Artificial intelligence-assisted system for the assessment of Forrest classification of peptic ulcer bleeding: a multicenter diagnostic study.

BACKGROUND: Inaccurate Forrest classification may significantly affect clinical outcomes, especially in high risk patients. Therefore, this study aimed to develop a real-time deep convolutional neural network (DCNN) system to assess the Forrest classification of peptic ulcer bleeding (PUB). METHODS: A training dataset (3868 endoscopic images) and an internal validation dataset (834 images) were retrospectively collected from the 900th Hospital, Fuzhou, China. In addition, 521 images collected from four other hospitals were used for external validation. Finally, 46 endoscopic videos were prospectively collected to assess the real-time diagnostic performance of the DCNN system, whose diagnostic performance was also prospectively compared with that of three senior and three junior endoscopists. RESULTS: The DCNN system had a satisfactory diagnostic performance in the assessment of Forrest classification, with an accuracy of 91.2% (95%CI 89.5%-92.6%) and a macro-average area under the receiver operating characteristic curve of 0.80 in the validation dataset. Moreover, the DCNN system could judge suspicious regions automatically using Forrest classification in real-time videos, with an accuracy of 92.0% (95%CI 80.8%-97.8%). The DCNN system showed more accurate and stable diagnostic performance than endoscopists in the prospective clinical comparison test. This system helped to slightly improve the diagnostic performance of senior endoscopists and considerably enhance that of junior endoscopists. CONCLUSION: The DCNN system for the assessment of the Forrest classification of PUB showed satisfactory diagnostic performance, which was slightly superior to that of senior endoscopists. It could therefore effectively assist junior endoscopists in making such diagnoses during gastroscopy.

Interpretable deep learning model for major depressive disorder assessment based on functional near-infrared spectroscopy.

BACKGROUND: Major depressive disorder (MDD) affects a substantial number of individuals worldwide. New approaches are required to improve the diagnosis of MDD, which relies heavily on subjective reports of depression-related symptoms. AIM: Establish an objective measurement and evaluation of MDD. METHODS: Functional near-infrared spectroscopy (fNIRS) was used to investigate the brain activity of MDD patients and healthy controls (HCs). Leveraging a sizeable fNIRS dataset of 263 HCs and 251 patients with MDD, including mild to moderate MDD (mMDD; n = 139) and severe MDD (sMDD; n = 77), we developed an interpretable deep learning model for screening MDD and staging its severity. RESULTS: The proposed deep learning model achieved an accuracy of 80.9% in diagnostic classification and 78.6% in severity staging for MDD. We discerned five channels with the most significant contribution to MDD identification through Shapley additive explanations (SHAP), located in the right medial prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, and left posterior superior frontal cortex. The findings corresponded closely to the features of haemoglobin responses between HCs and individuals with MDD, as we obtained a good discriminative ability for MDD using cortical channels that are related to the disorder, namely the frontal and temporal cortical channels with areas under the curve of 0.78 and 0.81, respectively. CONCLUSION: Our study demonstrated the potential of integrating the fNIRS system with artificial intelligence algorithms to classify and stage MDD in clinical settings using a large dataset. This approach can potentially enhance MDD assessment and provide insights for clinical diagnosis and intervention.

Groundwater antibiotics and microplastics in a drinking-water source area, northern China: Occurrence, spatial distribution, risk assessment, and correlation.

