Prediction of 3-year risk of diabetic kidney disease using machine learning based on electronic medical records.

BACKGROUND: Established prediction models of Diabetic kidney disease (DKD) are limited to the analysis of clinical research data or general population data and do not consider hospital visits. Construct a 3-year diabetic kidney disease risk prediction model in patients with type 2 diabetes mellitus (T2DM) using machine learning, based on electronic medical records (EMR). METHODS: Data from 816 patients (585 males) with T2DM and 3 years of follow-up at the PLA General Hospital. 46 medical characteristics that are readily available from EMR were used to develop prediction models based on seven machine learning algorithms (light gradient boosting machine [LightGBM], eXtreme gradient boosting, adaptive boosting, artificial neural network, decision tree, support vector machine, logistic regression). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was used to interpret the results of the best performing model. RESULTS: The LightGBM model had the highest AUC (0.815, 95% CI 0.747-0.882). Recursive feature elimination with random forest and SHAP plot based on LightGBM showed that older patients with T2DM with high homocysteine (Hcy), poor glycemic control, low serum albumin (ALB), low estimated glomerular filtration rate (eGFR), and high bicarbonate had an increased risk of developing DKD over the next 3 years. CONCLUSIONS: This study constructed a 3-year DKD risk prediction model in patients with T2DM and normo-albuminuria using machine learning and EMR. The LightGBM model is a tool with potential to facilitate population management strategies for T2DM care in the EMR era.

Long-term activity of tandem CD19/CD20 CAR therapy in refractory/relapsed B-cell lymphoma: a single-arm, phase 1-2 trial.

Increasing the remission rate and reducing the recurrence rate can improve the clinical efficacy of chimeric antigen receptor (CAR) T cell therapy in recurrent/refractory non-Hodgkin lymphoma (r/rNHL). In this open-label, single-arm phase I/II trial, 87 patients with r/rNHL, including 58 patients with aggressive diffuse large B-cell lymphoma and 24 with high tumour burden, received an infusion at doses of 0.5 × 106-8 × 106 TanCAR7 T cells per kilogram of body weight after conditioning chemotherapy. The best overall response rate was 78% (95% confidence interval [CI], 68-86); response rates were consistent across prognostic subgroups. The median follow-up was 27.7 months. The median progression-free survival was 27.6 months (95% CI, 11 to not reached). Cytokine release syndrome (CRS) occurred in 61 patients (70%) with 60% of cases being grade 1 or 2 and 10% being grade 3 or greater. Grade 3 CAR T cell-related encephalopathy syndrome (CRES) occurred in 2 patients (2%). Two patients died from treatment-associated severe pulmonary infection, and one died from CRS-related pulmonary injury between 1 and 3 months post infusion. Long-term remissions were observed following the use of TanCAR7 T cells in r/rNHL with a safety profile that included CRS but few cases of CRES.

Effectiveness and safety of pharmacological interventions for hospitalized neonatal pain ：an overview of systematic review and meta-analysis / 中国药房

OB JECTIVE To conduct overview of the systematic revi ew（SR）/meta-analysis for the effectiveness and safety of pharmacological interventions for hospitalized neconatal pain ， and to provide evidence-based reference for neonatal pain management. METHODS CNKI，CBM，Wanfang，VIP，PubMed，Embase，the Cochrane Library ，Web of Science ，CINAHL and Google Scholar were searched for SR/meta-analysis of pharmacological interventions for hospitalized neonatal pain. The search period was from Nov. 1st，2016-Nov. 1st，2021. After literature screening and data extraction ，AMSTAR 2 scale was used to evaluate the methodological quality of the included literature ，and GRADE method was used to assess the evidence quality of the outcome of the include d literature . A su mmary analysis was then conducted. RESULTS Totally 36 outcome indexes of 7 SR/ meta-analysis were included. Five studies were of moderate quality，and two were very poor according to AMSTAR 2 scale. GRADE results showed that among 36 outcome indexes，there were 7 moderate-quality indexes （19.44％），low-quality indexes （61.11％），and 7 critically-low-quality indexes （19.44％）. The main reason for downgrading the quality of evidence was impr ecision of results （71.74％）. CONCLUSIONS Opioids c an significantly reduce t he pain score of mechanically ventilated neonates but may increase hypotension. Acetaminophen can significantly reduce pain scores during eye examinations and postoperative morphine consumption with no adverse reaction report. However ，its analgesic effect on procedural pain is less than glucose and sucrose. Lidocaine and prilocaine and tetracaine may relieve venipuncture and lumbar puncture pain but lidocaine and prilocaine may increase the risk of adverse reaction. Clonidine can reduce neonatal mechanical ventilation pain with no adverse reaction report. It is suggested that neonatal pediatricians should use analgesic drugs selectively based on clinical judgment and pain assessment results.

Predictive model and risk analysis for diabetic retinopathy using machine learning: a retrospective cohort study in China.

