Construction of a multi-classified decision tree model for identifying malignant pleural effusion and tuberculous pleural effusion.

OBJECTIVE: Pleural effusion (PE) is a common clinical complication associated with various disorders. We aimed to utilize laboratory variables and their corresponding ratios in serum and PE for the differential diagnosis of multiple types of PE based on a decision tree (DT) algorithm. METHODS: A total of 1435 untreated patients with PE admitted to The First Affiliated Hospital of Ningbo University were enrolled. The demographic and laboratory variables were collected and compared. The receiver operating characteristic curve was used to select important variables for diagnosing malignant pleural effusion (MPE) or tuberculous pleural effusion (TPE) and included in the DT model. The data were divided into the training set and the test set at a ratio of 7:3. The training data was used to develop the DT model, and the test data was for evaluating the model. Independent data was collected as external validation. RESULTS: Three PE indicators (carcinoembryonic antigen, adenosine deaminase [ADA], and total protein), two serum indicators (neuron-specific enolase and cytokeratin 19 fragments), and two ratios [high-sensitivity C-reactive protein (hsCRP)/ PE lymphocyte and hsCRP/PE ADA] were used to construct the DT model. The area under the curve (AUC), sensitivity, and specificity for diagnosing MPE were 0.963, 84.0%, 91.6% in the training set, 0.976, 84.1%, 88.6% in the test set, and 0.955,83.3%, 86.7% in the external validation set. The AUC, sensitivity, and specificity of diagnosing TPE were 0.898, 86.8%, 92.3% in the training set, 0.888, 88.8%, 92.7% in the test set, and 0.778, 84.8%, 94.3% in the external validation set. CONCLUSION: The DT model showed good diagnostic efficacy and could be applied for the differential diagnosis of MPE and TPE in clinical settings.

HIV screening among patients seeking care at Xuanwu Hospital: A cross-sectional study in Beijing, China, 2011-2016.

OBJECTIVES: One-third of people living with HIV in China are still unaware of their status, so we sought to better understand HIV testing in the general hospital setting in China. METHODS: A cross-sectional study was conducted using the electronic medical records of all patients who attended Xuanwu Hospital in Beijing, January 1, 2011 to December 31, 2016. HIV screening and detection rates and characteristics of patients diagnosed with HIV were assessed. RESULTS: Overall, 235,961 patients were screened, for a screening rate of 1.4%. Although most were outpatients (98.4%), screening rate was higher among inpatients (70.0% versus 0.4%), and highest in internal medicine (36.1%) and surgery (33.3%) departments. A total of 140 patients were diagnosed with HIV, for a detection rate of 5.93 per 10,000. Detection rates were highest among outpatients (9.34 per 10,000), and patients attending the dermatology and sexually transmitted infection (STI) department (153.85 per 10,000). Most diagnoses were made among males (91.4%), aged 20-39 (67.1%), who reported becoming infected through homosexual contact (70.0%). CONCLUSIONS: HIV screening in China's general hospitals needs to be improved. More focus should be placed on screening outpatients, especially in the dermatology and STI department, and young men.

2D/3D CMR tissue tracking versus CMR tagging in the assessment of spontaneous T2DM rhesus monkeys with isolated diastolic dysfunction.

BACKGROUND: Spontaneous T2DM in rhesus monkeys manifests as isolated diastolic dysfunction in the early stage of diabetic cardiomyopathy, similar to humans. Myocardial deformation measurements have emerged as a superior way to measure left ventricular (LV) function in the early stage of cardiac dysfunction, making it possible to further evaluate early-stage LV dysfunction in spontaneous T2DM rhesus monkeys. METHODS: Spontaneous T2DM rhesus monkeys with isolated diastolic dysfunction (T2DM-DD, n = 10) and corresponding nondiabetic healthy animals (ND, n = 9) were prospectively scanned for a CMR study. Circumferential and longitudinal peak systolic strain (Ecc, Ell), time to peak strain (tEcc, tEll) and peak diastolic strain rate (CSR, LSR) obtained from 2D/3D CMR-TT were compared with those obtained from CMR tagging separately. In addition, all CMR imaging protocols were performed twice in 9 ND animals to assess test-retest reproducibility. RESULTS: Compared with the ND group, the T2DM-DD monkeys demonstrated significantly impaired LV Ecc (- 10.63 ± 3.23 vs - 14.18 ± 3.19, p < 0.05), CSR (65.50 ± 14.48 vs 65.50 ± 14.48, p < 0.01), Ell (- 9.11 ± 2.59 vs - 14.17 ± 1.68, p < 0.05), and LSR (59.43 ± 19.17 vs 108.46 ± 22.33, p < 0.01) with the tagging. Only Ecc (- 13.10 ± 2.47 vs - 19.03 ± 3.69, p < 0.01) and CSR (148.90 ± 31.27 vs 202.00 ± 51.88, p < 0.01) were significantly reduced with 2D CMR-TT, and only Ecc (- 13.77 ± 1.98 vs - 17.26 ± 3.78, p < 0.05) was significantly reduced with 3D CMR-TT. Moreover, 2D/3D CMR-TT-derived Ecc and CSR correlated with the corresponding tagging values collectively, with a statistically significant ICC value (p < 0.05). Test-retest repeatability analysis showed that most tagging-derived biomarkers had acceptable repeatability (p < 0.01). In addition, 2D CMR-TT-derived indicators were poorer than those derived from the tagging method but better than those obtained using the 3D method, with larger ICCs except for tEcc (p < 0.05). CONCLUSIONS: LV systolic and diastolic deformations were impaired in spontaneous T2DM rhesus monkeys previously diagnosed with isolated diastolic dysfunction by echocardiography. The 2D CMR-TT-derived Ecc and CSR were effective in the evaluation of the myocardial systolic and diastolic functions of early-diabetic cardiomyopathy, with relatively higher test-retest reproducibility and acceptable correlation with the tagging method compared with the 3D CMR-TT method.