In recent years, antibiotics and microplastics have both received increasing attention. However, the contamination and correlation between the two pollutants in the groundwater of drinking-water source areas has not yet been considered. In this study, eight antibiotics were detected in 81 groundwater samples from a drinking-water source area. These were trimethoprim (TMP), sulfadimidine (SDD), sulfadiazine (SDZ), sulfamethoxazole (SMX), sulfachloropyridazine (SCP), norfloxacin (NOR), ciprofloxacin (CIP) and enrofloxacin (ENRO). Detection rates ranged from 1.23% to 95.06% and the maximum concentration ranged from 0.44 ng/L to 45.40 ng/L. Antibiotics in the groundwater pose no threat to human health, while only ENRO, CIP, NOR, SMX, and SDZ posed medium to low risks to the aquatic ecosystem. In contrast, the detection rate of microplastics was 100% with abundance values ranging from 4 n/L to 72 n/L, with an average of 29 n/L. Microplastic polymers were identified as polyamide, polyethylene, polypropylene, polyvinyl chloride and polystyrene. These also occurred in surface water but the particle sizes in groundwater were lower than those in the surface water. Through correlation analysis, it was found that NOR, ENRO and total antibiotic concentrations were significantly correlated with microplastic abundances. This study revealed the contamination and potential risks of antibiotics and microplastics in the groundwater of a drinking-water source area and found a correlation between them, indicating that risk management of antibiotics and microplastics in groundwater should be highly concerned.

Distribution, Risk Assessment, and Sources of Trace Metals in Surface Sediments from the Sea Area of Macao, South China.

Due to rapid economic development in the Pearl River Delta, South China, trace metals pose a significant threat to the coastal ecosystems. In this study, we investigated the spatial distribution, contamination status, ecological risk, and possible sources of trace metals in 150 surface sediment samples from the Macao sea area. The results showed that concentrations of Ag, Pb, Cu, Zn, and Cd were highest in the Inner Harbour, whereas Cr, Co, As, and Ni were mainly accumulated in the downstream area of the Maliuzhou Waterway and the eastern area of Macao International Airport. Sediment grain composition, organic matter, total phosphorus, and hydrological regime were key factors influencing the spatial distribution patterns of trace metals. According to the environmental contamination indices of the enrichment factor, geo-accumulation index, and contamination factor, moderate contamination of trace metals occurs in the study area, while Ag and Pb contribute significantly to the contamination. Based on the potential ecological risk index, trace metals in surface sediments pose a low ecological risk. Correlation analysis and principal component analysis indicated that Cr, Co, Ni, and As were mainly derived from natural sources, whereas Ag, Pb, Cu, Zn, and Cd were mainly associated with anthropogenic sources.

Bioleaching of vanadium by Acidithiobacillus ferrooxidans from vanadium-bearing resources: Performance and mechanisms.

Bioleaching is promising to meet the demand of strategic vanadium both economically and environmentally. Whereas the combination of bioleaching with traditional techniques is of great interest, little is known on bioleaching of vanadium from abundant vanadium-bearing resources utilized/produced in existing processes. This study investigated the bioleaching of vanadium from vanadium-titanium magnetite, steel slag, and clinker, which are common raw mineral and intermediates used in conventional vanadium extraction process. Clinker had greater leachability by Acidithiobacillus ferrooxidans, compared to vanadium-titanium magnetite and steel slag. Pulp density, inoculum volume, initial pH and initial Fe2+ concentration had influencing effects on this bioleaching process. Under optimal condition with 3% pulp density, 10% inoculum volume, initial pH at 1.8, and 3 g/L initial Fe2+ concentration, the bioleaching of clinker achieved the maximum vanadium leaching efficiency of 59.0%. Both X-ray fluorescence and energy dispersive spectroscopy analysis confirmed the reduction of vanadium content in the solid residues after leaching. The results of Community Bureau of Reference sequential extraction suggested that vanadium in acid-soluble and oxidizable phase was more easily leachable. This study is helpful to develop sustainable and practical techniques for vanadium extraction from abundant raw materials and step forward in combining bioleaching with traditional process.

Electric field-induced chiral d + id superconductivity in AA-stacked bilayer graphene: a quantum Monte Carlo study.

