Quantifying changes in oxygen saturation of the internal jugular vein in vivo using deep neural networks and subject-specific three-dimensional Monte Carlo models.

Central venous oxygen saturation (ScvO2) is an important parameter for assessing global oxygen usage and guiding clinical interventions. However, measuring ScvO2 requires invasive catheterization. As an alternative, we aim to noninvasively and continuously measure changes in oxygen saturation of the internal jugular vein (SijvO2) by a multi-channel near-infrared spectroscopy system. The relation between the measured reflectance and changes in SijvO2 is modeled by Monte Carlo simulations and used to build a prediction model using deep neural networks (DNNs). The prediction model is tested with simulated data to show robustness to individual variations in tissue optical properties. The proposed technique is promising to provide a noninvasive tool for monitoring the stability of brain oxygenation in broad patient populations.

Patient-reported outcome (PRO)-based symptom assessment in patients with advanced lung cancer receiving first-line combination immunotherapy: a protocol for a multicenter, prospective, observational study.

BACKGROUND: Immunotherapy is currently applied in the first-line treatment regimens for numerous advanced cancers, especially advanced lung cancer. Immune-related adverse events (irAEs) resulting from immunotherapy can vary in severity and cause a substantial symptom burden to patients. However, there are limited data on symptom burden in patients with advanced lung cancer following immunotherapy. To address this deficit, this study aims to provide insight into the symptom burden and severity through patient-reported outcome measurements and conduct an analysis of temporal trends and clinical consequences of symptom burden in patients with advanced lung cancer receiving combination immunotherapy. METHODS: We will prospectively recruit 168 eligible patients from 14 hospitals in China. Eligible patients will be aged ≥ 18 years, pathologically diagnosed with locally advanced or stage IV primary lung cancer without surgical indications, and agreed to receive immunotherapy in combination with other therapies. The primary outcome of this study is the symptom burden of patients during the immunotherapy course. Longitudinal symptom data will be collected using the MD Anderson Symptom Inventory-Lung Cancer module (MDASI-LC) and the symptomatic irAEs scale at baseline (once before treatment) and weekly after treatment, until 1 month after the last treatment cycle has been completed. The trajectory of symptom burden following combination immunotherapy will be depicted, and by linking it to clinical outcomes (the secondary outcome and exploratory outcome of this study), the consequence of symptom burden in patients with advanced lung cancer receiving combination immunotherapy will be examined further. DISCUSSION: This study intends to establish longitudinal symptom trajectories in patients with lung cancer receiving immunotherapy, and explore its association with clinical outcomes. These findings may serve as an important reference for clinicians in the symptomatic management of patients with lung cancer receiving immunotherapy. TRIAL REGISTRATION NUMBER: ChiCTR2200061540. Registered on June 28, 2022.

Impact of financial development on the energy intensity of developing countries.

Climate change is an important and urgent challenge facing the world, affecting the survival and development of human beings from multiple dimensions such as environment and economy. Carbon emissions are a barometer of climate change, and energy consumption is closely related to carbon emissions. Reducing energy consumption can reduce carbon emissions, thereby optimizing the human living environment. Compared with developed countries, the carbon emissions and energy consumption of developing countries are still growing strongly, so it's significant to study the energy consumption of developing countries. Energy intensity can be reduced through reducing energy intensity, and financial development can have an impact on energy intensity. So, using panel data from 67 developing countries from 1995 to 2018, this study selected six financial development indicators and uses the system Generalized Method of Moments (sys-GMM for short) establishes a dynamic panel model to study the impact of financial development on energy intensity from the six aspects of access, depth and efficiency of financial institutions and financial markets, which are more implementable and more realistic for formulating relevant financial policies to reduce energy intensity. We introduced the index of industrial structure upgrading and studied the interaction between financial development and financial development in the impact of financial development on energy intensity for the first time. The findings revealed that improving financial institutions' access, depth, and efficiency, as well as financial markets' access, depth, and efficiency, might dramatically lower developing countries' energy intensity. The improvement of industrial structure resulted in a reduction in the energy intensity of financial development. Furthermore, the 67 developing countries were grouped from five different perspectives, and the influence of financial development on energy intensity reduction was found to be robust. Therefore, the research results significantly reduce energy intensity for financial development in developing countries.

Assessment of variation in paddy microbial communities under different storage temperatures and relative humidity by Illumina sequencing analysis.

