Diagnostic study on clinical feasibility of an AI-based diagnostic system as a second reader on mobile CT images: a preliminary result.

Background: Artificial intelligence (AI) has breathed new life into the lung nodules detection and diagnosis. However, whether the output information from AI will translate into benefits for clinical workflow or patient outcomes in a real-world setting remains unknown. This study was to demonstrate the feasibility of an AI-based diagnostic system deployed as a second reader in imaging interpretation for patients screened for pulmonary abnormalities in a clinical setting. Methods: The study included patients from a lung cancer screening program conducted in Sichuan Province, China using a mobile computed tomography (CT) scanner which traveled to medium-size cities between July 10th, 2020 and September 10th, 2020. Cases that were suspected to have malignant nodules by junior radiologists, senior radiologists or AI were labeled a high risk (HR) tag as HR-junior, HR-senior and HR-AI, respectively, and included into final analysis. The diagnosis efficacy of the AI was evaluated by calculating negative predictive value and positive predictive value when referring to the senior readers' final results as the gold standard. Besides, characteristics of the lesions were compared among cases with different HR labels. Results: In total, 251/3,872 patients (6.48%, male/female: 91/160, median age, 66 years) with HR lung nodules were included. The AI algorithm achieved a negative predictive value of 88.2% [95% confidence interval (CI): 62.2-98.0%] and a positive predictive value of 55.6% (95% CI: 49.0-62.0%). The diagnostic duration was significantly reduced when AI was used as a second reader (223±145.6 vs. 270±143.17 s, P<0.001). The information yielded by AI affected the radiologist's decision-making in 35/145 cases. Lesions of HR cases had a higher volume [309.9 (214.9-732.5) vs. 141.3 (79.3-380.8) mm3, P<0.001], lower average CT number [-511.0 (-576.5 to -100.5) vs. -191.5 (-487.3 to 22.5), P=0.010], and pure ground glass opacity rather than solid. Conclusions: The AI algorithm had high negative predictive value but low positive predictive value in diagnosing HR lung lesions in a clinical setting. Deploying AI as a second reader could help avoid missed diagnoses, reduce diagnostic duration, and strengthen diagnostic confidence for radiologists.

Characteristics of childhood-onset systemic lupus erythematosus in pregnancy and its association with pregnancy outcomes: a retrospective comparative cohort study.

BACKGROUND: Disease situations are more aggressive in patients with childhood-onset systemic lupus erythematosus (cSLE) than in those with adult-onset SLE (aSLE). However, information on pregnant women with cSLE and its association with pregnancy outcomes is limited. This study aimed to compare pregnancies in patients with cSLE vs. aSLE, and further analyse the characteristics of cSLE in pregnant women and explore its association with adverse pregnancy outcomes. METHODS: Altogether, data of 167 pregnancies from 150 women, including 22 pregnancies with cSLE and 145 pregnancies with aSLE, were retrospectively analysed. Characteristics and disease activity were compared between the cSLE and aSLE groups during pregnancy. Associations between cSLE and the risk of active SLE (SLEPDAI > 4), active lupus nephritis (LN), and adverse pregnancy outcomes were analysed using logistic regression. RESULTS: The cSLE group had a higher incidence of active SLE (12/22 vs. 30/145, P = 0.001) and active LN (11/22 vs. 26/145, P = 0.001) than the aSLE group. In the multivariable analysis, cSLE was a risk factor for active SLE and active LN during pregnancy, with ORs of 4.742 (95%CI 1.678-13.405, P = 0.003) and 4.652 (95%CI 1.630-13.279, P = 0.004), respectively. No significant association between cSLE and the risk of composite adverse gestational outcomes was identified after sequentially adjusting pre-pregnancy characteristics and pregnancy factors (P > 0.05). CONCLUSION: Disease activity of women with cSLE in pregnancy was more aggressive than that of women with aSLE, which was similar to the characteristics of non-pregnant women with SLE. cSLE might have indirect effects on the risk of adverse pregnancy outcomes through LN and active disease. Therefore, closely monitoring patients with cSLE during pregnancy is crucial.

Synthesis of Five-Membered Cyclic Guanidines via Cascade [3 + 2] Cycloaddition of α-Haloamides with Organo-cyanamides.

The convenient preparation of N2-unprotected five-membered cyclic guanidines was achieved through a cascade [3 + 2] cycloaddition between organo-cyanamides and α-haloamides under mild conditions in good to excellent yields (up to 99%). The corresponding cyclic guanidines could be easily transformed into hydantoins via hydrolysis.