Using the constrained-path quantum Monte Carlo method, we systematically study the half-filled Hubbard model on AA-stacked honeycomb lattice. Our simulations demonstrate that a dominant chiral d + id wave superconductivity can be induced by a perpendicular electric field. At a fixed electric field, the effective pairing interaction of chiral d + id superconductivity exhibits an increasing behavior with increasing the on-site Coulomb interaction. We attribute the electric field-induced d + id superconductivity to an increased density of states near the Fermi energy and robust antiferromagnetic spin correlation upon turning on electric field. Our results strongly suggest that the AA-stacked graphene system is a good candidate for chiral d + id superconductor.

Quantitative Assessment of Hippocampal Tau Pathology in AD and PART.

To quantitatively assess the distribution pattern of hippocampal tau pathology in Alzheimer's disease (AD) and primary age-related tauopathy (PART), we investigated the distribution of phosphorylated tau protein (AT8) in 6 anatomically defined subregions of the hippocampal formation and developed a mathematical algorithm to compare the patterns of tau deposition in PART and AD. We demonstrated regional patterns of selective vulnerability as distinguishing features of PART and AD in functionally relevant structures of the hippocampus. In AD cases, tau pathology was high in both CA1 and subiculum, followed by CA2/3, entorhinal cortex (EC), CA4, and dentate gyrus (DG). In PART, the severity of tau pathology in CA1 and subiculum was high, followed by EC, CA2/3, CA4, and DG. There are significant differences between sector DG and CA1, DG and subiculum in both AD and PART.

Achievements and challenges in health management for aged individuals in primary health care sectors: a survey in Southwest China.

BACKGROUND: China has rapidly transformed into an ageing nation and will be one of the countries with the highest percentage of aged people in 2050. Healthcare management for the aged (HMA) in basic public health service (BPHS), which is delivered by lay healthcare workers (LHWs) in primary health care (PHC) sectors, is an important strategy to address the healthcare challenges that have resulted from ageing in China since 2009. This survey aimed to understand the achievements made and challenges faced by HMA in Southwest China. METHODS: A multilevel stratified random and consecutive sampling method was used to select study places and participants respectively, and mixed research methods were used to collect data from the aged individuals, LHWs and leaders in PHC sectors. SPSS 21.0 was used for data analysis. RESULTS: Seven hundred seventy-two surveys with aged people (over 60 years old), 16 focus group discussions (FGDs) with 96 aged people, and 32 in-depth interviews with 16 LHWs and 16 leaders were completed in PHC sectors. More than 85% of aged individuals had knowledge and utilization of HMA, and over 94% of these respondents were satisfied with HMA. Meanwhile, challenges in HMA delivery included weakness (unmet items and lack of appropriate assessment indicators) in HMA design, low capacity of PHC sectors and competency of LHWs to deliver HMA, poor health literacy of aged individuals, insufficient funds and a lack of multi-sector cooperation. CONCLUSIONS: Though significant achievements in HMA were observed, this study highlighted the challenges in further quality improvement of HMA delivery program in Southwest China. The "older-person-centered and integrated care" model provided a good theory to improve the quality of HMA by reinforcing the needs-based HMA design, building a comprehensive assessment strategy, improving the capacity of PHC sectors and the LHWs' competency, and strengthening multi-sector cooperation.

Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials.

BACKGROUND: Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis. METHODS: We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary. RESULTS: Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50-1.09; P = 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62-1.38; P = 0.70), and morality (OR, 0.71; 95% CI, 0.44-1.15; P = 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42-0.84; P = 0.004). CONCLUSIONS: Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.

Severe malnutrition evaluated by patient-generated subjective global assessment results in poor outcome among adult patients with acute leukemia: A retrospective cohort study.

