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Bose-Einstein condensates (BECs) are macroscopic coherent matter waves that have revolutionized quantum science and atomic physics. They are important to quantum simulation1 and sensing2,3, for example, underlying atom interferometers in space4 and ambitious tests of Einstein's equivalence principle5,6. A long-standing constraint for quantum gas devices has been the need to execute cooling stages time-sequentially, restricting these devices to pulsed operation. Here we demonstrate continuous Bose-Einstein condensation by creating a continuous-wave (CW) condensate of strontium atoms that lasts indefinitely. The coherent matter wave is sustained by amplification through Bose-stimulated gain of atoms from a thermal bath. By steadily replenishing this bath while achieving 1,000 times higher phase-space densities than previous works7,8, we maintain the conditions for condensation. Our experiment is the matter wave analogue of a CW optical laser with fully reflective cavity mirrors. This proof-of-principle demonstration provides a new, hitherto missing piece of atom optics, enabling the construction of continuous coherent-matter-wave devices.
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OBJECTIVE: Immune checkpoint inhibitors (ICI) are recommended as the first-line therapy for platinum-refractory head and neck squamous cell carcinoma (HNSCC), a disease with a poor prognosis. However, biomarkers in this situation are rare. The objective was to identify radiomic features-associated biomarkers to guide the prognosis and treatment opinions in the era of ICI. METHODS: A total of 31 platinum-refractory HNSCC patients were retrospectively enrolled. Of these, 65.5% (20/31) received ICI-based therapy and 35.5% (11/31) did not. Radiomic features of the primary site at the onset of recurrent metastatic (R/M) status were extracted. Prognostic and predictive radiomic biomarkers were analysed. RESULTS: The median overall survival from R/M status (R/M OS) was 9.6 months. Grey-level co-occurrence matrix-associated texture features were the most important in identifying the patients with or without 9-month R/M death. A radiomic risk-stratification model was established and equally separated the patients into high-, intermittent- and lower-risk groups (1-year R/M death rate, 100.0% vs. 70.8% vs. 27.1%, p = 0.001). Short-run high grey-level emphasis (SRHGE) was more suitable than programmed death ligand 1 (PD-L1) expression in selecting whether patients received ICI-based therapy. CONCLUSIONS: Radiomic features were effective prognostic and predictive biomarkers. Future studies are warranted.
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Superconducting diodes are proposed nonreciprocal circuit elements that should exhibit nondissipative transport in one direction while being resistive in the opposite direction. Multiple examples of such devices have emerged in the past couple of years; however, their efficiency is typically limited, and most of them require a magnetic field to function. Here we present a device that achieves efficiencies approaching 100% while operating at zero field. Our samples consist of a network of three graphene Josephson junctions linked by a common superconducting island, to which we refer as a Josephson triode. The three-terminal nature of the device inherently breaks the inversion symmetry, and the control current applied to one of the contacts breaks the time-reversal symmetry. The triode's utility is demonstrated by rectifying a small (nA scale amplitude) applied square wave. We speculate that devices of this type could be realistically employed in the modern quantum circuits.
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Background: The scarcity of medical resources and personnel has worsened due to COVID-19. Telemedicine faces challenges in assessing wounds without physical examination. Evaluating pressure injuries is time consuming, energy intensive, and inconsistent. Most of today's telemedicine platforms utilize graphical user interfaces with complex operational procedures and limited channels for information dissemination. The study aims to establish a smart telemedicine diagnosis system based on YOLOv7 and large language model. Methods: The YOLOv7 model is trained using a clinical data set, with data augmentation techniques employed to enhance the data set to identify six types of pressure injury images. The established system features a front-end interface that includes responsive web design and a chatbot with ChatGPT, and it is integrated with a database for personal information management. Results: This research provides a practical pressure injury staging classification model with an average F1 score of 0.9238. The system remotely provides real-time accurate diagnoses and prescriptions, guiding patients to seek various medical help levels based on symptom severity. Conclusions: This study establishes a smart telemedicine auxiliary diagnosis system based on the YOLOv7 model, which possesses capabilities for classification and real-time detection. During teleconsultations, it provides immediate and accurate diagnostic information and prescription recommendations and seeks various medical assistance based on the severity of symptoms. Through the setup of a chatbot with ChatGPT, different users can quickly achieve their respective objectives.
