The effectiveness of artificial intelligence-based automated grading and training system in education of manual detection of diabetic retinopathy.

Background: The purpose of this study is to develop an artificial intelligence (AI)-based automated diabetic retinopathy (DR) grading and training system from a real-world diabetic dataset of China, and in particular, to investigate its effectiveness as a learning tool of DR manual grading for medical students. Methods: We developed an automated DR grading and training system equipped with an AI-driven diagnosis algorithm to highlight highly prognostic related regions in the input image. Less experienced prospective physicians received pre- and post-training tests by the AI diagnosis platform. Then, changes in the diagnostic accuracy of the participants were evaluated. Results: We randomly selected 8,063 cases diagnosed with DR and 7,925 with non-DR fundus images from type 2 diabetes patients. The automated DR grading system we developed achieved accuracy, sensitivity/specificity, and AUC values of 0.965, 0.965/0.966, and 0.980 for moderate or worse DR (95 percent CI: 0.976-0.984). When the graders received assistance from the output of the AI system, the metrics were enhanced in varying degrees. The automated DR grading system helped to improve the accuracy of human graders, i.e., junior residents and medical students, from 0.947 and 0.915 to 0.978 and 0.954, respectively. Conclusion: The AI-based systemdemonstrated high diagnostic accuracy for the detection of DR on fundus images from real-world diabetics, and could be utilized as a training aid system for trainees lacking formal instruction on DR management.

Utilization of tannery wastewater for biofuel production: New insights on microalgae growth and biomass production.

Microalgae cultivation on tannery wastewater (TWW) has been examined in some studies as a possible biological application to reduce contamination load and discharge effluents safely. However, Growth aspects, different tolerate strains and enriching the medium were not well investigated. In our study we applied Scenedesmus sp., Chlorella variabilis and Chlorella sorokiniana with different TWW concentrations. C. sorokiniana and C. variabilis cell density, chlorophyll, and sugar content grew substantially as compared to control. C. sorokiniana biomass and total lipids folded three and two times in 25% and 40% TWW, respectively as compared to control. Scenedesmus sp. showed longer lag phase and lower performance compared to the other two strains. Kelp waste extract (KWE) was added to balance the nutrients supply for C. sorokiniana, of which growth and effluents indicators were then greatly promoted in all concentrations. As the lag phase was shortened from 8 to 4 days in 60% concentration, subsequently, chlorophyll, carbohydrates, biomass and total lipids appreciated by 184%, 400%, 162% and 135%, respectively. Furthermore, the COD and ammonium removals improved by 51% and 45%, respectively. These outcomes emphasize the suitability of using TWW for microalgae cultivation with the suitable concentration while adding kelp waste extract for further enhancement.

Establishing the county-level medical institutions performance evaluation indicator system based on the PATH model / 中华医院管理杂志

ObjectiveTo encourage development of county-level hospitals by building a performance appraisal indicator system for such institutions. Methods Using the PATH model ( a performance appraisal tool for hospital ) quality improvement, an appraisal system was built for such institutions. Centering on patients, this system encompassed such dimensions as public benefits, quality of care and safety, staff and hospital development. Results This system consisted of six level-1 indicators, 21 level-2 indicators and 70 level-3 indicators, each given due weight. Conclusions This indicator system centers on patients, follows guidance of public benefits, and aims at continuous quality improvement, making it an effective in evaluating hospital performance and providing reference for the decision-makers to promote and adjust medical reform policies.

