[Clinical monitoring: numerical value is the body and timing is life].

Monitoring is more common in today's clinical practice, especially in critical care medicine. Any confusion between monitoring and diagnosis will mislead clinical behavior which could be disastrous. A monitoring parameter usually focuses on a specific physiological point and represents the immediate situation of the point with quantitative values. A series of numerical value of monitoring parameters indicate physiological change or a disease process. If the clinical intervention targeted at the point, the numerical value represents the strength and the direction of the intervention. However, monitoring itself is not a therapeutical method. Only when medical personnel understand the characteristics of the parameters totally and use them to guide feedback management, and then to constitute accurate implementation of intervention methods, monitoring is worth to practise, and it is of clinical significance.

Life-cycle and economic assessments of microalgae biogas production in suspension and biofilm cultivation systems.

Biogas production via anaerobic digestion is highly attractive for microalgae. The technology of microalgae cultivation has profound impacts on biogas production system as it is the most energy-consuming process. However, a comprehensive evaluation of the environmental and economic benefits of different cultivation systems has yet to be sufficiently conducted. Here, life-cycle and economic assessments of open raceway ponds, photobioreactors and biofilm systems were investigated. Results showed greenhouse gas emissions of all systems were positive because more than two-thirds of carbon in fuel gas was lost and the fixed carbon in product gas and solid fertilizer was less than the emitted carbon during energy input. Particularly, biofilm system achieved the least greenhouse gas emissions (9.3 g CO2-eq/MJ), net energy ratio (0.7) and levelized cost of energy (0.9 $/kWh), indicating the optimum cultivation system. Open raceway ponds and photobioreactors failed to achieve positive benefits because of low harvesting efficiency and biomass concentration.

Health economic analysis and medical cost analysis of children with severe hepatitis B in China: A retrospective study from 2016 to 2022.

BACKGROUND: Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China. METHODS: Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran's I  analysis. RESULTS: The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603,) of total cases and cirrhosis cases accounted for 11.23% (180/1603,). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (GDP, Moran's I <0) and percentage of urban population (Moran's I <0), and positively correlated with the number of pediatric beds per million population (Moran's I >0). CONCLUSION: The number of severe hepatitis B cases is low in areas with high GDP levels and high urban population ratios, and health care costs have been declining over the years.

Radiographic and histological assessment of root resorption associated with conventional and mini-screw assisted rapid palatal expansion: a systematic review.

BACKGROUND AND OBJECTIVES: The aim of this systematic review and meta-analysis was to evaluate root resorption after maxillary expansion with conventional rapid palatal expansion (RPE) and mini-screw assisted rapid palatal expansion appliances (MARPE) using 2D and 3D radiographic methods and histologic methods of measuring root resorption. SEARCH METHODS AND SELECTION CRITERIA: A search of PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Global Index Medicus, Dissertations & Theses Global, ClinicalTrials.gov registry, ISRCTN Registry, National Research Register, OpenGrey, and the Trip Database was performed. The studies that had analysed root resorption after RPE or MARPE were selected for the systematic review. DATA COLLECTION AND ANALYSIS: The database research, elimination of duplicate studies, data extraction, and risk of bias were performed by the authors independently and in duplication. This systematic review included prospective studies to evaluate root resorption following RPE after tooth-borne (TB), tooth-tissue borne (TTB), bone-borne (BB), and tooth-bone borne (TBB) expansion appliances. RESULTS: A total of 13 prospective trials (six randomized clinical trials and seven non-randomized prospective clinical trials) were identified for inclusion in this systematic review. Histological studies revealed that most teeth experience root resorption on the buccal surfaces after maxillary expansion. MARPE designs with BB and TBB expansion appliances were found to lead to reduced volumetric root resorption than conventional RPE using micro-computed tomography. However, one study using cone beam computed tomography showed no difference in the root resorption with MARPE and RPE designs. CONCLUSIONS AND IMPLICATIONS: Maxillary expansion with RPE can lead to root resorption of maxillary posterior teeth. Root resorption occurs more frequently on buccal surfaces on maxillary posterior teeth. Limited evidence suggests that MARPE may lead to reduced root resorption than RPE. REGISTRATION: This systematic review was conducted following the Cochrane handbook for systematic reviews and interventions and reported according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The protocol was registered at PROSPERO database (https://www.crd.york.ac.uk/prospero/; registration number: PROSPERO CRD42021271181).

Assessment the effect of genomic selection and detection of selective signature in broilers.