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COVID-19 , Úlcera por Pressão , Telemedicina , Humanos , Úlcera por Pressão/diagnóstico , COVID-19/diagnóstico , SARS-CoV-2RESUMO
The filamentous fungus Aspergillus oryzae, also known as koji mold, has been used for centuries in the production of fermented foods in East Asia. A. oryzae fermentation can produce enzymes and metabolites with various bioactivities. In this study, we investigated whether A. oryzae fermentation extract (AOFE) has any effect on Mycoplasma pneumoniae (Mp) pneumonia. We performed solid-state fermentation of A. oryzae and obtained the ethanol extract. AOFE was analyzed by HPLC, and the major component was identified to be kojic acid. In vitro, AOFE suppressed Mp growth and invasion into A549 lung epithelial cells as determined by the gentamicin protection assay. AOFE treatment also suppressed Mp-stimulated production of tumor necrosis factor (TNF)-α and interleukin (IL)-6 at mRNA and protein levels in murine MH-S alveolar macrophages. In a mouse model of Mp pneumonia, Mp infection induced a marked pulmonary infiltration of neutrophils, which was significantly reduced in mice pre-treated orally with AOFE. AOFE administration also suppressed the production of proinflammatory cytokines and chemokines in the lungs. Collectively, our results show that AOFE has the potential to be developed into a preventive/therapeutic agent for Mp pneumonia.
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Aspergillus oryzae , Pneumonia por Mycoplasma , Animais , Camundongos , Mycoplasma pneumoniae/metabolismo , Fermentação , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologia , Pneumonia por Mycoplasma/patologia , Inflamação/microbiologia , Interleucina-6/metabolismo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
We report on spectroscopic studies of hot and ultracold RbSr molecules, and combine the results in an analysis that allows us to fit a potential energy curve (PEC) for the X(1)2Σ+ ground state bridging the short-to-long-range domains. The ultracold RbSr molecules are created in a µK sample of Rb and Sr atoms and probed by two-colour photoassociation spectroscopy. The data yield the long-range dispersion coefficients C6 and C8, along with the total number of supported bound levels. The hot RbSr molecules are created in a 1000 K gas mixture of Rb and Sr in a heat-pipe oven and probed by thermoluminescence and laser-induced fluorescence spectroscopy. We compare the hot molecule data with spectra we simulated using previously published PECs determined by three different ab initio theoretical methods. We identify several band heads corresponding to radiative decay from the B(2)2Σ+ state to the deepest bound levels of X(1)2Σ+. We determine a mass-scaled high-precision model for X(1)2Σ+ by fitting all data using a single fit procedure. The corresponding PEC is consistent with all data, thus spanning short-to-long internuclear distances and bridging an energy gap of about 75% of the potential well depth, still uncharted by any experiment. We benchmark previous ab initio PECs against our results, and give the PEC fit parameters for both X(1)2Σ+ and B(2)2Σ+ states. As first outcomes of our analysis, we calculate the s-wave scattering properties for all stable isotopic combinations and corroborate the locations of Fano-Feshbach resonances between alkali Rb and closed-shell Sr atoms recently observed [V. Barbéet al., Nat. Phys., 2018, 14, 881]. These results and more generally our strategy should greatly contribute to the generation of ultracold alkali-alkaline-earth dimers, whose applications range from quantum simulation to state-controlled quantum chemistry.
