Influence of skeletal muscle and intermuscular fat on postoperative complications and long-term survival in rectal cancer patients.

BACKGROUND: The body composition of patients with rectal cancer potentially affects postoperative outcomes. This study explored the correlations between skeletal muscle and adipose tissue quantified by computed tomography (CT) with postoperative complications and long-term prognosis in patients with rectal cancer after surgical resection. METHODS: This retrospective cohort study included patients with rectal cancer who underwent surgical resection at the Wuhan Union Hospital between 2014 and 2018. CT images within 3 months prior to the surgery were used to quantify the indices of skeletal muscle and adipose tissue at the levels of the third lumbar vertebra (L3) and umbilicus. Optimal cut-off values for each index were defined separately for males and females. Associations between body composition and postoperative complications, overall survival (OS), and disease-free survival (DFS) were evaluated using logistic and Cox proportional hazards models. RESULTS: We included 415 patients (240 males and 175 females; mean age: 57.8 ± 10.5 years). At the L3 level, a high skeletal muscle density (SMD; hazard ratio [HR]: 0.357, 95% confidence interval [CI]: 0.191-0.665, P = 0.001; HR: 0.571, 95% CI: 0.329-0.993, P = 0.047) and a high skeletal muscle index (SMI; HR: 0.435, 95% CI 0.254-0.747, P = 0.003; HR: 0.568, 95% CI: 0.359-0.897, P = 0.015) were independent prognostic factors for better OS and DFS. At the umbilical level, a large intermuscular fat area (IMFA; HR: 1.904, 95% CI: 1.068-3.395, P = 0.029; HR: 2.064, 95% CI: 1.299-3.280, P = 0.002) was an independent predictive factor for worse OS and DFS, and a high SMI (HR: 0.261, 95% CI: 0.132-0.517, P < 0.001; HR: 0.595, 95% CI: 0.387-0.913, P = 0.018) was an independent prognostic factor for better OS and DFS. The models combining body composition and clinical indicators had good predictive abilities for OS. The receiver operating characteristic areas under the curve were 0.848 and 0.860 at the L3 and umbilical levels, respectively (both P < 0.05). CONCLUSIONS: No correlations existed between CT-quantified body composition parameters and postoperative complications. However, a high SMD and high SMI were significantly associated with longer OS and DFS at the L3 level, whereas a large IMFA and low SMI were associated with worse OS and DFS at the umbilical level. Combining CT-quantified body composition and clinical indicators could help physicians predict the prognosis of patients with rectal cancer after surgery.

Ablation alone is noninferior to radiotherapy plus ablation in the patients with early-stage hepatocellular carcinoma: a population-based study.

Recently, the efficacy of two low-invasive treatments, ablation, and radiotherapy, has been fully compared for the patients with the early-stage hepatocellular carcinoma (HCC). However, the comparison between radiotherapy plus ablation and ablation alone has been less frequently reported. Data from the Surveillance, Epidemiology, and End Results (SEER) database were searched for early-stage HCC patients treated with ablation plus radiotherapy or ablation alone. The outcome measures were overall survival (OS) and cancer-specific survival (CSS). The propensity score matching (PSM) was used to reduce selection bias. We included 240 and 6619 patients in the radiotherapy plus ablation group and ablation group before the PSM. After PSM, 240 pairs of patients were included. The median OS (mOS) and median CSS (mCSS) of patients receiving ablation alone were longer than that of receiving radiotherapy plus ablation (mOS: 47 vs. 34 months, P = 0.019; mCSS: 77 vs. 40 months, P = 0.018, after PSM) before and after PSM. The multivariate analysis indicated that radiotherapy plus ablation independent risk factor for OS and CSS before PSM, but the significance disappeared after PSM. The detailed subgroup analyses indicated ablation alone brought more benefit in very early-stage HCC and older patients. In addition, we found different types of radiotherapy might lead to different outcomes when combined with ablation. In conclusion, ablation alone is noninferior to radiotherapy plus ablation in patients with early-stage HCC. The additional radiation prior to ablation may bring survival benefits in the patients with higher tumor stage. However, due to the risk of selection bias in that study, the results should be interpreted cautiously.

Well-Aerated Lung and Mean Lung Density Quantified by CT at Discharge to Predict Pulmonary Diffusion Function 5 Months after COVID-19.