Recent advances in 1,4-functional group migration-mediated radical fluoroalkylation of alkenes and alkynes.

Recently, the combination of radical fluoroalkylation of alkenyl or alkynyl moieties and 1,4-functional group migration (1,4-FGM) has emerged as a powerful strategy for the synthesis of fluorine-containing compounds. In this article, some representative reactions of 1,4-FGM-mediated radical fluoroalkylation of N-(arylsulfonyl)acrylamides, tertiary alcohol-containing alkynes, tertiary alcohol-containing alkenes and intermolecular 1,4-FGM-type substrates have been discussed based on the types of substrates.

Application of lung ultrasonography in critically ill patients with COVID-19.

PURPOSE: Lung ultrasonography (LU) is useful to assess lung lesions and variations at bedside. To investigate the results of LU in severe and critical patients with coronavirus disease 2019 (COVID-19), we performed a single-institution study to evaluate the related lung lesions and variations, and prophylactic strategies, in a large referral and treatment center. METHODS: We included 91 adult patients with severe and critical COVID-19, namely 62 males and 29 females, with an average age of 59 ± 11 years, who underwent LU. We collected the following patient information: sex, age, days in hospital, and days in ICU. In the ultrasound examinations, we recorded the presence of discrete B lines, confluent B lines, consolidation, pleural thickening, pleural effusion, and pneumothorax (PTX). RESULTS: Among the 91 severe and critical patients, 59 cases had scattered B lines, 56 cases had confluent B lines, 58 cases had alveolar-interstitial syndrome (AIS), 48 cases had lung consolidation, six cases had pleural thickening, 39 cases had pleural effusion (average depth of the pleural effusion: 1.0 ± 1.5 cm), and 20 patients developed PTX. In the Cox multivariate analysis, there were significant differences in age, hospitalization days, ICU days, and lung consolidation. CONCLUSION: Lung ultrasonography performed at the bedside can detect lung diseases, such as B lines, PTX, pulmonary edema, lung consolidation, pleural effusion, and variations of these findings. Our findings support the use of LU and measurements for estimating factors, and monitoring response to therapy in severe and critical COVID-19 patients.

Synthesis of Sulfamate-Fused 2-Aminopyrroles via an Isocyanide-Based Three Component [1+2+2] Annulation.

An efficient preparation of sulfamate-fused 2-aminopyrroles was achieved through an isocyanide-based three-component [1+2+2] annulation of isocyanides, dialkyl acetylenedicarboxylates, and sulfamate-derived cyclic imines in good to excellent yields (up to 99 %). This reaction proceeds smoothly without any activation or modification of substances under neutral and metal-free conditions. The reaction could also be conveniently performed on a gram scale.

Regio- and Diastereoselective Access to 4-Imidazolidinones via an Aza-Mannich Initiated Cyclization of Sulfamate-Derived Cyclic Imines with α-Halo Hydroxamates.

An efficient regio- and diastereoselective cyclization of sulfamate-derived cyclic imines with unsubstituted or monosubstituted α-halo hydroxamates is developed under mild conditions. This reaction proceeds smoothly under transition-metal-free conditions via a domino aza-Mannich addition/intramolecular nucleophilic substitution sequence, providing a convenient route to access 2-monosubstituted and 2,5-disubstituted 4-imidazolidinones. Notably, the products were obtained with single trans-isomers in moderate to excellent yields.

[Effect of vimentin on activation of NLRP3 inflammasome in the brain of mice with EV71 infection].

OBJECTIVE: To explore whether vimentin (VIM) mediates the activation of inflammasome in mice with EV71 infection in the central nervous system. METHODS: Forty VIM knockout mice (VIM-/-, 3 to 5 days old) were randomly divided into control group and infection group. The infection group was intraperitoneally injected with EV71 (108 TCID50), while the control group was injected with PBS (10 µL); another 40 wild-type mice (WT, 3 to 5 days old) were grouped in the same manner. The general conditions of mice were observed each day. Western blotting, ELISA, and RT-PCR were used to measure the levels of IL-1ß and casepase-1 in the brain or cerebrospinal fluid. The pathological changes in the cerebella and brain were observed using immunohistochemistry. RESULTS: Compared with the control group, the VIM-/- mice infected with EV71 showed no significant changes in NLRP3, IL-1ß or caspase-1 expression. The WT mice infected with EV71 showed obviously increased NLRP3, IL-1ß, and caspase-1 expressions in the central nervous system. The neurons of infected VIM-/- mice exhibited milder cell damage than the those in WT mice. CONCLUSION: VIM mediates the activation of inflammasome and promotes brain inflammation and neuronal damage in mice with EV71 infection in the central nervous system.

