainly found in the first and second nucleic acid tests (53.69%), and the contact mode was mainly by sharing transportation (63.82%). In terms of close contact management time, both the supposed ((11.93 ± 3.00) days vs. (11.92 ± 7.24) days) and actual ((13.74 ± 17.47) days vs. (12.60 ± 4.35) days) isolation times in Chengdu were longer than those of the outer cities (P < 0.001). For the local clustered epidemics in Chengdu, the relationship with indexed cases was mainly colleagues (12.70%). The tracing and management of close contacts is a two-way management measure that requires cooperation among departments. Enhancing existing monitoring and response capabilities can control the spread of the epidemic to a certain extent.

Reinforcement Learning Based Diagnosis and Prediction for COVID-19 by Optimizing a Mixed Cost Function From CT Images.

A novel coronavirus disease (COVID-19) is a pandemic disease has caused 4 million deaths and more than 200 million infections worldwide (as of August 4, 2021). Rapid and accurate diagnosis of COVID-19 infection is critical to controlling the spread of the epidemic. In order to quickly and efficiently detect COVID-19 and reduce the threat of COVID-19 to human survival, we have firstly proposed a detection framework based on reinforcement learning for COVID-19 diagnosis, which constructs a mixed loss function that can integrate the advantages of multiple loss functions. This paper uses the accuracy of the validation set as the reward value, and obtains the initial model for the next epoch by searching the model corresponding to the maximum reward value in each epoch. We also have proposed a prediction framework that integrates multiple detection frameworks using parameter sharing to predict the progression of patients' disease without additional training. This paper also constructed a higher-quality version of the CT image dataset containing 247 cases screened by professional physicians, and obtained more excellent results on this dataset. Meanwhile, we used the other two COVID-19 datasets as external verifications, and still achieved a high accuracy rate without additional training. Finally, the experimental results show that our classification accuracy can reach 98.31%, and the precision, sensitivity, specificity, and AUC (Area Under Curve) are 98.82%, 97.99%, 98.67%, and 0.989, respectively. The accuracy of external verification can reach 93.34% and 91.05%. What's more, the accuracy of our prediction framework is 91.54%. A large number of experiments demonstrate that our proposed method is effective and robust for COVID-19 detection and prediction.

Tracing Management and Epidemiological Characteristics of COVID-19 Close Contacts in Cities Around Chengdu, China.

Introduction: Close contacts have become a potential threat to the spread of coronavirus disease 2019 (COVID-19). The purpose of this study was to understand the epidemiological characteristics of close contacts of confirmed or suspected cases of COVID-19 in the surrounding cities of Chengdu, China, so as to provide a basis for the management strategy of close contacts. Methods: Close contacts were determined through epidemiological investigation of indicated cases, and relevant information was entered in the "Close Contact Information Management System." Retrospective data of close contacts from January 22 to May 1, 2020 were collected and organized. Meanwhile, the contact mode, isolation mode, and medical outcome of close contacts were descriptively analyzed. Results: A total of 986 close contacts were effectively traced, with an average age of (36.69 ± 16.86) years old, who were mainly distributed in cities of eastern Chengdu. The frequency of contact was mainly occasional contact, 80.42% of them were relatives and public transportation personnel. Besides, the time of tracking close contacts and feedback was (10.64 ± 5.52) and (7.19 ± 6.11) days, respectively. A total of seven close contacts were converted to confirmed cases. Conclusions: Close contacts of COVID-19 have a risk of invisible infection. Early control of close contacts may be helpful to control the epidemic of COVID-19.

Deletion of ATF4 in AgRP Neurons Promotes Fat Loss Mainly via Increasing Energy Expenditure.

Although many functions of activating transcription factor 4 (ATF4) are identified, a role of ATF4 in the hypothalamus in regulating energy homeostasis is unknown. Here, we generated adult-onset agouti-related peptide neuron-specific ATF4 knockout (AgRP-ATF4 KO) mice and found that these mice were lean, with improved insulin and leptin sensitivity and decreased hepatic lipid accumulation. Furthermore, AgRP-ATF4 KO mice showed reduced food intake and increased energy expenditure, mainly because of enhanced thermogenesis in brown adipose tissue. Moreover, AgRP-ATF4 KO mice were resistant to high-fat diet-induced obesity, insulin resistance, and liver steatosis and maintained at a higher body temperature under cold stress. Interestingly, the expression of FOXO1 was directly regulated by ATF4 via binding to the cAMP-responsive element site on its promoter in hypothalamic GT1-7 cells. Finally, Foxo1 expression was reduced in the arcuate nucleus (ARC) of the hypothalamus of AgRP-ATF4 KO mice, and adenovirus-mediated overexpression of FOXO1 in ARC increased the fat mass in AgRP-ATF4 KO mice. Collectively, our data demonstrate a novel function of ATF4 in AgRP neurons of the hypothalamus in energy balance and lipid metabolism and suggest hypothalamic ATF4 as a potential drug target for treating obesity and its related metabolic disorders.