Due to high selection advances and shortened generation interval, genomic selection (GS) is now an effective animal breeding scheme. In broilers, many studies have compared the accuracy of different GS prediction methods, but few reports have demonstrated phenotypic or genetic changes using GS. In this study, the paternal chicken line B underwent continuous selection for 3 generations. The chicken 55 k SNP chip was used to estimate the genetic parameters and detect genomic response regions by selective sweep analysis. The heritability for body weight (BW), meat production, and abdominal fat traits were ranged from 0.12 to 0.38. A high genetic correlation was found between BW and meat production traits, while a low genetic correlation (<0.1) was found between meat production and abdominal fat traits. Selection resulted in an increase of about 516 g in BW and 140 g in breast muscle weight. Percentage of breast muscle and whole thigh were increased 0.8 to 1.5%. No change was observed in abdominal fat percentage. The genomic estimated breeding value advances was positive for BW and meat production (except whole thigh percentage), while negative for abdominal fat percentage. By selective sweep analysis, 39 common chromosomal regions and 102 protein coding genes were found to be influenced, including MYH1A, MYH1B, and MYH1D of the MYH gene family. Tight junction pathway as well as myosin complex related terms were enriched. This study demonstrates the effective use of GS for improvements in BW and meat production in chicken line B. Further, genomic regions, responsive to intensive genetic selection, were identified to contain genes of the MYH family.

A binary hidden Markov model on spatial network for amyotrophic lateral sclerosis disease spreading pattern analysis.

Amyotrophic lateral sclerosis (ALS) is a neurological disease that starts at a focal point and gradually spreads to other parts of the nervous system. One of the main clinical symptoms of ALS is muscle weakness. To study spreading patterns of muscle weakness, we analyze spatiotemporal binary muscle strength data, which indicates whether observed muscle strengths are impaired or healthy. We propose a hidden Markov model-based approach that assumes the observed disease status depends on two latent disease states. The model enables us to estimate the incidence rate of ALS disease and the probability of disease state transition. Specifically, the latter is modeled by a logistic autoregression in that the spatial network of susceptible muscles follows a Markov process. The proposed model is flexible to allow both historical muscle conditions and their spatial relationships to be included in the analysis. To estimate the model parameters, we provide an iterative algorithm to maximize sparse-penalized likelihood with bias correction, and use the Viterbi algorithm to label hidden disease states. We apply the proposed approach to analyze the ALS patients' data from EMPOWER Study.

Distinguishing soft tissue sarcomas of different histologic grades based on quantitative MR assessment of intratumoral heterogeneity.

PURPOSE: To explore the role of intratumoral heterogeneity on MRI assessed by histogram analysis in differentiating soft-tissue sarcomas (STS) of different grades. MATERIALS AND METHODS: Patients with primary STS undergoing MRI prior to iatrogenic procedures were included retrospectively. The histologic grade was assigned according to Federation Nationale des Centres de Lutte Contre le Cancer grading system. T1WI and T2WI were normalized by dividing mean signal intensity (SI) of contralateral/near unaffected muscles. Contrast-enhanced T1WI was normalized by computing enhancement ratio (ER) map as (SIpost-SIpre)/SIpre×100, where SIpre and SIpost represent SI of each pixel before and after enhancement. A region of interest (ROI) was manually drawn to include entire tumor area on axial slice with largest tumor diameter. Mean, mode, standard deviation, kurtosis and skewness on ROIs were extracted with ImageJ software. ANOVA/Kruskal-Wallis test was used to determine the significance of differences. ROC curve was applied for statistically significant parameters. P value ≤0.05 was considered statistically significant. RESULTS: Among involved 67 patients, 8 were assigned to grade 1, 38 to grade 2 and 21 to grade 3. Skewness (P =  0.022) and kurtosis (P =  0.035) on ER maps were significantly different among STS of different grades. The optimal cutoffs of skewness and kurtosis on ER maps were -0.488 (AUC[95% CI] 0.747[0.557-0.937]; sensitivity/specificity, 62.5%/86.4%) and 0.762 (AUC[95% CI] 0.684[0.548-0.821]; sensitivity/specificity, 76.2%/56.5%), respectively. CONCLUSION: Intratumoral heterogeneity on MRI quantitatively displayed by histogram parameters can differentiate STS of different grades. Skewness and kurtosis on ER maps show the capacity.

Left Ventricular Ejection Fraction Assessment: Unraveling the Bias between Area- and Volume-based Estimates.