To evaluate nutritional status in adult patients with acute leukemia (AL) using patient-generated subjective global assessment (PG-SGA) and to investigate the influence of nutritional status on prognosis.We observationally investigated 68 adult patients with newly diagnosed AL who received PG-SGA at the First Hospital of Jilin University between May 2013 and July 2015. Clinical features, chemotherapy regimens, biochemical indexes, body composition, complete remission (CR) rate, minimal residual disease (MRD), survival time, and side-effects of chemotherapy were compared between patients with and without severe malnutrition.Mean PG-SGA scores of the total patients were 6.1 ±â€Š4.0, and 19 of 68 (27.9%) patients had severe malnutrition (PG-SGA score ≥9). Patients with acute myeloid leukemia (AML) had higher scores than those with acute lymphocytic leukemia (ALL; P = .011) and high-risk patients had higher scores regardless of whether they had AML or ALL (AML, P = .012; ALL, P = .043). Univariate analysis showed that severe malnutrition was correlated with age (P = .041), transferrin (P = .042), Karnofsky Performance Status score (P = .006), and C-reactive protein (CRP) (P = .018). Multivariate analysis demonstrated that severe malnutrition was associated with CRP (hazard ratio [HR] = 1.020, 95% confidence interval [CI]: 1.002-1.039, P = .026). No difference was found in CR rate (P = .831) between patients with and without malnutrition, but those who were severely malnourished had higher MRD (P = .048 in AML patients, P = .036 in ALL patients) and more gastrointestinal side-effects (P = .014). Severe malnutrition was also associated with inferior overall survival (HR = 0.243, 95% CI: 0.063-0.945, P = .041) but not with event-free survival (HR = 0.808, 95% CI: 0.338-1.934, P = .663).Severe malnutrition defined by PG-SGA in adult patients with de novo AL may result in poor outcome.

The relationship between demands for lung cancer screening and the constructs of health belief model: a cross-sectional survey in Hefei, China.

The aim of investigation is to explore the relationship between demands for lung cancer screening (LCS) and the constructs derived from the health belief model (HBM) in Hefei. The study collected data about socio-demographics, health beliefs in and demands for LCS during early June to later July 2015. By constructing a LCS demands HBM constructs, it calculated indices of demands for LCS (DSI) and HBM constructs, which include perceived risk (PR) and seriousness (PS) of the cancers; and perceived effectiveness (PE), benefits (PB) and difficulties (PD) of the screening. It also performed descriptive and multivariate regression analysis of the demands and the HBM constructs. The amount of 823 respondents participated and completed the survey. 6.4% of them had ever undertaken LCS, whereas 60.1% of them expressed willingness to accept the service of LCS if it is free. In multiple regression analysis which used weights in calculating the HBM construct indices, education displayed significant positive associations with DSI (p = .044), and most of HBM constructs indices (PSI, PRI, PBI, and PDI) were statistically significant with DSI (p < .05). HBM-based constructs regarding LCS have important effects on demands for the service, and may provide effective paths to cancer screening promotion.

Determination of Tangeretin in Rat Plasma: Assessment of Its Clearance and Absolute Oral Bioavailability.

Tangeretin (TAN) is a dietary polymethoxylated flavone that possesses a broad scope of pharmacological activities. A simple high-performance liquid chromatography (HPLC) method was developed and validated in this study to quantify TAN in plasma of Sprague-Dawley rats. The lower limit of quantification (LLOQ) was 15 ng/mL; the intra- and inter-day assay variations expressed in the form of relative standard deviation (RSD) were all less than 10%; and the assay accuracy was within 100 ± 15%. Subsequently, pharmacokinetic profiles of TAN were explored and established. Upon single intravenous administration (10 mg/kg), TAN had rapid clearance (Cl = 94.1 ± 20.2 mL/min/kg) and moderate terminal elimination half-life (t1/2 λz = 166 ± 42 min). When TAN was given as a suspension (50 mg/kg), poor but erratic absolute oral bioavailability (mean value < 3.05%) was observed; however, when TAN was given in a solution prepared with randomly methylated-ß-cyclodextrin (50 mg/kg), its plasma exposure was at least doubled (mean bioavailability: 6.02%). It was obvious that aqueous solubility hindered the oral absorption of TAN and acted as a barrier to its oral bioavailability. This study will facilitate further investigations on the medicinal potentials of TAN.