Background: The aim of this study was to explore the predictive values of quantitative CT indices of the total lung and lung lobe tissue at discharge for the pulmonary diffusion function of coronavirus disease 2019 (COVID-19) patients at 5 months after symptom onset. Methods: A total of 90 patients with moderate and severe COVID-19 underwent CT scans at discharge, and pulmonary function tests (PFTs) were performed 5 months after symptom onset. The differences in quantitative CT and PFT results between Group 1 (patients with abnormal diffusion function) and Group 2 (patients with normal diffusion function) were compared by the chi-square test, Fisher's exact test or Mann−Whitney U test. Univariate analysis, stepwise linear regression and logistic regression were used to determine the predictors of diffusion function in convalescent patients. Results: A total of 37.80% (34/90) of patients presented diffusion dysfunction at 5 months after symptom onset. The mean lung density (MLD) of the total lung tissue in Group 1 was higher than that in Group 2, and the percentage of the well-aerated lung (WAL) tissue volume (WAL%) of Group 1 was lower than that of Group 2 (all p < 0.05). Multiple stepwise linear regression identified only WAL and WAL% of the left upper lobe (LUL) as parameters that positively correlated with the percent of the predicted value of diffusion capacity of the lungs for carbon monoxide (WAL: p = 0.002; WAL%: p = 0.004), and multiple stepwise logistic regression identified MLD and MLDLUL as independent predictors of diffusion dysfunction (MLD: OR (95%CI): 1.011 (1.001, 1.02), p = 0.035; MLDLUL: OR (95%CI): 1.016 (1.004, 1.027), p = 0.008). Conclusion: At five months after symptom onset, more than one-third of moderate and severe COVID-19 patients presented with diffusion dysfunction. The well-aerated lung and mean lung density quantified by CT at discharge could be predictors of diffusion function in convalesce.

Self-supervised learning enables 3D digital subtraction angiography reconstruction from ultra-sparse 2D projection views: A multicenter study.

3D digital subtraction angiography (DSA) reconstruction from rotational 2D projection X-ray angiography is an important basis for diagnosis and treatment of intracranial aneurysms (IAs). The gold standard requires approximately 133 different projection views for 3D reconstruction. A method to significantly reduce the radiation dosage while ensuring the reconstruction quality is yet to be developed. We propose a self-supervised learning method to realize 3D-DSA reconstruction using ultra-sparse 2D projections. 202 cases (100 from one hospital for training and testing, 102 from two other hospitals for external validation) suspected to be suffering from IAs were conducted to analyze the reconstructed images. Two radiologists scored the reconstructed images from internal and external datasets using eight projections and identified all 82 lesions with high diagnostic confidence. The radiation dosages are approximately 1/16.7 compared with the gold standard method. Our proposed method can help develop a revolutionary 3D-DSA reconstruction method for use in clinic.

Asynchronous changes of normal lung lobes during respiration based on quantitative computed tomography (CT).

Background: This study aimed to explore the coordinated and independent actions of lung lobes during respiration using quantitative computed tomography (CT) in order to increase our in vivo understanding of pulmonary anatomy. Methods: Cases for whom test results showed normal pulmonary function tests (PFTs) results, and normal paired inspiratory-expiratory chest CT findings, as assessed by 2 radiologists, were retrospectively included in this study. From the chest CT results, we measured quantitative indices of lung volume (LV) and mean lung density (MLD) for the total lung (TL), left lung (LL), right lung (RL), and 5 lobes in inspiratory and expiratory phases. The differences of these measures between bilateral lungs and among the lobes were evaluated to study whether they were consistent or different during respiration. Results: A total of 70 cases were included {median age of 49.5 [interquartile range (IQR), 38.0 to 60.3] years; 32 males; 38 females}. Overall, the inspiratory and expiratory volumes of the LL were smaller than those of the RL (both P<0.001). For the ventilation workload (λ, which indicates the ratio of lobar volume to total LV), the end-expiratory volume ratio (λex ) of the LL was 0.44 (IQR, 0.43 to 0.46), while the end-inspiratory volume ratio (λin ) had risen to 0.46 (IQR, 0.45 to 0.47) (P<0.001). Comparing the 5 lobes, not all lobes shared the same LV. However, the left lower lobe (LLL) and right lower lobe (RLL) showed some similarities. The λin-LLL and λin-RLL was higher than λex-LLL and λex-RLL , respectively (both P<0.001), while the ratios of the other lobes reduced. The pairwise mean absolute difference (PMAD) on λin and λex of the bilateral lower lobes was low in inspiration (0.0288) and expiration (0.0346). The MLD of bilateral lower lobes showed consistency in inspiration or in expiration (inspiration: P>0.999; expiration: P=0.975). In addition, the PMADs between the right middle lobe (RML) and other lobes were significantly larger than the PMAD between other pairs of lobes in both inspiration and expiration. Beyond that, the expiratory MLD of RML [-789.6 (IQR, -814 to -762.05) HU] was the lowest among the 5 lobes. Conclusions: We found that the LL assumes a higher workload during ventilation than it does during respiration. The 5 normal lobes were non-synchronous during respiration and contributed differently to ventilation. The bilateral lower lobes showed similarities and had a high-ventilation function, while and the LV and MLD of the RML showed the least changes within a respiration cycle.