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We demonstrate a continuously loaded ^{88}Sr magneto-optical trap (MOT) with a steady-state phase-space density of 1.3(2)×10^{-3}. This is 2 orders of magnitude higher than reported in previous steady-state MOTs. Our approach is to flow atoms through a series of spatially separated laser cooling stages before capturing them in a MOT operated on the 7.4-kHz linewidth Sr intercombination line using a hybrid slower+MOT configuration. We also demonstrate producing a Bose-Einstein condensate at the MOT location, despite the presence of laser cooling light on resonance with the 30-MHz linewidth transition used to initially slow atoms in a separate chamber. Our steady-state high phase-space density MOT is an excellent starting point for a continuous atom laser and dead-time free atom interferometers or clocks.
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BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) with unsatisfactory survival is common after surgical resection. Antiplatelet therapy with aspirin or clopidogrel was recently shown to prevent hepatic carcinogenesis in a murine model, but its effect in humans had not been clarified. This study aimed to investigate the association between antiplatelet therapy and the outcomes for patients with hepatitis B virus (HBV)-related HCC after liver resection. METHODS: By analyzing data from the Taiwan National Health Insurance Research Database, 9461 HBV-related HCC patients who had undergone liver resection between January 1997 and December 2011 were identified. After one-to-four matching by sex, age, and propensity score, 442 patients with antiplatelet therapy and 1768 patients without antiplatelet therapy were enrolled for the analysis. The Kaplan-Meier method and modified Cox proportional hazards models were used for survival and multivariable, stratified analyses. RESULTS: Recurrence-free survival and overall survival after resection surgery were significantly better after 5 years in the treated cohort than in the untreated cohort (52.8 vs 47.9 %; p = 0.021 and 80.3 vs 65.4 %; p < 0.001, respectively). Besides, antiplatelet therapy reduced the risk of HCC recurrence (hazard ratio [HR] 0.73; p < 0.001) and overall mortality (HR 0.57; p < 0.001) in the multivariable analysis. However, antiplatelet use significantly increased the risk of upper gastrointestinal bleeding (odds ratio [OR] 1.91; p < 0.001). CONCLUSIONS: Use of aspirin or clopidogrel was associated with better recurrence-free survival and overall survival among patients with HBV-related HCC after liver resection. However, these agents should be used with caution due to the adverse effects of upper gastrointestinal bleeding.
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Carcinoma Hepatocelular/mortalidade , Hemorragia Gastrointestinal/epidemiologia , Neoplasias Hepáticas/mortalidade , Recidiva Local de Neoplasia/epidemiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Adulto , Idoso , Aspirina/uso terapêutico , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/virologia , Clopidogrel , Intervalo Livre de Doença , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hepatectomia , Hepatite B Crônica/complicações , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Modelos de Riscos Proporcionais , Fatores de Risco , Taxa de Sobrevida , Taiwan/epidemiologia , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêuticoRESUMO
BACKGROUND & AIMS: Stress alters brain-gut interactions and could exacerbate intestinal disorders, including irritable bowel syndrome. Alterations in the intestinal microbiota have been associated with irritable bowel syndrome. Maintenance of healthy microbiota requires nucleotide-binding oligomerization domain protein-like receptors, pyrin-domain containing (NLRP)-6 inflammasomes. We investigated the involvement of NLRP6 in water-avoidance stress (WAS)-induced intestinal disorders in mice. METHODS: B57BL6 mice were subjected to WAS for 1 hour each day for 10 days; body weights and intestinal inflammation and permeability were analyzed. We investigated signaling via the NLRP3 and NLRP6 inflammasomes, and the role of corticotropin-releasing hormone (CRH) in WAS-associated inflammation and NLRP6 inhibition. Mice that were not exposed to stress were co-housed with mice subjected to WAS to determine the effects of WAS-induced dysbiosis, measured by sequencing bacterial 16S ribosomal RNA. We also assessed the effects of a peroxisome proliferator-activated receptor-γ agonist and probiotics. RESULTS: WAS-induced small-bowel inflammation (enteritis) was associated with inhibition of NLRP6, but not NLRP3, and was prevented by a peroxisome proliferator-activated receptor-γ agonist, which induced epithelial expression of NLRP6. CRH was released during WAS and inhibited NLRP6 expression. WAS induced alterations in the gut microbiota of mice; co-housed nonstressed mice developed enteritis associated with increased CRH and decreased levels of NLRP6. Probiotic therapy reduced intestinal inflammation in mice with WAS-induced enteritis. CONCLUSIONS: Exposure of mice to stress inhibits NLRP6 and alters the composition of the gut microbiota, leading to intestinal inflammation. These findings might explain the benefits of probiotics for patients with stress-associated gastrointestinal disorders.