OBJECTIVE: Aiming to investigate diabetic retinopathy (DR) risk factors and predictive models by machine learning using a large sample dataset. DESIGN: Retrospective study based on a large sample and a high dimensional database. SETTING: A Chinese central tertiary hospital in Beijing. PARTICIPANTS: Information on 32 452 inpatients with type-2 diabetes mellitus (T2DM) were retrieved from the electronic medical record system from 1 January 2013 to 31 December 2017. METHODS: Sixty variables (including demography information, physical and laboratory measurements, system diseases and insulin treatments) were retained for baseline analysis. The optimal 17 variables were selected by recursive feature elimination. The prediction model was built based on XGBoost algorithm, and it was compared with three other popular machine learning techniques: logistic regression, random forest and support vector machine. In order to explain the results of XGBoost model more visually, the Shapley Additive exPlanation (SHAP) method was used. RESULTS: DR occurred in 2038 (6.28%) T2DM patients. The XGBoost model was identified as the best prediction model with the highest AUC (area under the curve value, 0.90) and showed that an HbA1c value greater than 8%, nephropathy, a serum creatinine value greater than 100 µmol/L, insulin treatment and diabetic lower extremity arterial disease were associated with an increased risk of DR. A patient's age over 65 was associated with a decreased risk of DR. CONCLUSIONS: With better comprehensive performance, XGBoost model had high reliability to assess risk indicators of DR. The most critical risk factors of DR and the cut-off of risk factors can be found by SHAP method to render the output of the XGBoost model clinically interpretable.

Preparation of aminoalkyl-grafted bacterial cellulose membranes with improved antimicrobial properties for biomedical applications.

Bacterial cellulose (BC) membranes display special properties and structures, thus attracting much attention in application in the biomedical areas, for example, as implants for bone or cartilage tissue engineering, as substitutes for skin repairing, and as supports for controlled drug delivery. However, native BC lacks the activity to inhibit bacteria growth on its surface, which limits its applications in biomedical fields. There have been reports on chemical modification of BC membranes to endow them with antimicrobial properties needed for some special biomedical applications. In the present study, aminoalkyl-grafted BC membranes were prepared by alkoxysilane polycondensation using 3-aminopropyltriethoxysilane (APTES). The characterization for morphology and chemical composition showed that BC membranes were successfully grafted with aminoalkylsilane groups through covalent bonding. The surface morphology and roughness of the membranes changed after chemical grafting. Furthermore, after grafting with APTES, the membranes got less hydrophilic than native BC. The aminoalkyl-grafted BC membranes showed strong antibacterial properties against Staphylococcus aureus and Escherichia coli and moreover, they were nontoxic to normal human dermal fibroblasts. These results indicate that aminoalkyl-grafted BC membranes are potential to be used for biomedical applications.

High-Speed Efficient Terahertz Modulation Based on Tunable Collective-Individual State Conversion within an Active 3 nm Two-Dimensional Electron Gas Metasurface.

Terahertz (THz) modulators are always realized by dynamically manipulating the conversion between different resonant modes within a single unit cell of an active metasurface. In this Letter, to achieve real high-speed THz modulation, we present a staggered netlike two-dimensional electron gas (2DEG) nanostructure composite metasurface that has two states: a collective state with massive surface resonant characteristics and an individual state with meta-atom resonant characteristics. By controlling the electron transport of the nanoscale 2DEG with an electrical grid, collective-individual state conversion can be realized in this composite metasurface. Unlike traditional resonant mode conversion confined in meta-units, this state conversion enables the resonant modes to be flexibly distributed throughout the metasurface, leading to a frequency shift of nearly 99% in both the simulated and experimental transmission spectra. Moreover, such a mechanism can effectively suppress parasitic modes and significantly reduce the capacitance of the metasurface. Thereby, this composite metasurface can efficiently control the transmission characteristics of THz waves with high-speed modulations. As a result, 93% modulation depth is observed in the static experiment and modulated sinusoidal signals up to 3 GHz are achieved in the dynamic experiment, while the -3 dB bandwidth can reach up to 1 GHz. This tunable collective-individual state conversion may have great application potential in wireless communication and coded imaging.

Developmental trends and precursors of English spelling in Chinese children who learn English-as-a-second language: Comparisons between average and at-risk spellers.

BACKGROUND: Invented spelling has been viewed as a window to young children's spelling development. AIMS: This longitudinal study investigated the developmental trends in invented spelling as a function of phoneme position in very young ESL children. It also investigated cognitive-linguistic precursors of L2 spelling difficulties. METHODS AND PROCEDURES: We identified 2 groups of spellers in kindergarten based on their invented spelling performances at the end of kindergarten: average spellers and at-risk spellers. The two groups were compared on invented spelling performance at varied phoneme positions of a word. They were also administered a battery of cognitive-linguistic tasks, including letter knowledge, phonemic awareness, vocabulary and rapid automatized naming at an earlier timepoint. OUTCOMES AND RESULTS: Both groups performed better in invented spelling on initial consonants than on medial vowels, which in turn were better than final consonants at two time points. In addition, the average spellers improved significantly more than the at-risk spellers at all phoneme positions. Vocabulary was a significant predictor of spelling difficulties when other crucial cognitive-linguistic variables were taken into consideration simultaneously. CONCLUSIONS AND IMPLICATIONS: The current findings suggest the unique features of invented spelling development in L2 learners and identified precursors to L2 spelling difficulties. Very young average and at-risk L2 spellers showed differential gains in L2 invented spelling. Implications of the present study are (1) invented spelling at kindergarten is able to differentiate average and at-risk spellers and (2) invented spelling training and vocabulary intervention could be useful in the remediation of spelling difficulties.