Timing of endovascular repair impacts long-term outcomes of uncomplicated acute type B aortic dissection.

OBJECTIVE: To compare the 5-year outcomes of acute versus subacute thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated acute type B aortic dissection (ATBAD). METHODS: Between March 2008 and September 2018, 238 consecutive patients with uncomplicated ATBAD underwent TEVAR in the acute or subacute phase and were analyzed retrospectively. The primary end points were all-cause death and aortic-related death. The secondary end point was a composite of the outcomes of death from any cause, rupture, new dissection, retrograde type A aortic dissection, endoleak, and late reintervention. Inverse probability treatment weighting was used to balance baseline characteristics. Weight-adjusted Kaplan-Meier estimate with landmark analysis and weighted Cox model were performed to assess time-to-event outcomes. RESULTS: In the inverse probability treatment weighting-adjusted population, the 30-day mortality was 1.5% in the acute TEVAR group and 0% in the subacute TEVAR group (P = .24). The incidence of 30-day adverse events occurred in 16.8% and 6.9% patients in the acute TEVAR and subacute TEVAR groups, respectively (P = .13). At 5 years, there was no statistically significant difference in all-cause death (hazard ratio [HR], 1.50; 95% confidence interval [CI], 0.59-3.81; P = .39) and aortic-related death (HR, 1.11; 95% CI, 0.34-3.60; P = .86) between the two groups. The composite outcomes occurred in 30 patients (23.0%) in the acute TEVAR group and 18 patients (22.3%) in the subacute TEVAR group, respectively (HR, 0.67; 95% CI, 0.36-1.25; P = .20). However, a landmark analysis of the composite outcomes indicated that there was a significant interaction between treatment effect and time (Pinteraction = .01), with a significantly higher incidence of the composite outcomes in the acute TEVAR group compared with the subacute TEVAR group within 1 year (HR, 0.25; 95% CI, 0.08-0.79; P = .02), and a comparable rate between 1 and 5 years (HR, 1.25; 95% CI, 0.56-2.76; P = .59). CONCLUSIONS: At the 5-year follow-up, no significant differences exist in the all-cause death and aortic-related death between acute and subacute TEVAR. However, acute TEVAR is associated with an increased rate of severe complications within 1 year, which suggests that performing TEVAR in the subacute phase of ATBAD may be the preferable option.

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor.

Background: Sarcopenia is a progressive generalized loss of skeletal muscle mass commonly observed in advanced stages of cancer. Objective: To assess the relationship between sarcopenia and the prognosis of patients with hepatocellular carcinoma (HCC) treated with a programmed cell death 1 (PD-1) inhibitor. Design: This is a retrospective study. Methods: This study included patients with HCC treated with camrelizumab between 1 March 2020 and 1 December 2021. The skeletal muscle area at the L3 vertebra middle level was used to calculate the skeletal muscle index. Propensity score matching (PSM) analysis was used to balance the variables between the two groups. Results: In all, 97 patients with HCC were included in the study, with 46 and 51 patients in the sarcopenia group and the non-sarcopenia group, respectively. The baseline characteristics of albumin, Child-Pugh class, albumin-bilirubin score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were significantly different between the two groups. In total, 26 patients from each group (n = 52) were selected after the PSM analysis. The progression-free survival (PFS) in the non-sarcopenia group was significantly longer than that in the sarcopenia group before and after PSM analysis (6.5 versus 4.8 months, p = 0.038). In addition, the disease control rate was similar before and after PSM analysis (57.7% versus 69.2%, p = 0.388). The objective response rate in the non-sarcopenia group tended to be higher than that in the sarcopenia group (11.5% versus 30.8%, p = 0.090, after PSM), but no statistically significant difference was found. The median overall survival (OS) in the non-sarcopenia group tended to longer than it in the sarcopenia group before PSM without significant differences (16.3 versus 11.3 months, p = 0.090) and the median OS was similar between the two groups after PSM (16.3 versus 16.8 months, p = 0.735). Conclusions: HCC patients with sarcopenia tended to have higher levels of inflammation and lower levels of albumin than patients without sarcopenia. Sarcopenia is associated with a shorter PFS in HCC patients treated with PD-1 inhibitor.