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Hormônio Liberador da Corticotropina/fisiologia , Enterite/etiologia , Receptores de Superfície Celular/fisiologia , Estresse Psicológico/fisiopatologia , Animais , Modelos Animais de Doenças , Enterite/terapia , Feminino , Inflamassomos/metabolismo , Síndrome do Intestino Irritável/fisiopatologia , Síndrome do Intestino Irritável/psicologia , Metagenoma/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , PPAR gama/agonistas , Probióticos/uso terapêutico , Estresse Psicológico/complicaçõesRESUMO
Betel quid (BQ) and areca nut (AN) (major BQ ingredient) are group I human carcinogens illustrated by International Agency for Research on Cancer and are closely associated with an elevated risk of oral potentially malignant disorders (OPMDs) and cancers of the oral cavity and pharynx. The primary alkaloid of AN, arecoline, can be metabolized via the monoamine oxidase (MAO) gene by inducing reactive oxygen species (ROS). The aim of this study was to investigate whether the variants of the susceptible candidate MAO genes are associated with OPMDs and oral and pharyngeal cancer. A significant trend of MAO-A mRNA expression was found in in vitro studies. Using paired human tissues, we confirmed the significantly decreased expression of MAO-A and MAO-B in cancerous tissues when compared with adjacent noncancerous tissues. Moreover, we determined that MAO-A single nucleotide polymorphism variants are significantly linked with oral and pharyngeal cancer patients in comparison to OPMDs patients [rs5953210 risk G-allele, odds ratio = 1.76; 95% confidence interval = 1.02-3.01]. In conclusion, we suggested that susceptible MAO family variants associated with oral and pharyngeal cancer may be implicated in the modulation of MAO gene activity associated with ROS.
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Arecolina/toxicidade , Carcinoma de Células Escamosas/genética , Monoaminoxidase/genética , Neoplasias Bucais/genética , Neoplasias Faríngeas/genética , RNA Mensageiro/genética , Areca/química , Arecolina/metabolismo , Carcinoma de Células Escamosas/enzimologia , Carcinoma de Células Escamosas/patologia , Expressão Gênica , Humanos , Monoaminoxidase/metabolismo , Boca/enzimologia , Boca/patologia , Neoplasias Bucais/enzimologia , Neoplasias Bucais/patologia , Neoplasias Faríngeas/enzimologia , Neoplasias Faríngeas/patologia , Faringe/enzimologia , Faringe/patologia , Polimorfismo de Nucleotídeo Único , RNA Mensageiro/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Risco , Microambiente TumoralRESUMO
This study used artificial intelligence techniques to identify clinical cancer biomarkers for recurrent gastric cancer survivors. From a hospital-based cancer registry database in Taiwan, the datasets of the incidence of recurrence and clinical risk features were included in 2476 gastric cancer survivors. We benchmarked Random Forest using MLP, C4.5, AdaBoost, and Bagging algorithms on metrics and leveraged the synthetic minority oversampling technique (SMOTE) for imbalanced dataset issues, cost-sensitive learning for risk assessment, and SHapley Additive exPlanations (SHAPs) for feature importance analysis in this study. Our proposed Random Forest outperformed the other models with an accuracy of 87.9%, a recall rate of 90.5%, an accuracy rate of 86%, and an F1 of 88.2% on the recurrent category by a 10-fold cross-validation in a balanced dataset. We identified clinical features of recurrent gastric cancer, which are the top five features, stage, number of regional lymph node involvement, Helicobacter pylori, BMI (body mass index), and gender; these features significantly affect the prediction model's output and are worth paying attention to in the following causal effect analysis. Using an artificial intelligence model, the risk factors for recurrent gastric cancer could be identified and cost-effectively ranked according to their feature importance. In addition, they should be crucial clinical features to provide physicians with the knowledge to screen high-risk patients in gastric cancer survivors as well.