Temperature and relative humidity are important conditions in paddy storage; however, their influence on microbial communities in stored paddy remains poorly understood. In this study, paddy was stored at different temperatures and relative humidity, and severe mildew was observed in samples stored at relative humidity of 97% and different temperatures (15, 28, and 37 °C) after 50 days. High-throughput 16S rRNA and ITS genes amplicon sequencing analyses showed that Proteobacteria, Firmicutes, and Ascomycota were the dominant phyla across the paddy samples. Moreover, Staphylococcus in bacteria and Aspergillus in fungi were predominant in the composition of microbial community among mildewed paddy samples. The maximum abundance of the two types of organisms appeared in samples stored at 37 °C and relative humidity of 97% (T37H97; 85.02 ±â€¯9.77%), and 15 °C and relative humidity of 97% (T15H97; 93.60 ±â€¯0.01%), respectively. In addition, the two genera were also found in mildew from spoiled paddy by using plate isolation method, revealing their important role in paddy spoilage. Statistical analysis indicated that relative humidity was the most important factor affecting the relative abundances of microbial communities and had the 38.98% and 15.74% contributions to the variation of bacterial and fungal communities, respectively. Hence these results could be very conducive to the promotion of safe storage of paddy.

A prospective, observational study to explore health disparities in patients with heart failure-ethnicity and financial status.

BACKGROUND: Health disparities are related to race/ethnicity, financial status and poor self-care behaviors, but the relationships between these factors remain unknown. OBJECTIVE: To explore the relationships between race/ethnicity, financial status and cardiac event-free survival, and the reasons for any disparities in patients with heart failure (HF). METHODS: We collected demographic data (e.g., race/ethnicity and financial status), clinical data (e.g., medication regimen) and self-care behaviors (by the Self-Care of Heart Failure Index) in 173 HF patients at baseline. Patients were grouped by race/ethnicity (African-American and Caucasian) and financial status (higher if they reported having "enough or more than enough to make ends meet" and lower if they "did not have enough to make ends meet"). Chi-square tests, t-tests and survival analyses were used to explore the relationships between race/ethnicity, financial status, self-care and survival. RESULTS: African-American race/ethnicity and poor financial status were associated with poor outcomes ( p < 0.005) when controlling for covariates. HF patients with lower financial status reported engaging in fewer self-care maintenance behaviors than those with higher financial status. African-American HF patients trended to report engaging in fewer self-care maintenance behaviors than Caucasian HF patients. African-Americans with lower financial status had a four- to six-times higher risk of experiencing cardiac events compared to patients who were Caucasian with higher financial status before and after controlling for covariates. CONCLUSIONS: African-American HF patients and those with lower financial status had worse outcomes and reported fewer self-care maintenance behaviors. Interventions promoting self-care may decrease the disparity in outcomes and should be tailored to African-Americans and those with lower financial status.

Depressive symptoms, health-related quality of life, and cardiac event-free survival in patients with heart failure: a mediation analysis.

PURPOSE: Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL. METHODS: A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival. RESULTS: In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001-1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025-1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized ß = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001-1.139), demonstrating a mediation effect of depressive symptoms. CONCLUSIONS: Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.

[Imaging assessment of neonatal necrotizing enterocolitis].

OBJECTIVE: To improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC), imaging assessment of neonates with NEC was analyzed retrospectively. METHOD: Data of 211 cases of NEC were retrospectively collected from the Department of Neonatology, Children's Hospital of Chongqing Medical University between Jan.1(st) 2006-Dec.31(st) 2011. RESULT: Analysis of abdominal X-ray of 211 cases showed that there were 40 cases (19.0%) who had no changes on each X-ray, 47 cases (22.3%) had improvement and 23 cases (10.9%) became worse. In the group of no changes, positive rate with good prognosis was 97.5% and with poor prognosis, it was 2.5%. In the group of improvement, positive rate with good prognosis was 97.9%, and the contrary was 2.1%. Positive rate with good prognosis was 56.5%, and the contrary was 43.5% in worse group. Chi-square analysis of the three groups showed χ(2) = 31.742, P < 0.01. Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0%, 12/75) and Doppler US (1.3%, 1/75), χ(2) = 10.191, P < 0.05, portal pneumatosis on abdominal X-ray(1.3%, 1/75) versus Doppler US (12.0%,9/75), χ(2) = 6.857, P < 0.05. Surgical timing mostly corresponded to pneumoperitoneum (OR = 19.543) and intestinal obstruction (OR = 19.527) of abdominal X-ray. The logistic regression equation is y = -2.915-1.588x1+2.972x4+2.973x7 + 1.711x9 (χ(2) = 101.705, P < 0.01). CONCLUSION: Abdominal X-ray is the most important method of diagnosis of NEC, the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group. Comparison with abdominal X-ray and Doppler US, the former in pneumoperitoneum positive rate was higher than the latter, at the same time, portal pneumatosis on Doppler US is more sensitive to abdominal X-ray, the value of two imaging assessments both supplement each other. Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.