Total Lung and Lobar Quantitative Assessment Based on Paired Inspiratory-Expiratory Chest CT in Healthy Adults: Correlation with Pulmonary Ventilatory Function.

OBJECTIVE: To provide the quantitative volumetric data of the total lung and lobes in inspiration and expiration from healthy adults, and to explore the value of paired inspiratory-expiratory chest CT scan in pulmonary ventilatory function and further explore the influence of each lobe on ventilation. METHODS: A total of 65 adults (29 males and 36 females) with normal clinical pulmonary function test (PFT) and paired inspiratory-expiratory chest CT scan were retrospectively enrolled. The inspiratory and expiratory volumetric indexes of the total lung (TL) and 5 lobes (left upper lobe [LUL], left lower lobe [LLL], right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]) were obtained by Philips IntelliSpace Portal image postprocessing workstation, including inspiratory lung volume (LVin), expiratory lung volume (LVex), volume change (∆LV), and well-aerated lung volume (WAL, lung tissue with CT threshold between -950 and -750 HU in inspiratory scan). Spearman correlation analysis was used to explore the correlation between CT quantitative indexes of the total lung and ventilatory function indexes (including total lung capacity [TLC], residual volume [RV], and force vital capacity [FVC]). Multiple stepwise regression analysis was used to explore the influence of each lobe on ventilation. RESULTS: At end-inspiratory phase, the LVin-TL was 4664.6 (4282.7, 5916.2) mL, the WALTL was 4173 (3639.6, 5250.9) mL; both showed excellent correlation with TLC (LVin-TL: r = 0.890, p < 0.001; WALTL: r = 0.879, p < 0.001). From multiple linear regression analysis with lobar CT indexes as variables, the LVin and WAL of these two lobes, LLL and RUL, showed a significant relationship with TLC. At end-expiratory phase, the LVex-TL was 2325.2 (1969.7, 2722.5) mL with good correlation with RV (r = 0.811, p < 0.001), of which the LVex of RUL and RML had a significant relationship with RV. For the volumetric change within breathing, the ∆LVTL was 2485.6 (2169.8, 3078.1) mL with good correlation with FVC (r = 0.719, p < 0.001), moreover, WALTL showed a better correlation with FVC (r = 0.817, p < 0.001) than that of ∆LVTL. Likewise, there was also a strong association between ∆LV, WAL of these two lobes (LLL and RUL), and FVC. CONCLUSIONS: The quantitative indexes derived from paired inspiratory-expiratory chest CT could reflect the clinical pulmonary ventilatory function, LLL, and RUL give greater impact on ventilation. Thus, the pulmonary functional evaluation needs to be more precise and not limited to the total lung level.

CT-Based Radiomics Helps to Predict Residual Lung Lesions in COVID-19 Patients at Three Months after Discharge.

BACKGROUND: In this study, our focus was on pulmonary sequelae of coronavirus disease 2019 (COVID-19). We aimed to develop and validate CT-based radiomic models for predicting the presence of residual lung lesions in COVID-19 survivors at three months after discharge. METHODS: We retrospectively enrolled 162 COVID-19 confirmed patients in our hospital (84 patients with residual lung lesions and 78 patients without residual lung lesions, at three months after discharge). The patients were all randomly allocated to a training set (n = 114) or a test set (n = 48). Radiomic features were extracted from chest CT images in different regions (entire lung or lesion) and at different time points (at hospital admission or at discharge) to build different models, sequentially, or in combination, as follows: (1) Lesion_A model (based on the lesion region at admission CT); (2) Lesion_D model (based on the lesion region at discharge CT); (3) Δlesion model (based on the lesion region at admission CT and discharge CT); (4) Lung_A model (based on the lung region at admission CT); (5) Lung_D model (based on the lung region at discharge CT); (6) Δlung model (based on the lung region at admission CT and discharge CT). The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to evaluate the predictive performances of the radiomic models. RESULTS: Among the six models, the Lesion_D and the Δlesion models achieved better predictive efficacy, with AUCs of 0.907 and 0.927, sensitivity of 0.898 and 0.763, and specificity of 0.855 and 0.964 in the training set, and AUCs of 0.875 and 0.837, sensitivity of 0.920 and 0.680, and specificity of 0.826 and 0.913 in the test set, respectively. CONCLUSIONS: The CT-based radiomic models showed good predictive effects on the presence of residual lung lesions in COVID-19 survivors at three months after discharge, which may help doctors to plan follow-up work and to reduce the psychological burden of COVID-19 survivors.