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Human papillomavirus (HPV) has been implicated in various cancers, including those affecting the skin. The study assessed the long-term risk of skin cancer associated with HPV infection in Taiwan region, using data from the National Health Insurance Research Database between 2007 and 2015. Our analysis revealed a significant increase in skin cancer risk among those with HPV, particularly for squamous cell carcinoma (SCC), the subtype with the highest observed adjusted hazard ratio (aHR) = 5.97, 95% CI: 4.96-7.19). The overall aHR for HPV-related skin cancer was 5.22 (95% CI: 4.70-5.80), indicating a notably higher risk in the HPV-positive group. The risk of skin cancer was further stratified by type, with basal cell carcinoma (aHR = 4.88, 95% CI: 4.14-5.74), and melanoma (aHR = 4.36, 95% CI: 2.76-6.89) also showing significant associations with HPV. The study also highlighted regional variations, with increased risks in southern Taiwan and the Kaohsiung-Pingtung area. Key findings emphasize the importance of sun protection, particularly in regions of high UV exposure and among individuals in high-risk occupations. This research contributes to a better understanding of the complex interactions between HPV and skin cancer risk, reinforcing the importance of preventive strategies in public health.
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BACKGROUND: Dementia is a prevalent neurological condition, yet the relationship between dementia and general anesthesia remains uncertain. The study aimed to explore the association between general anesthesia and dementia using a nationwide population-based database. METHODS: The study extracted data from Taiwan's national health insurance, which encompassed the records of one million insured residents. A total of 59,817 patients aged 65 years and above, diagnosed with osteoarthritis between 2002 and 2010, were included. Among these patients, 3277 individuals with an initial diagnosis of dementia between 2004 and 2013 were matched with non-dementia patients based on age, gender, and the date of osteoarthritis diagnosis. Following a 1:2 random matching, the case group included 2171 patients with dementia, while the control group consisted of 4342 patients without dementia. The data was analyzed using conditional and unconditional logistic regressions. RESULTS: No significant differences in the odds of dementia were found between individuals exposed to general and regional anesthesia during hip/knee replacement surgeries (OR = 1.11; 95%CI: 0.73-1.70), after adjusting for age, sex, and co-morbidities. Similarly, there were no significant differences in the odds of dementia based on different durations of anesthesia exposure (General: <2 h: OR = 0.91, 95%CI = 0.43-1.92; 2-4 h: OR = 1.21, 95%CI = 0.82-1.79; >4 h: OR = 0.39, 95%CI = 0.15-1.01; compared to no exposure. Regional: <2 h: OR = 1.18, 95%CI = 0.85-1.62; 2-4 h: OR = 0.9, 95%CI = 0.64-1.27; >4 h: OR = 0.55, 95%CI = 0.15-1.96; compared to no exposure). Likewise, no significant differences were observed in the odds of dementia based on the number of replacement surgeries (twice: OR = 0.74, 95%CI = 0.44-1.23, compared to once). CONCLUSION: Neither general anesthesia nor regional anesthesia in hip/knee surgery was associated with dementia. Different numbers and durations of anesthesia exposure showed no significant differences in the odds for dementia.
