Effect of volatile versus propofol anaesthesia on major complications and mortality after cardiac surgery: a multicentre randomised trial.

BACKGROUND: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).

Structural Health Monitoring in Long-Span Steel Structures Based on the BeiDou Navigation Satellite System.

The BeiDou navigation satellite system (BDS) provides precise positioning, navigation, and timing (PNT) services in the Asia-Pacific Region, but the BDS-based structural health monitoring (SHM) approach (SHM) is rarely studied, especially in civil engineering. Moreover, how BDS can be applied to complete the tasks of SHM in a real project is also not fully investigated, especially working in conjunction with other techniques. This study aims to propose a BDS-based approach for SHM in civil engineering. The performance of the proposed approach is investigated through a case study-the Tianhan Grand Theater (TGT). A specific Tianhan system corresponding to BDS is proposed to complete the SHM tasks of TGT. Based on the collected data, the trusses with maximum displacement and stress are found by BDS to evaluate structural health in the construction stage. The results show that the maximum displacement and stress have certain safety reserves and meet the requirements of the specifications and regulations. Thus, BDS can satisfactorily complete the tasks of SHM for Long-span steel structures. This study gives a clear view to engineers and researchers that how to apply BDS in structural construction and provides a valuable real case for evaluating the performance of BDS in SHM.

[Exploring and analyzing the improvement mechanism of U-Net and its application in medical image segmentation].

Remarkable results have been realized by the U-Net network in the task of medical image segmentation. In recent years, many scholars have been researching the network and expanding its structure, such as improvement of encoder and decoder and improvement of skip connection. Based on the optimization of U-Net structure and its medical image segmentation techniques, this paper elucidates in the following: First, the paper elaborates on the application of U-Net in the field of medical image segmentation; Then, the paper summarizes the seven improvement mechanism of U-Net: dense connection mechanism, residual connection mechanism, multi-scale mechanism, ensemble mechanism, dilated mechanism, attention mechanism, and transformer mechanism; Finally, the paper states the ideas and methods on the U-Net structure improvement in a bid to provide a reference for later researches, which plays a significant part in advancing U-Net.

Utility of enzyme-linked immunosorbent assays to test core antigen in the diagnosis and antiviral therapy management of hepatitis C virus infections.

In this study, we evaluate the performance of the enzyme-linked immunosorbent assays (ELISAs) for HCV Ag detection in the diagnosis and antiviral therapy management of HCV infections. For the diagnosis of an active HCV infection, the limit of detection of HCV Ag corresponding to HCV RNA level was approximately 7300 IU/mL; the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HCV-Ag were 88.96, 100, 100, and 91.33%, respectively. The Pearson's correlation coefficient between HCV Ag and HCV RNA was 0.891. All patients with negative HCV Ag at interferon-α2α/ribavirin therapy week 1 achieved a sustained viral response (SVR), and the PPV was 100%; whereas in patients with positive HCV Ag at therapy weeks 12, the NPV for achieving non-response (NR) was 100%. The results showed that ELISAs for HCV Ag detection could be cost effectively applied to diagnose and evaluate the response to antiviral therapy for HCV infections.

Teeth U-Net: A segmentation model of dental panoramic X-ray images for context semantics and contrast enhancement.

BACKGROUND AND OBJECTIVE: It is very significant in orthodontics and restorative dentistry that the teeth are segmented from dental panoramic X-ray images. Nevertheless, there are some problems in panoramic X-ray images of teeth, such as blurred interdental boundaries, low contrast between teeth and alveolar bone. METHODS: In this paper, The Teeth U-Net model is proposed in this paper to resolve these problems. This paper makes the following contributions: Firstly, a Squeeze-Excitation Module is utilized in the encoder and the decoder. And proposing a dense skip connection between encoder and decoder to reduce the semantic gap. Secondly, due to the irregular shape of the teeth and the low contrast of the dental panoramic X-ray images. A Multi-scale Aggregation attention Block (MAB) in the bottleneck layer is designed to resolve this problem, which can effectively extract teeth shape features and fuse multi-scale features adaptively. Thirdly, in order to capture dental feature information in a larger field of perception, this paper designs a Dilated Hybrid self-Attentive Block (DHAB) at the bottleneck layer. This module effectively suppresses the task-irrelevant background region information without increasing the network parameters. Finally, the effectiveness of the algorithm is validated using a clinical dental panoramic X-ray image datasets. RESULTS: The results of the three comparison experiments are shown that Accuracy, Precision, Recall, Dice, Volumetric Overlap Error and Relative Volume Difference for dental panoramic X-ray teeth segmentation are 98.53%, 95.62%, 94.51%, 94.28%, 88.92% and 95.97% by the proposed model respectively. CONCLUSION: The proposed modules complement each other in processing every detail of the dental panoramic X-ray images, which can effectively improve the efficiency of preoperative preparation and postoperative evaluation, and promote the application of dental panoramic X-ray in medical image segmentation. There are more accuracy about Teeth U-Net than others model in dental panoramic X-ray teeth segmentation. That is very important to clinical doctors to cure in orthodontics and restorative dentistry.