Breakthrough indicator for aromatic VOCs using needle trap samplers for activated carbon adsorbent.

Internal circulation cabinets equipped with granular activated carbon (GAC) for adsorbing volatile organic compounds (VOCs) are widely used to store bottles containing organic solvents in universities, colleges, and hospital laboratories throughout Taiwan. This work evaluates the VOC adsorption capacities of GAC using various adsorption times for gas stream mixtures of 100 ppm toluene and 100 ppm o-xylene. Additionally, needle trap sampling (NTS) technology was used to indicate the time for renewing the GAC to avoid VOC breakthrough from adsorbents. Experimental results demonstrate that the proposed models can linearly express toluene and o-xylene adsorption capacities as the natural logarithm of adsorption time (ln(t)) and can accurately simulate the equilibrium adsorption capacities (Qe, g VOCs/g GAC) for gaseous toluene and o-xylene. The NTS, packed with 60-80 mesh divinylbenzene (DVB) particles, was compared in terms of extraction efficiency by simultaneously using the 75-microm Carboxen/polydimethylsiloxane-solid-phase microextraction (Carboxen/PDMS-SPME) fiber for time-weighted average (TWA) sampling, and experimental results indicated that the packed DVB-NTS achieved higher toluene extraction rates. Additionally, the NTS installed in the outlet air stream for adsorbing toluene and o-xylene exhausted through GAC accurately indicated toluene and o-xylene breakthrough times of 4700-5000 min. The GAC-NTS operational instructions to indicate the replacing time of adsorbent in the internal circulation cabinets are also included in this paper.

Investigating properties of the cardiovascular system using innovative analysis algorithms based on ensemble empirical mode decomposition.

Cardiovascular system is known to be nonlinear and nonstationary. Traditional linear assessments algorithms of arterial stiffness and systemic resistance of cardiac system accompany the problem of nonstationary or inconvenience in practical applications. In this pilot study, two new assessment methods were developed: the first is ensemble empirical mode decomposition based reflection index (EEMD-RI) while the second is based on the phase shift between ECG and BP on cardiac oscillation. Both methods utilise the EEMD algorithm which is suitable for nonlinear and nonstationary systems. These methods were used to investigate the properties of arterial stiffness and systemic resistance for a pig's cardiovascular system via ECG and blood pressure (BP). This experiment simulated a sequence of continuous changes of blood pressure arising from steady condition to high blood pressure by clamping the artery and an inverse by relaxing the artery. As a hypothesis, the arterial stiffness and systemic resistance should vary with the blood pressure due to clamping and relaxing the artery. The results show statistically significant correlations between BP, EEMD-based RI, and the phase shift between ECG and BP on cardiac oscillation. The two assessments results demonstrate the merits of the EEMD for signal analysis.

Rurality and event-free survival in patients with heart failure.

BACKGROUND: Evidence of health disparities between urban and rural populations usually favors urban dwellers. The impact of rurality on heart failure (HF) outcomes is unknown. OBJECTIVE: We compared event-free survival between HF patients living in urban and rural areas. METHODS: In this longitudinal study, 136 patients with HF (male, 70%; age, mean ± SD 61 ± 11 years; New York Heart Association class III/IV, 60%) were enrolled. Patients' emergency department visits for HF exacerbation and rehospitalization during follow-up were identified. Rural status was determined by rural-urban commuting area code. Survival analysis was used to determine the effect of rurality on outcomes while controlling for relevant demographic, clinical, and psychosocial variables. RESULTS: Rural patients (64%) had longer event-free survival than urban patients (P = .015). Rurality (P = .04) predicted event-free survival after controlling for age, marital status, New York Heart Association class, medications, adherence to medications, depressive symptoms, and social support. CONCLUSIONS: Rural patients were less likely than their urban counterparts to experience an event. Further research is needed to identify protective factors that may be unique to rural settings.

Medication adherence in patients who have heart failure: a review of the literature.

Data indicate that nonadherence plays a major role in preventable rehospitalizations. The first step to improving adherence is determining the affecting factor. This article critically reviews the literature on factors affecting medication adherence in heart failure patients. Findings about effects of age, gender, race, and living status on adherence are quite inconsistent. Patients who believe taking medications is beneficial or who have no side effects are more adherent, as are those highly motivated to improve their well-being. Forgetfulness, social support, and patient-provider relationship are related to adherence. Providers seeking to increase adherence must consider patients' expectations for their health, their environment, their barriers to following prescribed regimen, and their understanding of their condition and how it relates to medication taking.