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Anestesia Geral , Artroplastia de Quadril , Artroplastia do Joelho , Demência , Humanos , Feminino , Masculino , Anestesia Geral/efeitos adversos , Demência/epidemiologia , Idoso , Estudos de Casos e Controles , Taiwan/epidemiologia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Bases de Dados Factuais , Anestesia por Condução/efeitos adversos , Anestesia por Condução/estatística & dados numéricos , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/epidemiologiaRESUMO
BACKGROUND & AIMS: The chronic, persistent pain associated with chronic pancreatitis (CP) has many characteristics of neuropathic pain, initiated and maintained by the activation of spinal microglia. We investigated whether activated microglia in the thoracic spinal cord contribute to chronic pain in a rat model of CP. METHODS: CP was induced in Sprague-Dawley rats by an intraductal injection of 2% trinitrobenzene sulfonic acid. Hyperalgesia was assessed by the measurement of mechanical sensitivity of the abdomen and nocifensive behavior to electrical stimulation of the pancreas. Three weeks after induction of CP, spinal samples were analyzed by immunostaining and immunoblot analyses for levels of CD11 (a marker of microglia, determined with the antibody OX42) and phosphorylated p38 (P-p38, a marker of activation of p38 mitogen-activated protein kinase signaling). We examined the effects of minocycline (inhibitor of microglia) and fractalkine (microglia-activating factor) on visceral hyperalgesia in rats with CP. RESULTS: Rats with CP had increased sensitivity and nociceptive behaviors to mechanical probing of the abdomen and electrical stimulation of the pancreas. The dorsal horn of the thoracic spinal cords of rats with CP contained activated microglia (based on increased staining with OX42), with an ameboid appearance. Levels of P-p38 increased in rats with CP and colocalized with OX42-positive cells. Intrathecal injection of minocycline reversed and prevented the increase of nocifensive behaviors and levels of P-p38 in rats with CP. Fractalkine induced hyperalgesia in rats without CP, which was blocked by minocycline. CONCLUSIONS: Activated spinal microglia have important roles in maintaining and initiating chronic pain in a rat model of CP. Microglia might be a target for treatment of hyperalgesia caused by pancreatic inflammation.
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Hiperalgesia/etiologia , Microglia , Limiar da Dor , Pancreatite Crônica/complicações , Medula Espinal/fisiopatologia , Animais , Western Blotting , Antígenos CD11/metabolismo , Quimiocina CX3CL1/farmacologia , Modelos Animais de Doenças , Ativação Enzimática , Hiperalgesia/metabolismo , Hiperalgesia/fisiopatologia , Hiperalgesia/prevenção & controle , Imuno-Histoquímica , Masculino , Microglia/efeitos dos fármacos , Microglia/metabolismo , Minociclina/farmacologia , Medição da Dor , Limiar da Dor/efeitos dos fármacos , Pancreatite Crônica/induzido quimicamente , Pancreatite Crônica/tratamento farmacológico , Pancreatite Crônica/metabolismo , Pancreatite Crônica/fisiopatologia , Fosforilação , Ratos , Ratos Sprague-Dawley , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Vértebras Torácicas , Fatores de Tempo , Ácido Trinitrobenzenossulfônico , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
BACKGROUND AND OBJECTIVES: Burn injuries range from minor medical issues to severe, life-threatening conditions. The severity and location of the burn dictate its treatment; while minor burns might be treatable at home, severe burns necessitate medical intervention, sometimes in specialized burn centers with extended follow-up care. This study aims to leverage artificial intelligence (AI)/machine learning (ML) to forecast potential adverse effects in burn patients. METHODS: This retrospective analysis considered burn patients admitted to Chi Mei Medical Center from 2010 to 2019. The study employed 14 features, comprising supplementary information like prior comorbidities and laboratory results, for building models for predicting graft surgery, a prolonged hospital stay, and overall adverse effects. Overall, 70% of the data set trained the AI models, with the remaining 30% reserved for testing. Three ML algorithms of random forest, LightGBM, and logistic regression were employed with evaluation metrics of accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). RESULTS: In this research, out of 224 patients assessed, the random forest model yielded the highest AUC for predictions related to prolonged hospital stays (>14 days) at 81.1%, followed by the XGBoost (79.9%) and LightGBM (79.5%) models. Besides, the random forest model of the need for a skin graft showed the highest AUC (78.8%), while the random forest model and XGBoost model of the occurrence of adverse complications both demonstrated the highest AUC (87.2%) as well. Based on the best models with the highest AUC values, an AI prediction system is designed and integrated into hospital information systems to assist physicians in the decision-making process. CONCLUSIONS: AI techniques showcased exceptional capabilities for predicting a prolonged hospital stay, the need for a skin graft, and the occurrence of overall adverse complications for burn patients. The insights from our study fuel optimism for the inception of a novel predictive model that can seamlessly meld with hospital information systems, enhancing clinical decisions and bolstering physician-patient dialogues.