The influence of climate change on the accumulation of polycyclic aromatic hydrocarbons, black carbon and mercury in a shrinking remote lake of the southern Tibetan Plateau.

A sediment core from a remote lake, Pumoyum Co, located in the southern TP, was analyzed for polycyclic aromatic hydrocarbons (PAHs), black carbon (BC) and mercury. Concentrations ranged from 30 to 229ng/g for PAHs, 0.46 to 1.48mg/g for BC and 10 to 30ng/g for mercury. Significant correlations were found among the concentrations of PAHs, BC and mercury, suggesting the sources of these pollutants to be similar; mainly from combustion processes. Further diagnosis of the likely sources of BC and PAHs suggested that petroleum combustion has been one of the increasing sources in the last few decades, but biomass burning remains the dominant source of these pollutants. The historic trends of the three pollutants closely followed historic BC emission trends from Europe (before 1970) and southern Asia (after 2000). With economic development in southern Asia, concentrations of pollutants in the sediments of Pumoyum Co have increased during the past decade. However, the accumulation fluxes of the pollutants during that period remained stable, which may be due to the recent low precipitation and less catchment erosion of Pumoyum Co (experienced a drier climate and shrinking of lake area).

Quantum Monte Carlo study of a dominant s-wave pairing symmetry in iron-based superconductors.

We perform a systematic quantum Monte Carlo study of the pairing correlation in the S(4) symmetric microscopic model for iron-based superconductors. It is found that the pairing with an extensive s-wave symmetry robustly dominates over other pairings at low temperature in a reasonable parameter region regardless of the change of Fermi surface topologies. The pairing susceptibility, the effective pairing interaction, and the (π, 0) antiferromagnetic correlation strongly increase as the on-site Coulomb interaction increases, indicating the importance of the effect of electron-electron correlation. Our nonbiased numerical results provide a unified understanding of the superconducting mechanism in iron pnictides and iron chalcogenides and demonstrate that the superconductivity is driven by strong electron-electron correlation effects.

[Evaluation and choice of PCR-DGGE primers in analyzing the microbial community structure of activated sludge in traditional Chinese medicine wastewater].

In the study of traditional Chinese medicine wastewater, it was discussed for the effect of different sets of 16S rDNA universal primers on DGGE fingerprinting and microbial community diversity of aerobic and anaerobic activated sludge from one traditional Chinese medicine wastewater treatment. The genome DNA of activated sludge was isolated, and eleven sets of primers were used to amplify the four variable regions of 16S rDNA, the resolution of DGGE fingerprinting and community diversity was analyzed. The results indicated that community diversity with different sets of universal primers by DGGE was obviously different. Separated patterns of the V3 and V6-V8 regions were better than of V1-V3 and V3-V5. In the DGGE profiles, bands and diversity from V3 were most, bands and diversity from V3-V5 and V6-V8 were a little worse than those of V3. According to the length of targeted sequence and the resolution of DGGE fingerprinting, V6-V8 (B968F/B1401R) are recommended to be used to do the DGGE analysis. Mix I341F/I534R and B341F/B534R PCR product equally to make DGGE analysis can get more community diversity information.

Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine.