[Epidemiological status and risk factors of hyperuricemia in rural area of the Three Gorges].

OBJECTIVE: To explore the epidemiological status and risk factors of hyperuricemia in rural area of the Three Gorges. METHODS: A cross-sectional survey was carried out in rural area of Yiling District, Yichang City, which was located north-west bank of Xiling Gorge in 2007. A standard structure questionnaire was used to collect demographic data, social-economic status and life-style features. Fasting venous blood was collected and serum uric acid (SUA) was determined. Hyperuricemia was defined as SUA levels ≥ 417 µ mol/L (70 mg/L) in men and ≥ 357 µmol/L (60 mg/L) in women. Multiple logistic regression analysis was used to analysed the risk factors of hyperuricemia. RESULTS: A total of 9354 participants aged 35 and above were included, 19.9% (1866/9354) participants were the Three Gorges migrants. Serum uric acid level in men was significantly higher than that in women [(285.1 ± 80.2) µmol/L vs. (210.3 ± 65.0) µmol/L,P < 0.01].Serum uric acid level increased significantly in both genders in proportion to increase of age, and was higher in men than in women in all age groups (all P < 0.01). The age-adjusted prevalence was significantly higher in men than in women (5.6% vs. 3.3%, P < 0.01), and was also higher in men aged 35-44 and aged 45-54 than in women (both P < 0.01). There was no significance in prevalence of hyperuricemia in both men and women aged 55-64 and aged ≥ 65. After adjusting age, gender, educational level, migration and occupation, the multiple logistic regression analysis showed that the prevalence of hyperuricemia was higher in alcohol drinking participants than that of non-alcohol drinking participants (OR = 2.06, 95%CI:1.59-2.67, P < 0.01), and in participants used to consume less green vegetables and fruits than in participants consuming more green vegetables and fruits (OR = 1.77, 95% CI:1.27-2.47, P < 0.01). CONCLUSIONS: The prevalence of hyperuricemia is relatively low in rural area of the Three Gorges.Alcohol drinking and low intake of green vegetables and fruits are the risk factors of hyperuricemia in this population.

[Type 2 diabetes prevalence and its risk factors among migrants and nonmigrants aged 35 years and older in Three Gorge Dam area, China].

OBJECTIVE: To explore type 2 diabetes prevalence and its risk factors among migrants and nonmigrants aged 35 years and older in Three Gorge Dam area in Yichang City of Hubei province, China. METHODS: A sample of 9865 rural residents (including 1949 Three Gorge Dam migrants and 7916 nonmigrants) aged 35 years old and over was selected from September to December in 2007 by the method of multi-stage cluster random sampling in Yiling district, Yichang City of Hubei province. The study subjects were assessed by interview, examination, and blood samples. Information on demographics, migrant information, lifestyle, history of diabetes and hypertension was obtained by a questionnaire interview. An overnight fasting blood specimen was collected to measure serum glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). Height, weight, waist circumference, hip circumference and blood pressure were measured. Oral glucose tolerance test (OGTT) was carried out for those whose fasting glucose was equal to or exceeded 6.1 mmol/L. The standardized prevalence of type 2 diabetes was calculated based on national census in the year of 2000. Multiple logistic regression analysis was used to explore the potential risk factors of type 2 diabetes. RESULTS: The crude prevalence of type 2 diabetes among nonmigrants was 3.93% (310/7885) (male: 3.90% (129/3304), female: 3.95% (181/4581)), and that of migrants was 6.55% (127/1939) (male: 6.85% (52/759), female: 6.36% (75/1180)). The crude prevalence of type 2 diabetes among migrants was higher than that of nonmigrants (χ² = 25.10, P < 0.01 (male: χ² = 12.59, P < 0.01; female: χ² = 12.78, P < 0.01)). The prevalence of type 2 diabetes among nonmigrants was 3.87% in males and 4.15% in females. The standardized prevalence of type 2 diabetes among migrants was 6.92% in males and 6.33% in females. Logistic regression analysis showed that age (taking 35 - 44 years old as reference, 45 - 54 years old: OR = 1.45, 95%CI: 1.07 - 1.95; 55 - 64 years old: OR = 2.08, 95%CI: 1.53 - 2.84; 65 years old and over: OR = 1.85, 95%CI: 1.25 - 2.75), family history of diabetes (OR = 2.83, 95%CI: 1.70 - 4.72), overweight or obesity (overweight: OR = 1.36, 95%CI: 1.05 - 1.78; obesity: OR = 2.11, 95%CI: 1.47 - 3.01), central obesity (OR = 1.84, 95%CI: 1.39 - 2.44), abnormal triglyceride (OR = 1.54, 95%CI: 1.21 - 1.97), abnormal total cholesterol (OR = 1.40, 95%CI: 1.11 - 1.77) and abnormal LDL-C (OR = 1.82, 95%CI: 1.19 - 2.79) increased the risk of type 2 diabetes, and regular physical activity (OR = 0.57, 95%CI: 0.45 - 0.72) was the protective factor of type 2 diabetes. CONCLUSION: The prevalence of type 2 diabetes among Three Gorge Dam migrants was higher than that of nonmigrants. Increasing age, regular physical activity, family history of diabetes, overweight or obesity, central obesity, abnormal triglyceride, abnormal total cholesterol and abnormal LDL-C were related to type 2 diabetes.