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Recently, immune checkpoint inhibitors (ICIs) have become the standard treatment option for patients with lung cancer, including small cell lung cancer (SCLC). ICI-induced neurological immune-related adverse events are rare and exhibit diverse clinical manifestations, often leading to missed or delayed diagnosis. Herein, we report the case of a patient with extensive-stage SCLC who received atezolizumab with etoposide/platinum and gradually developed neurological symptoms after three cycles of chemoimmunotherapy. Subsequently, the patient received a diagnosis of subacute immune-related cerebellar ataxia and was treated successfully with pulse steroid therapy. The patient exhibited almost complete remission of neurological symptoms and had progression-free survival for >24 months.
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Background: Influenza virus infection leads to acute pulmonary injury and acute respiratory distress syndrome (ARDS). The Radiographic Assessment of Lung Edema (RALE) score has been proposed as a reliable tool for the evaluation of the opacity of chest X-rays (CXRs). This study aimed to examine the RALE scores and outcomes in patients with influenza-associated ARDS. Methods: Patients who were newly diagnosed with influenza-associated ARDS from December 2015 to March 2016 were enrolled. Two independent reviewers scored the CXRs obtained on the day of ICU admission and on days 2 and 7 after intensive care unit (ICU) admission. Results: During the study, 47 patients had influenza-associated ARDS. Five died within 7 days of ICU admission. Of the remaining 42, non-survivors (N = 12) had higher Sequential Organ Failure Assessment scores (SOFA) at ICU admission and higher day 7 RALE scores than survivors (N = 30). The day 7 RALE score independently related to late in-hospital mortality (aOR = 1.121, 95% CI: 1.014-1.240, p = 0.025). Conclusions: The RALE score for the evaluation of opacity on CXRs is a highly reproducible tool. Moreover, RALE score on day 7 was an independent predictor of late in-hospital mortality in patients with influenza-associated ARDS.
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The gut microbiota is essential for the maintenance of intestinal immune homeostasis and is responsible for breaking down dietary fiber into short-chain fatty acids (SCFAs). Butyrate, the most abundant bioactive SCFA in the gut, is a histone deacetylase inhibitor (HDACi), a class of drug that has potent immunomodulatory properties. This characteristic of butyrate, along with our previous discovery that conventional dendritic cells (DCs) are required for the development of experimental colitis, led us to speculate that butyrate may modulate DC function to regulate gut mucosal homeostasis. We found that butyrate, in addition to suppressing LPS-induced bone marrow-derived DC maturation and inhibiting DC IL-12 production, significantly induced IL-23 expression. The upregulation of mRNA subunit IL-23p19 at the pretranslational level was consistent with the role of HDACi on the epigenetic modification of gene expression. Furthermore, the mechanism of IL-23p19 upregulation was independent of Stat3 and ZBP89. Coculture of splenocytes with LPS-stimulated DCs pretreated with or without butyrate was performed and showed a significant induction of IL-17 and IL-10. We demonstrated further the effect of butyrate in vivo using dextran sulfate sodium (DSS)-induced colitis and found that the addition of butyrate in the drinking water of mice worsened DSS-colitis. This is in contrast to the daily intraperitoneal butyrate injection of DSS-treated mice, which mildly improved disease severity. Our study highlights a novel effect of butyrate in upregulating IL-23 production of activated DCs and demonstrates a difference in the host response to the oral vs. systemic route of butyrate administration.