Ultra-High Performance Amorphous Ga2 O3 Photodetector Arrays for Solar-Blind Imaging.

The growing demand for scalable solar-blind image sensors with remarkable photosensitive properties has stimulated the research on more advanced solar-blind photodetector (SBPD) arrays. In this work, the authors demonstrate ultrahigh-performance metal-semiconductor-metal (MSM) SBPDs based on amorphous (a-) Ga2 O3 via a post-annealing process. The post-annealed MSM a-Ga2 O3 SBPDs exhibit superhigh sensitivity of 733 A/W and high response speed of 18 ms, giving a high gain-bandwidth product over 104 at 5 V. The SBPDs also show ultrahigh photo-to-dark current ratio of 3.9 × 107 . Additionally, the PDs demonstrate super-high specific detectivity of 3.9 × 1016 Jones owing to the extremely low noise down to 3.5 fW Hz-1/2 , suggesting high signal-to-noise ratio. Underlying mechanism for such superior photoelectric properties is revealed by Kelvin probe force microscopy and first principles calculation. Furthermore, for the first time, a large-scale, high-uniformity 32 × 32 image sensor array based on the post-annealed a-Ga2 O3 SBPDs is fabricated. Clear image of target object with high contrast can be obtained thanks to the high sensitivity and uniformity of the array. These results demonstrate the feasibility and practicality of the Ga2 O3 PDs for applications in solar-blind imaging, environmental monitoring, artificial intelligence and machine vision.

Physical and chemical control on CO2 gas transfer velocities from a low-gradient subtropical stream.

CO2 exchanges across the water-air interface in rivers and lakes are currently believed to be responsible for the dominant share of global aquatic CO2 emissions. The gas transfer velocity (k600) is the key factor that constrains the CO2 fluxes. It is also the most problematic to establish because of its high spatial and temporal variability. Here, we have evaluated the seasonal and spatial dynamics in k600 values and their physical and chemical controlling processes by gas tracer and floating chamber (FC) methods in three reaches of a low-gradient stream channel (Guancun surface stream, 'GSS') in a karst terrain in subtropical southwestern China in December 2016 and March, July and September 2017. The k600 values were highly variable in space and time in this small stream. Physical processes, including the velocity of the stream and its slope, were found to control the variations of k600. The k600 values recorded in the dry season (March and December) were at minimal levels due to very slow flow and gentle slope, and were also affected by complexation in the solute-enriched waters. The characteristics high pH and low turbulence of gentle streams in carbonate karst areas are conducive to such complexation, which is of great significance in the limiting CO2 degassing in such regions. We have obtained the first k600 prediction model for small streams in subtropical karst regions. In conclusion, we present a comprehensive approach for predicting the k600 values in small channels by comparison of independent SF6 gas tracer and floating chamber methods.

Comparison of Residual Pulmonary Abnormalities 3 Months After Discharge in Patients Who Recovered From COVID-19 of Different Severity.

Background and Objectives: To investigate whether coronavirus disease 2019 (COVID-19) survivors who had different disease severities have different levels of pulmonary sequelae at 3 months post-discharge. Methods: COVID-19 patients discharged from four hospitals 3 months previously, recovered asymptomatic patients from an isolation hotel, and uninfected healthy controls (HCs) from the community were prospectively recruited. Participants were recruited at Wuhan Union Hospital and underwent examinations, including quality-of-life evaluation (St. George Respiratory Questionnaire [SGRQ]), laboratory examination, chest computed tomography (CT) imaging, and pulmonary function tests. Results: A total of 216 participants were recruited, including 95 patients who had recovered from severe/critical COVID-19 (SPs), 51 who had recovered from mild/moderate disease (MPs), 28 who had recovered from asymptomatic disease (APs), and 42 HCs. In total, 154 out of 174 (88.5%) recovered COVID-19 patients tested positive for serum SARS-COV-2 IgG, but only 19 (10.9%) were still positive for IgM. The SGRQ scores were highest in the SPs, while APs had slightly higher SGRQ scores than those of HCs; 85.1% of SPs and 68.0% of MPs still had residual CT abnormalities, mainly ground-glass opacity (GGO) followed by strip-like fibrosis at 3 months after discharge, but the pneumonic lesions were largely absorbed in the recovered SPs or MPs relative to findings in the acute phase. Pulmonary function showed that the frequency of lung diffusion capacity for carbon monoxide abnormalities were comparable in SPs and MPs (47.1 vs. 41.7%), while abnormal total lung capacity (TLC) and residual volume (RV) were more frequent in SPs than in MPs (TLC, 18.8 vs. 8.3%; RV, 11.8 vs. 0%). Conclusions: Pulmonary abnormalities remained after recovery from COVID-19 and were more frequent and conspicuous in SPs at 3 months after discharge.