Calculating left ventricular ejection fraction (LVEF) accurately is crucial for the clinical diagnosis of cardiac disease, patient management, or other therapeutic treatment decisions. The measure of a patient's LVEF often affects their candidacy for cardiovascular intervention. Ultrasound (US) is one of the imaging modalities used to non-invasively assess LVEF, and it is the most common and least expensive. Despite the advances in 3D US transducer technology, only limited US machines are equipped with such transducer to enable true 3D US image acquisition. Thus, 2D US images remain to be widely used by cardiologists to image the heart and their interpretation is inherently based on two dimensional information immediately available in the US images. Past knowledge indicates that visual estimation of the LVEF based on the area changes of the left ventricle blood pool between systole and diastole (as depicted in 2D ultrasound images) may significantly underestimate the ejection fraction, rendering some patients as suitable candidates for potentially unnecessary interventions or implantation of assistive devices. True LVEF should be calculated based on changes in LV volumes, but equipment and time constraint limit the current technique to assess 3D LV geometry. The estimation of the systolic and diastolic blood pool volumes requires additional work beyond a simple visual assessment of the blood pool area changed in the 2D US images. Specifically, following the manual segmentation of the endocardial LV border, 3D volume would be assessed by reconstructing a LV volume from multiple tomographic views. In this work, we leverage on two idealized mathematical models of the left ventricle - a truncated prolate spheroid (TPS) and a paraboloid geometric model to characterize the LV shape according to the range of possible dimensions gathered from our patient-specific multi-plane US imaging data. The objective of this work is to reveal the necessity of calculating LVEFs based on volumes by showing that LVEF estimated using area changes underestimate the LVEF computed using volume changes. Additionally, we present a method to reconstruct the LV volume from 2D blood pool representations identified in the multi-plane 2D US images and use the reconstructed 3D volume throughout the cardiac cycle to estimate the LVEF. Our preliminary results show that the area-based LVEF significantly underestimates the true volume-based LVEF across both the theoretical simulations using idealized geometric models of the LV shape, as well as the patient-specific US imaging data. Specifically, both the TPS and paraboloid model showed an area-based LVEF of 41.3 ± 4.7% and a volume-based LVEF of 55.4 ± 5.7%, while the US image data showed an area-based LVEF of 34.7 ± 11.9% and a volume-based LVEF of 48.0 ± 14.0%. In summary, the area-based LVEF estimations using both the idealized TPS and paraboloid models was 14.1% lower than volume- based LVEF calculations using corresponding models. Furthermore, the area-based LVEF based on reconstructed LV volumes are 13.3% lower than volume-based estimates. Evidently, there is a need to further investigate a method to enable practical volume-based LVEF calculations to avoid the need for clinicians to estimate LVEF based on visual, holistic assessment of the blood pool area changes that improperly infer volumetric blood pool changes.

Assessment of Lung Recruitment by Electrical Impedance Tomography and Oxygenation in ARDS Patients.

We hypothesized that not all patients with appreciably recruited lung tissue during a recruitment maneuver (RM) show significant improvement of oxygenation. In the present study, we combined electrical impedance tomography (EIT) with oxygenation measurements to examine the discrepancies of lung ventilation and perfusion versus oxygenation after RM.A 2-minute RM (20 cm H2O positive end-expiratory pressure [PEEP] + 20 cm H2O pressure control) was prospectively conducted in 20 acute respiratory distress syndrome patients from January 2014 to December 2014. A decremental PEEP trial was performed to select the PEEP level after RM. A positive response to RM was identified as PaO2 + PaCO2 ≥400 mm Hg. Relative differences in the distribution of ventilation and perfusion in the most dependent region of interest (ROI4) were monitored with EIT and denoted as the ventilation-perfusion index.Ten patients were found to be responders and 10 patients to be nonresponders. No significant difference in baseline PaO2/FiO2 was observed between nonresponders and responders. A significantly higher PaO2/FiO2 ratio during RM and higher PEEP set after PEEP titration were recorded in responders. In both responders and nonresponders, the proportion of ventilation distributed in ROI4 compared with the global value was lower than the cardiac-related activity before RM, but this situation was reversed after RM (P < 0.01 in each group). Six out of 10 nonresponders exhibited a remarkable increase in ventilation in ROI4. A significant difference in the relative ventilation-perfusion index was found between the patients with remarkable and insufficient lung tissue reopening in the nonresponder group (P < 0.01).A discrepancy between lung tissue reopening and oxygenation improvement after RM was observed. EIT has the potential to evaluate the efficacy of RM by combining oxygenation measurements.