The role of butyrylcholinesterase in the regulation of cognitive dysfunction in minimal hepatic encephalopathy: A potential blood marker of disease evolution.

Background and aims: Patients with cirrhosis commonly experience minimal hepatic encephalopathy (MHE), and alterations in neurotransmitters have been thought to be related to cognitive function. However, the relationship between alterations in peripheral and central butyrylcholinesterase (BuChE) with MHE disease progression remains unknown. As such, this study was designed to investigate potential changes in peripheral and central BuChE activity and their effects on cognitive function in the context of MHE. Materials and methods: We enrolled 43 patients with cirrhosis secondary to hepatitis B, 20 without MHE and 23 with MHE, and 25 with healthy controls (HC). All the selected subjects underwent resting-state functional MRI, and the original images were processed to obtain the regional homogeneity (ReHo) brain maps. Thereafter, the correlation of BuChE activity with ReHo, number connection test of type A (NCT-A), and digital symbol test (DST) scores with MHE patients were analyzed using Person correlation analysis. Meanwhile, we purchased 12 Sprague-Dawley (SD) rats and divided them into an experimental group (n = 6) and a control group (n = 6). The rats in the experimental group were intraperitoneally injected with thioacetamide (TAA) to prepare MHE model rats. After modeling, we used the Morris water maze (MWM) and elevated plus maze (EPM) to assess the cognition function and exploratory behavior of all rats. The activity of serum, hippocampus, and frontal lobe tissue BuChE was detected by ELISA. Results: BuChE activity gradually decreased among the HC, patients with cirrhosis, and MHE groups (all P < 0.01). We observed a linear correlation between serum BuChE and NCT-A and DST scores in MHE patients (all P < 0.01). We noted that BuChE activity can negatively correlate with ReHo values in the left middle temporal gyrus and left inferior temporal gyrus, and positively correlate with ReHo values in the right inferior frontal gyrus, and also found that the peripheral BuChE activity of MHE rats was significantly lower than their control counterparts, and the BuChE activity in frontal lobe extracts was significantly higher than the control rats (all P < 0.05). Conclusion: The altered activity of BuChE may contribute to cognitive impairment in MHE patients, which may be a potential biomarker of disease evolution in the context of MHE.

Decreased brain noradrenaline in minimal hepatic encephalopathy is associated with cognitive impairment in rats.

BACKGROUND AND AIMS: Minimal hepatic encephalopathy (MHE) is a common neuropsychiatric complication in patients with cirrhosis. Alterations in monoamine neurotransmitters have been associated with the pathogenesis of MHE. We investigated the levels of hippocampal noradrenergic neurotransmitter in a rat model of thioacetamide-induced chronic liver failure-related MHE, and their role in cognitive impairment. MATERIALS: 18 male Sprague-Dawley (SD) rats were equally divided in MHE and control groups. A rat model of MHE was established by intraperitoneal injection of thioacetamide (TAA) for 12 weeks. Cognitive function was assessed using the Morris water maze (MWM) test and locomotor activity and exploratory behavior assessed with open field test. The concentration of hippocampal noradrenaline (NE) was detected by ELISA, and the magnetic susceptibility value in the hippocampus was detected by quantitative susceptibility mapping. Hippocampal iron content was quantified by Prussian blue staining. RESULTS: MHE rats performed significantly poorer than their control counterparts in the MWM test, as seen by decreased number of platform crossings and time in the target quadrant, and increased path length to reach the target zone (P < 0.05 for all parameters). In the open field test, the MHE group exhibited lower locomotor activity and exploratory behavior than the control group (P < 0.05 for all parameters). We detected pronounced iron staining in the hippocampus of MHE rats, whereas no iron-stained particles were found in control rats. We observed an imbalance of inflammatory (increased pro- and decreased anti-) cytokines in the hippocampus of MHE rats. Further analysis of the data showed that the level of hippocampal noradrenaline in MHE rats was significantly lower than that of control rats (P < 0.05). We observed a correlation between the level of inflammatory cytokine and noradrenaline land susceptibility value in the rat hippocampus of the MHE group. CONCLUSION: Our results suggest that MHE associated with TAA-induced chronic liver failure is associated with alterations in noradrenergic neurotransmission. We propose that iron imbalance in the brain might lead to reduction in the levels of noradrenaline, and cognitive impairment.