Visualization of the morphology and pathology of the peripheral branches of the cranial nerves using three-dimensional high-resolution high-contrast magnetic resonance neurography.

PURPOSE: To assess the feasibility and advantages of high-resolution high-contrast magnetic resonance neurography (HRHC-MRN) for visualizing the morphology and pathology of the peripheral branches of cranial nerves. MATERIALS: cMRN (3D SPACE STIR sequence) and HRHC-MRN (contrast enhanced 3D SPACE STIR sequence) were performed at 3 T MR unit on 16 volunteers and 12 patients with head and neck tumors. Quantitative measurements such as SNR, CNR and CR were calculated. Three readers evaluated the continuity of the 10 major peripheral branches of cranial nerves using a 5-score scale (scores 0-4). Interobserver variability was tested. Quantitative measurements and scores were compared between cMRN and HRHC-MRN. The imaging features of the nerve pathology were analyzed. RESULTS: The CRs of nerve to bone marrow, nerve to muscle, and nerve to gland were significantly higher with HRHC-MRN than with cMRN (P = 0.014, P = 0.02, P <0.001, respectively). The scores of all nerve trunks were significantly higher with HRHC-MRN than with cMRN (all, P < 0.001). For all nerves on HRHC-MRN, the interobserver consistency was excellent across the three readers (all κ > 0.8). The scores of the inferior alveolar nerve, hypoglossal nerve, lingual nerve, facial nerve, infraorbital nerve, masseteric nerve, glossopharyngeal/vagus nerve, supraorbital nerve, auriculotemporal nerve and buccal nerve were 3.95, 3.77, 3.63, 3.25, 3.15, 3.04, 3.04, 2.87, 2.79, 1.88, respectively. CONCLUSION: HRHC-MRN provides improved visualization of the peripheral branches of cranial nerves and is a promising nerve-selective imaging method for evaluating cranial nerve morphology and pathology.

Correlation Between Chest CT Findings and Clinical Features of 211 COVID-19 Suspected Patients in Wuhan, China.

BACKGROUND: Chest computed tomography (CT) has been widely used to assess pulmonary involvement in COVID-19. We aimed to investigate the correlation between chest CT and clinical features in COVID-19 suspected patients with or without fever. METHODS: We retrospectively enrolled 211 COVID-19 suspected patients who underwent both chest CT and reverse transcription polymerase chain reaction in Wuhan, China. The performance of CT in patients with relevant onset of symptoms, with fever (n = 141) and without fever (n = 70), was assessed respectively. RESULTS: The sensitivity of CT for COVID-19 was 97.3%, with area under the curve (AUC) of 0.71 (95% confidence interval [CI], 0.66-0.76). There were 141 suspected patients with fever and 70 without fever. In the fever group, 4 variables were screened to establish the basic model: age, monocyte, red blood cell, and hypertension. The AUC of the basic model was 0.72 (95% CI, 0.63-0.81), while the AUC of the CT-aided model was 0.77 (95% CI, 0.68-0.85), a significant difference (P < .05). In the nonfever group, only dry cough was screened out to establish the basic model. The AUC was 0.76 (95% CI, 0.64-0.88), which was not significantly different than the CT-aided model (P = .08). CONCLUSIONS: Chest CT has a high sensitivity in patients with COVID-19, and it can improve diagnostic accuracy for COVID-19 suspected patients with fever during the initial screen, whereas its value for nonfever patients remains questionable.

The Transition to Paschen's Law for Microscale Gas Breakdown at Subatmospheric Pressure.

The decrease in electronic device size necessitates greater understanding of gas breakdown and electron emission at microscale to optimize performance. While traditional breakdown theory using Paschen's law (PL), driven by Townsend avalanche, fails for gap distance d [Formula: see text] 15 µm, recent studies have derived analytic equations for breakdown voltage when field emission and Townsend avalanche drive breakdown. This study derives a new analytic equation that predicts breakdown voltage VB within 4% of the exact numerical results of a previously derived theory and new experimental results at subatmospheric pressure for gap distances from 1-25 µm. At atmospheric pressure, VB transitions to PL near the product of pressure and gap distance, pd, corresponding to the Paschen minimum; at lower pressures, the transition to PL occurs to the left of the minimum. We further show that the work function plays a major role in determining which side of the Paschen minimum VB transitions to PL as pressure approaches atmospheric pressure while field enhancement and the secondary emission coefficient play smaller roles. These results indicate that appropriate combinations of these parameters cause VB to transition to PL to the left of the Paschen minimum, which would yield an extended plateau similar to some microscale gas breakdown experimental observations.