[The role of end-tidal carbon dioxide partial pressure in fluid responsiveness assessment in septic shock patient].

OBJECTIVE: To assess whether end-tidal carbon dioxide partial pressure (PETCO2) can predict the fluid responsiveness in septic shock patients. METHODS: Septic shock patients under mechanical ventilation without spontaneous breathing and with the need of a fluid challenge test were included in this study.Heart rate, central venous pressure, pulse pressure, PETCO2, and CI before and after the fluid challenge test were conducted in all the patients. RESULTS: Of the 48 septic shock patients included, 34 had preload responsiveness, 14 had no responsiveness. ΔCI and ΔPETCO2 after the fluid challenge test in "volume responders" were (0.85 ± 0.47) L×min(-1)×m(-2) and (3.5 ± 2.5) mmHg respectively, which were higher than those in "no volume responders"(P < 0.05). The fluid-induced changes in PETCO2 and CI were correlated (r = 0.072, P < 0.05). The AUCROC of fluid challenge-induced ΔPETCO2 as the predictor for volume responsiveness was 0.943, and its sensitivity was 87.9% and specificity was 93.4% with a critical value of 5%. The AUCROC of ΔPP as the predictor for volume responsiveness was 0.801, and its sensitivity was 68.1% and specificity was 73.2% with a critical value of 10%. CONCLUSION: The changes of PETCO2 induced by a fluid challenge test can predict fluid responsiveness with reliability, and have a better sensitivity and specificity than the changes of PP.

Integrated cardiopulmonary sonography: a useful tool for assessment of acute pulmonary edema in the intensive care unit.

OBJECTIVES: Bedside sonography has become a popular method of assessment of critically ill patients with shock and dyspnea. This study evaluated the usefulness of integrated cardiopulmonary sonography for assessment of acute pulmonary edema. METHODS: A total of 128 intensive care unit (ICU) patients with acute pulmonary edema were randomly divided into 2 groups: a sonography group, which received standard treatment as well as cardiopulmonary sonography, and a control group, which received standard treatment only. All patients were treated according to the same therapeutic strategies and underwent chest radiography and central venous catheter placement. Serum myocardial injury marker levels and central venous/arterial blood gas parameters were measured 0, 24, and 72 hours after enrollment. The cumulative fluid infusion volume at 6, 12, 24, and 72 hours, the time to diagnosis of the pulmonary edema etiology by the attending physician, the lengths of ICU and hospital stays, and ICU mortality were recorded. RESULTS: The sonography group had a shorter time to diagnosis and received a smaller fluid infusion volume than the control group. There were no significant differences in ICU mortality and lengths of ICU and hospital stays between the sonography and control groups. In patients with cardiogenic pulmonary edema, the sonography group had a significantly shorter ICU stay and a faster return to normal myocardial injury marker levels and perfusion parameters than the control group (P < .05). CONCLUSIONS: Integrated cardiopulmonary sonography resulted in faster and better-informed clinical decision making, shortened the time to diagnosis of the pulmonary edema etiology, and decreased fluid use. However, the impact of this examination on prognoses requires further study. We propose that integrated cardiopulmonary sonography may be a useful bedside tool for treatment of ICU patients with acute pulmonary edema.

[Value of peripheral perfusion index in the assessment of reactive hyperemia in septic patients].

OBJECTIVE: To explore the changes of peripheral perfusion index (PI) during forearm vascular occlusion test (VOT) and examine its evaluative value of reactive hyperemia in septic patients. METHODS: Twenty-one patients with septic shock, 21 postoperative ones without infection and 18 health volunteers were prospectively recruited to undergo vascular occlusion test. An arrest of forearm blood flow was applied for 3 min with a sphygmomanometer inflated to a pressure approximately 30 mm Hg greater than systolic pressure around forearm. PI was measured and recorded continuously by conventional pulse oximetry during VOT. RESULTS: (1)In all subjects, the PI values decreased to zero during ischemic period. There were no changes in heart rate or blood pressure between baseline and reperfusion. The maximum PI (PI-max) after a release of pneumatic cuff was significantly higher than baseline PI; (2)The change rates of PI-max and PI were significantly lower and the time to PI-max was longer in septic group after reperfusion; (3) A negative relationship existed between PI change rate and sequential organ failure assessment (SOFA) score in septic group. CONCLUSIONS: PI may be used to assess vascular reactive hyperemia in critically ill patients. And the capacity of peripheral vascular reactive hyperemia decreases in septic patients.