BACKGROUND: Recent studies have suggested that there is a positive impact of patient-centered care (PCC) on both the patient-physician relationship and subsequent patient health-related behaviors. One recent prospective study reported a significant relationship between the degree of PCC experienced by patients during their hospitalization for acute myocardial infarction (AMI) and their postdischarge cardiac symptoms. A limitation of this study, however, was a lack of information regarding the technical quality of the AMI care, which might have explained at least part of the differences in outcomes. The present study was undertaken to test the influence of both PCC and technical care quality on outcomes among AMI patients. METHODS: We analyzed data from a national sample of 1,858 veterans hospitalized for an initial AMI in a Department of Veterans Affairs medical center during fiscal years 2003 and 2004 for whom data had been compiled on evidence-based treatment and who had also completed a Picker questionnaire assessing perceptions of PCC. Cox proportional hazards models were used to estimate the relationship between PCC and survival 1-year postdischarge, controlling for technical quality of care, patient clinical condition and history, admission process characteristics, and patient sociodemographic characteristics. We hypothesized that better PCC would be associated with a lower probability of death 1-year postdischarge, even after controlling for patient characteristics and the technical quality of care. RESULTS: Better PCC was associated with a significantly but modestly lower hazard of death over the 1-year study period (hazard ratio 0.992, 95 percent confidence interval 0.986-0.999). CONCLUSIONS: Providing PCC may result in important clinical benefits, in addition to meeting patient needs and expectations.

Racial/ethnic differences in diabetes care for older veterans: accounting for dual health system use changes conclusions.

BACKGROUND: Veterans Health Administration (VHA) databases are used extensively to study racial/ethnic disparities; however, these databases may not capture all care received by VHA patients. OBJECTIVES: We examined the extent to which accounting for non-VHA care changed conclusions about racial/ethnic disparities for VHA patients with diabetes. METHODS: Using a cross-sectional observational study, we analyzed a national sample of noninstitutionalized Hispanic (n = 5931), black (n = 24,670), and white (n = 149,222) VHA patients with diabetes who were at least 65 years of age for receipt of annual HbA1c testing, low-density lipoprotein (LDL) cholesterol testing, or eye examination from VHA and Medicare administrative files. RESULTS: In VHA alone data, adjusting for patient characteristics, Hispanic and black patients were as likely as white patients to receive HbA1c testing (odds ratio 1.06 [95% confidence interval 0.99-1.13] and 1.04 [1.00-1.07], respectively), and more likely to receive eye examinations (1.31 [1.24-1.38] and 1.33 [1.29-1.37], respectively). Hispanic patients were equally likely (1.01 [0.95-1.07]) and black patients were less likely (0.81 [0.79-0.84]) to receive LDL testing versus white patients. In VHA plus Medicare data, Hispanic and black patients were less likely than white patients to receive HbA1c (0.76 [0.71-0.82] and 0.83 [0.80-0.87], respectively) and LDL testing (0.84 [0.79-0.90] and 0.70 [0.68-0.72], respectively), and equally likely to receive eye examinations (0.91 [0.86-0.96]) and 0.98 [0.95-1.01]), respectively). Accounting for VHA facility had little effect on results. CONCLUSIONS: Restricting to VHA data masks racial/ethnic disparities in care of VHA patients. VHA researchers must be aware and supplement VHA data with other sources whenever possible.

Effect of patient gender on late-life depression management.

PURPOSE: To determine whether patient gender influences physicians' management of late-life major depression in older and younger elderly patients. METHODS: In 1996-2001, physician subjects viewed a professionally produced videotape vignette portraying an elderly patient meeting diagnostic criteria for major depression, then answered interviewer-administered questions about differential diagnosis and treatment. Patient gender and other characteristics were systematically varied in different versions of the videotape, but clinical content was held constant. This was a stratified random sample of 243 internists and family physicians with Veterans Health Administration (VA) or non-VA ambulatory care practices in the Northeastern United States. Outcomes were whether physicians followed a guideline-recommended management approach: treating with antidepressants or mental health referral or both and seeing the patient for follow-up within 2 weeks. RESULTS: Only 19% of physicians recommended treating depression (12% recommended antidepressants and 7% mental health referral), and 43% recommended follow-up within 2 weeks. Patient gender did not influence management recommendations in either younger old (67 year old) or older old (79 year old) patients (p > 0.12 for all comparisons). CONCLUSIONS: Gender disparities previously documented in the management of major conditions are not seen for the management of depression, a potentially stigmatized condition that does not require resource-intense interventions.