Origin and effect factors of sedimentary organic carbon in a karst groundwater-fed reservoir, South China.

Reservoirs are commonly recharged by groundwater that is rich in bicarbonate ions in karst regions of South China, and the recharge of this groundwater to the reservoir can affect the biogeochemical processes of carbon sedimentation at the reservoir bottom. In this study, Dalongdong Reservoir, which is mainly recharged by two subterranean streams, was investigated based on a 42-cm-thick sedimentary core and the 210Pb/137Cs dating technique and isotope analyses to understand the sedimentary history and identify the carbon sources. The 210Pb/137Cs age model showed that the sediments were accumulated over the last 60 years. The annual increase precipitation and temperature showed no obvious change compared with trends of δ13C in total organic carbon (δ13Corg), δ15N values in total nitrogen, and the carbon and nitrogen ratio (C/N). This shows that climate was not the main control of the variation in sediment factors. Based on δ13Corg, δ15N, C/N, and isotopic mixing modeling, sources of organic carbon in the sediments were derived from plankton (60.84%), soil (22.93%), waste water (14.56%), and terrestrial plants (1.67%). From 1958 to 1978, reservoir establishment and leakage affected the contribution of the four sources. The contribution of the plankton source increased from 1978 to 2015, resulting from change of water level and continued input of external nitrogen. However, because of the revegetation supplied by an economic aid project the contribution of soil showed a considerable decreasing trend from 1978 to 2002. After 2002, For "Grain for Green" project, the contribution from soil further decreased. After reservoir construction, the contribution of waste water stabilized. The contribution of terrestrial plants started increased rapidly after 2002. Karst groundwater, which contains more dissolved inorganic carbon containing lower δ13CDIC than the water sources of other lakes or reservoirs, makes the δ13Corg value of sediment more negative by phytoplankton photosynthesis in the reservoir.

River sequesters atmospheric carbon and limits the CO2 degassing in karst area, southwest China.

CO2 fluxes across water-air interfaces of river systems play important roles in regulating the regional and global carbon cycle. However, great uncertainty remains as to the contribution of these inland water bodies to the global carbon budget. Part of the uncertainty stems from limited understanding of the CO2 fluxes at diurnal and seasonal frequencies caused by aquatic metabolism. Here, we measured surface water characteristics (temperature, pH, and DO, DIC, Ca2+ concentrations) and CO2 fluxes across the air-water interface at two transects of Guijiang River, southwest China to assess the seasonal and diurnal dynamics of fluvial carbon cycling and its potential role in regional and global carbon budgets. The two transects had differing bedrock; DM transect is underlain by carbonate and detrital rock and PY is underlain by pure carbonate. Our results show that the river water both degasses CO2 to and absorbs CO2 from the atmosphere in both summer and winter, but the degassing and absorption varied between the two transects. Further, CO2 fluxes evolve through diurnal cycles. At DM, the river evaded CO2 from early morning through noon and absorbed CO2 from afternoon through early morning. At PY in summer, the CO2 evasion decreased during the daytime and increased at night while in winter at night, CO2 uptake increased in the morning and decreased in the afternoon but remained relatively stable at night. Although the river is a net source of carbon to the atmosphere (~15mMm-2day-1), the evasion rate is the smallest of all reported world's inland water bodies reflecting sequestration of atmospheric carbon through the carbonate dissolution and high primary productivity. These results emphasize the need of seasonal and diurnal monitoring of CO2 fluxes across water-air interface, particularly in highly productive rivers, to reduce uncertainty in current estimates of global riverine CO2 emission.

[Spatial Variations of CO2 Degassing Across Water-air Interface and Its Impact Factors in Summer in Guijiang River, China].