Expression and prognostic significance of CD19 in patients with acute myelogenous leukemia with AML1-ETO positive / 中国免疫学杂志

Objective:To investigate the expression and prognostic significance of CD19 in patients with Acute myelogenous leukemia with AML1-ETO positive. Methods: Clinical data of 66 patients AML with AML1-ETO positive who were newly diagnosed from Jan 2010 to Dec 2015 were collected. To retrospectively analyze the relationship between clinical characteristics and expression of CD19,so dose the prognosis. Results:The positive rate of CD19 expressing in AML with AML1-ETO positive was 50. 0%. There were no statistically significant differences in terms of age,gender,hemoglobin,platelet,percentage of bone marrow blasts,accompanied with chromosome ,gene mutations between patients with and without CD19 expression(P>0. 05). The white blood cell count(WBC) of the CD19 negative group was higher than CD19 positive group,while showed significant difference(P=0. 027). Although the relapse-free survival (RFS) of patients with CD19 expression was higher than those without,no significant difference was calculated (P=0. 105). Patients with CD19 expression had superior overall survival ( OS ) compared to those without CD19 expression ( P = 0. 030 ) . Multivariable analysis for OS identified CD19 positivity as an independent predictor associated with better prognosis. Conclusion: The expression of CD19 in AML with AML1-ETO positive may be an indicator associated with better prognosis.

Analysis of influencing factors for doctors'prescription of essential medicines at county hospitals in Anhui province / 中华医院管理杂志

Objective To analyze the influencing factors for doctors' prescription of essential medicines at county hospitals of Anhui province.Methods Multi-stage random sampling method was designed to conduct an investigation for doctors at nine county hospitals in Anhui province,and SPSS 1 6.0 was used to conduct descriptive statistical,chi-square test and binary logistic regression.Results 50.8% respondents reported that they had prescribed essential medicines with the rate of less than 60%. The factors of doctors'prescription for essential medicines are work experience,average monthly income, policy awareness, recognition, training willingness, training times, hospital support, medication preferences,and drug marketing.Conclusion The prescription rate of essential medicines in the sampled hospitals is low,and the targeted comprehensive intervention measures should be taken to promote prescription rate of essential medicines in county hospitals.

Considerations on the 5-in-1 social co-governance for drug safety / 中华医院管理杂志

In this consideration,the paper described the imperatives of drug safety,constraints of governance by the government,and advantages of social co-governance,proposing the necessity to establish aFive-in-One (referring to the involvement of the government,enterprises,industry associations,media and the public) drug safety social co-governance.In its analysis of the present dilemma o[drug safety governance,the authors proposed such measures as perfecting legal and institutional system,reforming governmental power allocation mechanism,improving the incentive mechanism,innovating governance means and improving social governance ability,for the purpose of enhancing such a co-governance pattern.

A Cross-sectional Study Assessing Predictors of Essential Medicines Prescribing Behavior Based on Information-motivation-behavioral Skills Model among County Hospitals in Anhui, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The self-consciousness and practicality of preferentially prescribed essential medicines (EMs) are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills (IMB) model to identify the predictors of essential medicines prescribing behavior (EMPB) among doctors and to examine the association between demographic variables, IMB, and EMPB.</p><p><b>METHODS</b>A cross-sectional study was carried out to assess predictive relationships among demographic variables and IMB model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the IMB model to test the instruments using analysis of moment structures 17.0.</p><p><b>RESULTS</b>A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old (range: 22-67 years old). The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 ± 7.34 (hundred mark system: 75.77) and 19.92 ± 3.44 (hundred mark system: 79.68), respectively. Approximately half (50.8%) of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data (χ2 /df = 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066). More work experience (β = 0.153, P < 0.001) and behavioral skills (β = 0.449, P < 0.001) predicted more EMPB. Higher income predicted less information (β = -0.197, P < 0.001) and motivation (β = -0.204, P < 0.001). Behavioral skills were positively predicted by information (β = 0.135, P < 0.001) and motivation (β = 0.742, P < 0.001).</p><p><b>CONCLUSION</b>The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.</p>

Up-regulation of thy-1 promotes invasion and metastasis of hepatocarcinomas.