[Epidemiological characteristics and control status of hypertension in rural area of the Three Gorges].

OBJECTIVE: To evaluate the epidemiological features and control status of hypertension in rural area of The Three Gorges. METHODS: A cross-sectional survey was carried out in rural area of Yiling District, Yichang City, which was located north-west bank of Xiling Gorges in 2007. A standard structure questionnaire was used to collect data on the hypertension history and treatment, social-economic status and life-styles, and so on. Blood pressure was measured by trained observers using standardized mercury sphygmomanometer. Hypertension was defined as systolic blood pressure ≥ 140 mm Hg (1 mm Hg = 0.133 kPa) and/or diastolic ≥ 90 mm Hg, or current treatment with antihypertensive medications. Hypertension control was defined as blood pressure levels of less than 140/90 mm Hg. RESULTS: A total of 9618 residents aged 35 years and above were included (response rate: 81.3%), and 19.7% residents were the Three Gorges migrants. The age-adjusted prevalence of hypertension was 37.3% for all, and 21.3%, 39.8%, 58.0% for aged 35 - 44, 45 - 59, ≥ 60 years, respectively. The age-adjusted rate was higher in men for all (39.1%) and aged 35 - 44 years (27.0%) than in women (36.3% for all and 17.8% for aged 35 - 44 years, P < 0.01). The age-adjusted rate of awareness, treatment and control rates of hypertension were lower in men (18.5%, 9.0%, 0.9%, respectively) than in women (23.5%, 13.6%, 2.0%, respectively, all P < 0.01). Among the participants with treated hypertension, the control rate of hypertension was only 17.0%. Prevalence and rate of awareness, treatment and control of hypertension were similar between migrants and non-migrants. CONCLUSION: The prevalence of hypertension is high, but the awareness, treatment, control rates were low in rural area of Yiling District. Efforts should be made to reduce the prevalence rate and to improve the control rate of hypertension in this area.

[Association and meta-analysis of ENPP1 K121Q with type 2 diabetes in Han Chinese.].

Multiple meta-analyses in Europeans showed that ENPP1 K121Q polymorphism was associated with type 2 diabetes. However, no association in Japanese, Korean, and Chinese in Taiwan, and inconsistent results in mainland Chinese were reported. In this study, the single nucleotide polymorphism K121Q of the ENPP1gene was genotyped in 539 type 2 diabetes patients and 404 healthy controls. No difference was observed in the genotypic and alle-lic frequencies of ENPP1 K121Q between the cases and the controls. Logistic regression analysis with adjustment of sex, age, and BMI suggested that the XQ genotype was significantly associated with the risk of type 2 diabetes (OR=1.5, 95%CI: 1.39-1.62, P<0.001). Sub-group analysis by gender revealed that the association between ENPP1 K121Q and type 2 diabetes was observed only in women (Q: 12.4% vs. 6.1%, P=0.001; XQ: 23.7% vs. 11.7%, P=0.001). Our results suggest that the association of ENPP1 K121Q with type 2 diabetes in Hubei Han Chinese population is more evident in women. The first meta-analysis of 10 Chinese studies indicated that the Q allele increased the risk of type 2 diabetes (OR=1.42, P=0.042).