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Butiratos/farmacologia , Colite/metabolismo , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/metabolismo , Interleucina-23/metabolismo , Animais , Células Cultivadas , Feminino , Camundongos , Camundongos Endogâmicos C57BLRESUMO
BACKGROUND AND AIM: Although alpha-fetoprotein (AFP) is a widely used serological marker for hepatocellular carcinoma (HCC), its utility is limited due to its unsatisfactory sensitivity. Meanwhile, a newly developed immunoassay-DR-70-has been reported to have a good sensitivity for HCC in a small-scale study. The aim of this study was to determine the clinical value of DR-70 for the surveillance of HCC. METHODS: Serum levels of DR-70 and AFP were measured in 103 patients with HCC, 50 healthy volunteers, and 33 patients with chronic liver disease. In addition, we investigated the prognostic value of DR-70 in patients with HCC correlating with the clinical staging-Cancer of the Liver Italian Program (CLIP) score and Barcelona Clinic Liver Cancer (BCLC) classification. RESULTS: Based on the receiver operating characteristic curve with area under the curve of 0.836, the DR-70 cut-off value for detecting HCC was determined to be 0.75 µg/mL. DR-70 provided a sensitivity of 81.6% and a specificity of 77.1%, and correlated well with the CLIP score and BCLC classification. The combination of DR-70 and AFP increased the sensitivity to 91.2%. The prognosis for patients with HCC with DR-70 level > 0.75 µg/mL was worse than that for those with DR-70 ≤ 0.75 µg/mL. Among the patients with early stage HCC (CLIP score 0-2), DR-70 > 0.75 µg/mL independently predicted a poor survival. CONCLUSIONS: DR-70 immunoassay is complementary to AFP for the detection of HCC and has a good correlation with clinical staging and prognosis.
Assuntos
Biomarcadores Tumorais/análise , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/patologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores Tumorais/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Estimativa de Kaplan-Meier , Hepatopatias/sangue , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Curva ROC , Estatísticas não Paramétricas , Adulto Jovem , alfa-Fetoproteínas/metabolismoRESUMO
BACKGROUND AND AIMS: Epidemiological data have recently emerged to suggest Helicobacter pylori may protect against certain chronic inflammatory diseases such as inflammatory bowel disease (IBD). However, the mechanism for the observed inverse association between H pylori and IBD has not been described. METHODS: The frequency of immunoregulatory (IRS) to immunostimulatory (ISS) sequences within the genome of various bacteria was calculated using MacVector software. The induction of type I IFN and IL-12 responses by DNA-pulsed murine bone marrow-derived dendritic cells (BMDC) and human plasmacytoid dendritic cells (DC) was analysed by cytokine production. The effect of H pylori DNA on Escherichia coli DNA production of type I IFN and IL-12 was assessed. The in-vivo significance of H pylori DNA suppression was assessed in a dextran sodium sulphate (DSS) model of colitis. The systemic levels of type I IFN were assessed in H pylori-colonised and non-colonised patients. RESULTS: H pylori DNA has a significantly elevated IRS:ISS ratio. In-vitro experiments revealed the inability of H pylori DNA to stimulate type I IFN or IL-12 production from mouse BMDC or human plasmacytoid DC. H pylori DNA was also able to suppress E coli DNA production of type I IFN and IL-12. The administration of H pylori DNA before the induction of DSS colitis significantly ameliorated the severity of colitis compared with E coli DNA or vehicle control in both an acute and chronic model. Finally, the systemic levels of type I IFN were found to be lower in H pylori-colonised patients than non-colonised controls. CONCLUSIONS: This study indicates that H pylori DNA has the ability to downregulate pro-inflammatory responses from DC and this may partly explain the inverse association between H pylori and IBD.