An assessment of the Chinese medicinal Dendrobium industry: Supply, demand and sustainability.

ETHNOPHARMACOLOGICAL RELEVANCE: A high proportion of species native to China from the genus Dendrobium (Orchidaceae) have been used as folk medicine for more than 2300 years. The fresh or dried stem of many Dendrobium species are regarded as "superior grade" tonic in Traditional Chinese Medicine (TCM), for their traditional properties of nourishing the kidney, moisturizing the lung, benefiting the stomach, promoting the production of body fluids and clearing heat. AIM OF THE STUDY: This review aims to provide comprehensive and updated information on the diversity of Dendrobium species used in TCM and the development of the Dendrobium industry. The supply and demand of the Chinese medicinal Dendrobium are investigated. Moreover, we discuss the problems the industry faces and the relationship between the cultivation and species conservation. MATERIALS AND METHODS: The available information on many Dendrobium species (especially D. officinale) was collected from the electronic databases (using Pubmed, CNKI, Baidu scholar, Google scholar and Web of Science). We also obtained information from communication with specialists with profound knowledge in related research field and industry practitioners. Information was also obtained from website of the Forestry Bureau or relevant government departments, online databases, books, Ph.D. dissertations and M.Sc. theses. RESULTS: Approximately 41 species in genus Dendrobium have been recorded in TCM. The development of the Dendrobium industry could be divided into three phases: (a) the wild-collection phase, (b) the massive commercial artificial-sheltered cultivation phase and (c) the diversified ecologically-friendly cultivation phase. The development of seedlings production technology, the improvement of substrates and the integration of cultivation technology support the rapid increase of Dendrobium herbs in the Chinese TCM market. Doubts around the quality and efficacy of product in artificial-sheltered cultivation, the lack of product standards and the low level of product development have limited the utilization for TCM and hampered the development of the Dendrobium industry. Both the artificial-sheltered cultivation and ecologically-friendly cultivation contribute to the conservation of Dendrobium species, through the use seedlings derived from seeds of sexual reproduction rather than meristematic-based clonal propagation. CONCLUSIONS: This review summarizes the species and cultivation history of medicinal herbs in the Dendrobium. The review can help inform future scientific research towards the TCM in Dendrobium, including mycorrhizal technology and microorganism fertilizer, pharmacological studies, the directed cultivation of varieties and diversified product. It is suggested that Dendrobium cultivation has a great potential to link the commercial TCM industry together with initiatives of biodiversity conservation.

Evaluation of the characteristics of the enzyme-linked immunospot assay for diagnosis of active tuberculosis in China.

The purpose of this study was to evaluate the characteristics of the T-SPOT.TB test for the diagnosis of active tuberculosis (ATB) and to distinguish ATB from other diseases using a receiver operating characteristic (ROC) curve. A total of 535 patients with suspected active tuberculosis were enrolled in the study and divided into ATB and nonactive tuberculosis (NATB) groups, as well as pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) subgroups. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB test for the diagnosis of ATB were 84.95%, 85.12%, 82.94%, 86.93%, 5.71, and 0.18, respectively. The median number of spot-forming cells (SFCs) in the ATB group was higher than that in the NATB group (71 versus 1; P < 0.0001). The sensitivities in the PTB and EPTB subgroups were 92.31% and 81.77%. The areas under the curve (AUC) for the diagnosis of ATB using the T-SPOT.TB, early secreted antigenic target 6 (ESAT-6), and culture filtrate protein 10 (CFP-10) were 0.906, 0.884, and 0.877, respectively. A cutoff of 42.5 SFCs for ATB yielded a positive predictive value of 100%. Our study shows that the T-SPOT.TB test is useful for the diagnosis of ATB. Utilizing an ROC curve to select an appropriate cutoff made it possible to discriminate ATB from NATB.