River is characterized by obvious spatial heterogeneity in catchment, which is exacerbated by special environment features of calcium-rich, alkaline and DIC-rich(dissolved inorganic carbon) in karst river. Thus, it also leads to significant spatial variation in the CO2 degassing across water-air interface. Main ions, physicochemical parameters, δ13CDIC value and two common approaches(floating chamber(FC) and thin boundary layer models(TBL) were used to analyze the CO2 degassing characteristics in Guijiang River, a karst river, China. The results were as follows:1 Hydrochemistry in Guijiang River basin showed a significant spatial change. All of HCO3-, Ca2+, specific conductivity, total dissolved solids(TDS), SIc and pCO2 showed similar distribution characteristics in the following order:tributaries in the middle reaches > middle reaches > Downstream > Upstream of Guijiang River. 2 During the monitoring period, CO2 degassing occurred in all the sampling sites and it was the CO2 source for the atmosphere. The mean CO2 evasion was 237 mg·(m2·h)-1 in Guijiang River, which located in the range of average CO2 evasion of global river. However, significant spatial variations also occurred along Guijiang River. The CO2 degassing flux in tributaries of the middle reaches and middle reaches of the mainstream were obviously larger than those in downstream and upstream of the mainstream. 3 CO2 degassing was mainly affected by carbonate equilibrium system in tributaries in the middle reaches and middle reaches in the mainstream of the Guijiang River basin, which resulted in obviously larger CO2 degassing than those in downstream and upstream of mainstream. However, the CO2 degassing flux in tributaries of the middle reaches was also simultaneously affected by biological photosynthesis, and the minimum CO2 degassing flux[6.38 mg·(m2·h)-1] appeared in tributaries of the middle reaches. In addition, the CO2 degassing flux in mainstream upstream was mainly affected by atmospheric environmental factors, while it was synergetically influenced by many factors in mainstream downstream.

[Impacts of Thermal Stratification on the Hydrochemistry and Dissolved Inorganic Carbon in a Typical Karst Reservoir in Summer].

Thermal stratification leads to significant stratification characteristics of hydrochemistry and aquatic organisms in reservoirs, and thus affects the biogeochemical cycle in the reservoir. This study aims to understand physico-chemical properties and dissolved inorganic carbon change processes and its factors in a karst groundwater-fed reservoir, Dalongdong Reservoir, located in Shanglin County, Guangxi Zhuang Autonomous Region, China. The eight sampling points were placed along the direction of the water flow on June 19-21, 2015. The results show that: ① The reservoir exhibited obvious thermal stratification in the summer. There were significant differences in physical and chemical parameters, such as pH and conductivity (Spc) between the epilimnion and thermocline; ② The dissolved oxygen (DO) and chlorophyll a (Chl-a) content from the surface to the bottom did not show a single decreasing trend, but the maximum value occurred 2.5 m or 5 m below the surface; ③ From the surface to the bottom, dissolved inorganic carbon (DIC) concentrations showed an increasing trend with the average DIC concentration of 2.03 mmol·L-1 in the epilimnion and the average DIC concentration of 4.18 mmol·L-1 at the bottom of the thermocline. The value of stable carbon isotope (δ13CDIC) was more positive in the epilimnion than in the thermocline, where δ13CDIC gradually became partially negative with water depth. Possible reasons of these results include: ① The significant differences in temperature, distribution of aquatic organisms, and strength and direction of metabolisms in different water layers due to thermal stratification; ② The DIC variations in the epilimnion were mainly affected by the carbonate precipitation process and phytoplankton photosynthesis, thereby affecting the DIC stable isotope fractionation. DIC was mainly controlled by biological respiration and the organic matter decomposition process in the thermocline.

[The evaluation of 128 slice spiral CT for soft palate, hard palate and mandible in patients with obstructive sleep apnea hypopnea syndrom].

OBJECTIVE: To discuss the soft palate, hard palate and mandibule for the pathogenesis and clinical treatment of patients who have obstructive sleep apnea hypopnea syndrome. METHOD: There were 52 patients with OSAHS diagnosed by the PSG and 32 cases of normal healthy volunteers in our hospital. All objects were given 128 slice spiral CT scan of the upper airway. We measured the related indexes of the soft palate, hard palate and mandible, then analysed statistical differences between them and did Pearson correlation analysis with apnea hypoventilation index (AHI), average blood oxygen saturation (MSaO2) in PSG. RESULT: Compared with the control group, the soft palate length [(37.93 ± 5.20)mm VS (33.52 ± 4.25)mm] and the distance between mandible with cervical vertebra [(75.00 ± 7.10)mm VS (69.93 ± 5.58)mm] increased significantly, but the distance of trailing edge of hard palate to inferior margin of slope significantly reduced [(42.57 ± 4.52)mm VS (45.80 ± 2.94)mm, P < 0.01] in patients with OSAHS. Each measurement associated with AHI and MSaO2 had no significant correlation (P > 0.05). CONCLUSION: The soft palate, hard palate and mandibular are some of the important risk factors of OSAHS, and they also have reference value for the choice of clinical treatment operation. Preoperative CT examination can offer help in the treatment of OSAHS.