Tumor LXR Expression is a Prognostic Marker for Patients with Hepatocellular Carcinoma.

Liver X receptor (LXR) activation exerts an anti-tumor effect. However, whether the tumor LXR expression has prognostic significance in hepatocellular carcinoma (HCC) patient has not been addressed yet. Primary HCC and the adjacent non-tumor tissues were obtained from 169 patients who underwent routine curative surgical treatment. All patients were followed for prognosis analyses. Tumor LXR was detected by immunohistochemical analysis. In in vitro study, several HCC cell lines were cultured for cellular protein detection of LXR and other cytokines, including nuclear factor kappa (NFκB), Matrix metalloproteinases 2 and 9 (MMP-2 and -9). Meanwhile, the invasion ability of cultured HCC cell lines was performed. We found that LXR expression status in tumor samples is associated with the clinical characteristics, such as tumor stage and metastasis, of HCC patients. Prognosis analysis shows that tumor LXR expression status is closely related to the post-operative outcome in HCC patients who underwent surgical treatment. Patients with low LXR expression have a significantly lower mean 5-year overall survival rate and mean overall survival period than those with high LXR level. Our in vitro data reveal that HCC cell lines had increased NF-κB, MMP2, MMP9 and invasive ability than normal cell line, which are suppressed by LXR activation via NFκB pathway. Our data suggest that LXR could be used as a biomarker for HCC prognosis. Further study is warranted to explore the molecular mechanism under which LXR regulates tumor behaves.

Drug supply chain management mode for hospital-enterprise cooperation in new medical reform / 医学研究生学报

In order to comply with canceling the drug price addition policy in the new medical reform program, meet the requirements of meticulous management and intensified medication safety, and improve the efficiency of pharmacies, the hospital pharmaceutical supply chain must be rebuilt by modern logistics and information technologies. This article compared three models of current hospital pharmaceutical chain and considered the supply chain management model of cooperating with the third party as the most effective one in the aspects of cost, efficiency,quality control management and so on. System deployment and implementation Methods of this model were further elaborated from the aspects of Hospital Information System(HIS) reform, management strategy, system architecture and security.

Design of TCM Chronic Disease Tracking Management Platform Based on Remote Monitoring Technology / 医学信息学杂志

The paper sets forth the system architecture of Traditional Chinese Medicine (TCM) for chronic disease tracking management platform based on remote monitoring technology,including business architecture,technical architecture and key technology modules;builds the new mode of chronic disease management and recovery based on household self-management and gives full play to the role of TCM in home care and disease prevention.

Gbps terahertz external modulator based on a composite metamaterial with a double-channel heterostructure.

The past few decades have witnessed a substantial increase in terahertz (THz) research. Utilizing THz waves to transmit communication and imaging data has created a high demand for phase and amplitude modulation. However, current active THz devices, including modulators and switches, still cannot meet THz system demands. Double-channel heterostructures, an alternative semiconductor system, can support nanoscale two-dimensional electron gases (2DEGs) with high carrier concentration and mobility and provide a new way to develop active THz devices. In this Letter, we present a composite metamaterial structure that combines an equivalent collective dipolar array with a double-channel heterostructure to obtain an effective, ultrafast, and all-electronic grid-controlled THz modulator. Electrical control allows for resonant mode conversion between two different dipolar resonances in the active device, which significantly improves the modulation speed and depth. This THz modulator is the first to achieve a 1 GHz modulation speed and 85% modulation depth during real-time dynamic tests. Moreover, a 1.19 rad phase shift was realized. A wireless free-space-modulation THz communication system based on this external THz modulator was tested using 0.2 Gbps eye patterns. Therefore, this active composite metamaterial modulator provides a basis for the development of effective and ultrafast dynamic devices for THz wireless communication and imaging systems.

Photoinduced active terahertz metamaterials with nanostructured vanadium dioxide film deposited by sol-gel method.

Applying the photoexcitation characteristics of vanadium dioxide (VO(2)), a dynamic resonant terahertz (THz) functional device with the combination of VO(2) film and dual-resonance metamaterial was suggested to realize the ultrafast external spatial THz wave active manipulation. The designed metamaterial realizes a pass band at 0.28-0.36 THz between the dual-resonant frequencies, and the VO(2) film is applied to control the transmittance of the spatial THz wave. More than an 80% modulation depth has been observed in the statics experiment, and the dynamic experimental results illustrate that this active metamaterial realizes up to a 1 MHz amplitude modulation signal loaded on a 0.34 THz carrier wave without any low noise amplified devices. The electromagnetic properties and photoinduced dynamic characteristics of this structure may have many potential applications in THz functional components, including modulators, intelligent switches, and sensors.