[The value of bedside lung ultrasound in emergency-plus protocol for the assessment of lung consolidation and atelectasis in critical patients].

OBJECTIVE: To investigate the effect of the bedside lung ultrasound in emergency(BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients. METHODS: All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study. BLUE-plus and BLUE lung ultrasound, bedside X-ray, lung CT examination were performed on all patients at the same time. The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT. The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared. RESULTS: A total of 78 patients were finally enrolled in the study. The lung CT found 70 cases (89.74%) had different degrees of lung consolidation and atelectasis. The sensitivity, specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29%, 75.00% and 38.46%, respectively. BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 95.71%, 87.50% and 94.87%, respectively, which were significantly higher than those of lung CT. BLUE protocol found 48 cases of lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 65.71%, 75.00% and 66.67%, respectively. The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT. CONCLUSIONS: The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high. The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity, specificity and diagnostic accuracy for consolidation and atelectasis, which can find majority of consolidation and atelectasis. As BLUE-plus lung ultrasound is a bedside noninvasive method allowing immediate assessment of most lung consolidation and atelectasis, it will be likely the alternative of the CT and play a key role in assessment of lung consolidation and atelectasis.

Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: initial results from the National Oncologic PET Registry.

PURPOSE: Under Medicare's Coverage with Evidence Development policy, positron emission tomography (PET)/computed tomography (CT) and PET became covered services for previously noncovered cancer indications if prospective registry data were collected. The National Oncologic PET Registry (NOPR) was developed to meet these coverage requirements and to assess how PET affects care decisions. METHODS: The NOPR collected questionnaire data from referring physicians on intended patient management before and after PET. After 1 year, the cohort included data from 22,975 studies (83.7% PET/CT) from 1,178 centers. The numbers of scans performed for diagnosis of suspected cancer (or unknown primary cancer), initial cancer staging, restaging, and suspected cancer recurrence were approximately equal. Prostatic, pancreatic and ovarian cancers represented approximately 30% of cases. RESULTS: If PET data were not available, the most common pre-PET plan would have been other imaging. In these patients, the post-PET strategies changed to watching in 37% and treatment in 48%. In patients with planned biopsy before PET, biopsy was avoided in approximately 70%. If the pre-PET strategy was treatment, the post-PET strategy involved a major change in type in 8.7% and goal in 5.6%. When intended management was classified as either treatment or nontreatment, the post-PET plan was three-fold more likely to lead to treatment than nontreatment (28.3% v 8.2%; odds ratio = 3.4; 95% CI, 3.2 to 3.6). Overall, physicians changed their intended management in 36.5% (95% CI, 35.9 to 37.2) of cases after PET. CONCLUSION: This large, prospective, nationally representative registry of elderly cancer patients found that physicians often change their intended management on the basis of PET scan results across the full spectrum of its potential uses.

The National Oncologic PET Registry (NOPR): design and analysis plan.

UNLABELLED: The Centers for Medicare and Medicaid Services (CMS) has provided a mechanism for expanded coverage of selected promising technologies under its "coverage with evidence development (CED)" policy. The National Oncologic PET Registry (NOPR) was designed to address the CED requirements for collection of clinical and demographic data to allow for CMS coverage of PET for previously noncovered cancer types and indications. The NOPR opened in May 2006. This report reviews the NOPR's data collection and analysis plan. METHODS: NOPR is a nationwide prospective internet-based registry. All PET facilities that are participating providers in the Medicare program may enroll in NOPR. The PET facility is responsible for collecting and entering patient data into the NOPR database through a Web application at: (http://www.cancerPETregistry.org/). Data are collected from the requesting physician on Pre-PET and Post-PET forms. The primary research goal is to assess the effect of PET on referring physicians' plans of intended patient management across the spectrum of expanded cancer indications (diagnosis, staging, restaging, suspected recurrence, and treatment monitoring). The NOPR investigators will have access to data only on cases in which both the patient and the referring physician have consented to allow their data to be used for research. Data will be analyzed and compared in aggregate for all cancers by category (e.g., staging) and then for specific high-impact types and indications (e.g., staging of pancreatic cancer) when 200 patients have been accrued to a specific combination or after the NOPR has been operational for 1 y. CONCLUSION: The NOPR will allow an accurate assessment of the impact of PET on intended patient management across a wide spectrum of cancer indications.