Increasing evidence has revealed that thy-1 was a potential stem cell marker of liver cancer, but no data have been shown on how thy-1 regulates the pathophysiology of liver cancer, such as proliferation, apoptosis, invasion and migration. We previously demonstrated that thy-1 was expressed in about 1% of hepg2 cells, thy-1+ hepg2 cells, but not thy-1-, demonstrating high tumorigenesis on inoculation 0.5x105 cells per BACA/LA mouse after 2 months. In the present study, our results showed that higher expression of thy-1 occurs in 72% (36/50 cases) of neoplastic hepatic tissues as compared to 40% (20/50 cases) of control tissues, and the expression of thy-1 is higher in poorly differentiated liver tumors than in the well-differentiated ones. In addition, thy-1 expression was detected in 85% of blood samples from liver cancer patients, but none in normal subjects or patients with cirrhosis or hepatitis. There was a significant negative correlation between thy-1 expression and E-cadherin expression (a marker of invasion and migraton), but not between thy-1 expression and AFP expression in all the liver cancer and blood samples. We further investigated the relationship between thy-1 and E- cadherin in liver cancer hepg2 cell line which was transfected with pReceiver-M29/thy-1 eukaryotic expression vector followed by aspirin treatment. Lower expression of E- cadherin but higher expressions of thy-1 were detected in hepg2 cells transfected with pReceiver-M29/thy-1. Taken together, our study suggested that thy-1 probably regulates liver cancer invasion and migration.

Construction of fusion gene vaccine of WT1 multi-epitope fused with stimulating epitope of mycobacterium tuberculosis heat shock protein 70 and its expression and immunogenicity / 中国实验血液学杂志

This study was purposed to construct a fusion DNA vaccine containing WT1 multi-epitope and stimulating epitope of mycobacterium tuberculosis heat shock protein 70 and to detect its expression and immunogenicity. On the basis of published data, a multi-epitope gene (Multi-WT1) containing three HLA *0201-restricted CTL epitopes: one HLA*2402-restricted CTL epitope, two Th epitopes and one universal Th Pan-DR epitope (PADRE) was constructed. DNA-coding sequence was modified by Computer-Aided Design (CAD) to optimize proteasome-mediated epitope processing through the introduction of different amino acid spacer sequences. The synthetic nucleotide sequence was then inserted into an eukaryotic vector to construct the plasmid pcDNA3.1-WT1.For enhancing CTL activity, HSP70 fragment including stimulatory domain P407-426 was amplified by PCR from mycobacterial HSP70 gene and cloned into pcDNA3.1(+). Then Multi-WT1 was fused to the N-terminal of pcDNA3.1-mHSP70(407-426) to make the multi-epitope fusion gene vaccine pcDNA3.1-WT1-mHSP70(407-426). HEK-293T cells were transfected with this vaccine and the expressed product was identified by RT-PCR. Enzyme-linked immunospot assay (ELISPOT) was used to evaluate the immunological responses elicited by vaccine. The results showed that the most of WT1 epitopes could be correctly cleaved which was confirmed by software Net Chop 3.1 and PAPROCIanalysis. RT-PCR showed correct expression of target gene in HEK293T cells and ELISPOT showed specific T-cell responses. It is concluded that the eukaryotic expression vector PcDNA3.1-WT1-mHSP70(407-426) fusion gene has been successfully constructed and the immunity response is also elicited, which is a good candidate for further research of DNA vaccine.

Effects of nitric oxide on experimental hepatic fibrosis in rats / 中国药理学通报

AIM: To study the role of nitric oxide (NO) in the pathogenesis of hepatic fibrosis. METHODS: To establish the model of hepatic fibrosis in rats and treated with L-Arg (preNO) and L-NNA (NOS inhibitor). The degree of hepatic fibrosis, the levels of HA, AST, ALT determined with histology, radioimmunoassay, autochemol-analysis, respectively. NO and NOS were also determined. RESULTS: The degree of hepatic fibrosis, the levels of AST, ALT and HA in L-Arg group were all lower than those in hepatic fibrosis control group. While the levels of HA and AST in L-NNA group were higher than that in hepatic fibrosis control group. CONCLUSION: NO has the function of protecting liver cells and anti-hepatofibrosis liver fibrosis induced by CCl4 in rats.