Radiographic chest wall abnormalities in primary spontaneous pneumothorax identified by artificial intelligence

Primary spontaneous pneumothorax (PSP) primarily affects slim and tall young males. Exploring the etiological link between chest wall structural characteristics and PSP is crucial for advancing treatment methods. In this case-control study, chest computed tomography (CT) images from patients undergoing thoracic surgery, with or without PSP, were analyzed using Artificial Intelligence. Convolutional Neural Network (CNN) model of EfficientNetB3 and InceptionV3 were used with transfer learning on the Imagenet to compare the images of both groups. A heatmap was created on the chest CT scans to enhance interoperability, and the scale-invariant feature transform (SIFT) was adopted to further compare the image level. A total of 2,312 CT images of 26 non-PSP patients and 1,122 CT images of 26 PSP patients were selected. Chest-wall apex pit (CAP) was found in 25 PSP and three non-PSP patients (p < 0.001). The CNN achieved a testing accuracy of 93.47 % in distinguishing PSP from non-PSP based on chest wall features by identifying the existence of CAP. Heatmap analysis demonstrated CNN's precision in targeting the upper chest wall, accurately identifying CAP without undue influence from similar structures, or inappropriately expanding or minimizing the test area. SIFT results indicated a 10.55 % higher mean similarity within the groups compared to between PSP and non-PSP (p < 0.001). In conclusion, distinctive radiographic chest wall configurations were observed in PSP patients, with CAP potentially serving as an etiological factor linked to PSP. This study accentuates the potential of AI-assisted analysis in refining diagnostic approaches and treatment strategies for PSP.

A Cost-Effective Model for Predicting Recurrent Gastric Cancer Using Clinical Features

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.

Applying Object Detection and Large Language Model to Establish a Smart Telemedicine Diagnosis System with Chatbot: A Case Study of Pressure Injuries Diagnosis System

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.

A novel therapeutic approach for endometriosis using adipose-derived stem cell-derived conditioned medium- A new hope for endometriotic patients in improving fertility

Introduction

Endometriosis is defined as the growth of endometrial glands and stromal cells in a heterotopic location with immune dysregulation. It usually leads to chronic pelvic pain and subfertility. Although various treatments are available, the recurrence rate remains high. Adipose tissue is an abundant source of multipotent mesenchymal adipose-derived stem cells (ADSCs). ADSCs display effects on not only tissue regeneration, but also immune regulation. Thus, the current study aims to test the effects of ADSCs on the growth of endometriosis.

Methods

ADSCs isolated from lipoaspiration-generated adipose tissue and their conditioned medium (ADSC-CM) were subjected to quality validation, including karyotyping as well as growth promotion and sterility tests for microbial contamination under Good Tissue Practice and Good Manufacturing Practice regulations. An autologous endometriosis mouse model was established by suturing endometrial tissue to peritoneal wall followed by treating with DMEM/F12 medium, ADSC-CM, ADSCs or ADSC-CM+ADSCs for 28 days. The area of endometriotic cysts and the degree of pelvic adhesion were measured. ICAM-1, VEGF and caspase 3 expression was assessed by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry. Moreover, the mice were allowed to mate and deliver. The pregnancy outcomes were recorded. The ADSC-CM was subjected to proteomics analysis with further data mining with Ingenuity Pathway Analysis (IPA).

Results

Both ADSC-CM and ADSCs passed quality validation. ADSC-CM reduced the area of endometriotic cysts. The inhibition by ADSC-CM was obliterated by adding ADSCs. The presence of ADSCs with or without ADSC-CM increased the peritoneal adhesion. ADSC-CM inhibited ICAM-1 and VEGF mRNA and protein expression, whereas the addition of ADSCs not only did not inhibit by itself, but also blocked the inhibition by ADSC-CM. The resorption rate was reduced by ADSC-CM. The number of live birth/dam and the survival rate of pup at 1 week-old were both increased by ADSC-CM in mice with endometriosis. IPA demonstrated that PTX3 was potentially critical for the inhibition of endometriosis by ADSC-CM due to its anti-inflammatory and antiangiogenic properties as well as its importance in implantation.

Conclusion

ADSC-CM inhibited endometriosis development and improved pregnancy outcomes in mice. Potential translation to clinical treatment for human endometriosis is expected.

Plasma levels and tissue expression of liver-type fatty acid-binding protein in patients with breast cancer

BACKGROUND

Liver-type fatty acid-binding protein (L-FABP) is widely expressed in hepatocytes and plays a role in lipid metabolism. It has been demonstrated to be overexpressed in different types of cancer; however, few studies have investigated the association between L-FABP and breast cancer. The aim of this study was to assess the association between plasma concentrations of L-FABP in breast cancer patients and the expression of L-FABP in breast cancer tissue.

METHOD

A total of 196 patients with breast cancer and 57 age-matched control subjects were studied. Plasma L-FABP concentrations were measured using ELISA in both groups. The expression of L-FABP in breast cancer tissue was examined using immunohistochemistry.

RESULT

The patients had higher plasma L-FABP levels than the controls (7.6 ng/mL (interquartile range 5.2-12.1) vs. 6.3 ng/mL (interquartile range 5.3-8.5), p = 0.008). Multiple logistic regression analysis showed an independent association between L-FABP and breast cancer, even after adjusting for known biomarkers. Moreover, the rates of pathologic stage T2+T3+T4, clinical stage III, positive HER-2 receptor status, and negative estrogen receptor status were significantly higher in the patients with an L-FABP level greater than the median. Furthermore, the L-FABP level gradually increased with the increasing stage. In addition, L-FABP was detected in the cytoplasm, nuclear, or both cytoplasm and nuclear of all breast cancer tissue examined, not in the normal tissue.

CONCLUSIONS

Plasma L-FABP levels were significantly higher in the patients with breast cancer than in the controls. In addition, L-FABP was expressed in breast cancer tissue, which suggests that L-FABP may be involved in the pathogenesis of breast cancer.

Neuroprotective Effect of Abelmoschus manihot Flower Extracts against the H2O2-Induced Cytotoxicity, Oxidative Stress and Inflammation in PC12 Cells

The progression of neurodegenerative diseases is associated with oxidative stress and inflammatory responses. Abelmoschus manihot L. flower (AMf) has been shown to possess excellent antioxidant and anti-inflammatory activities. This study investigated the protective effect of ethanolic extract (AME), water extract (AMW) and supercritical extract (AMS) of AMf on PC12 neuronal cells under hydrogen peroxide (H2O2) stimulation. This study also explored the molecular mechanism underlying the protective effect of AME, which was the best among the three extracts. The experimental results showed that even at a concentration of 500 μg/mL, neither AME nor AMW showed toxic effects on PC12 cells, while AMS caused about 10% cell death. AME has the most protective effect on apoptosis of PC12 cells stimulated with 0.5 mM H2O2. This is evident by the finding when PC12 cells were treated with 500 μg/mL AME; the viability was restored from 58.7% to 80.6% in the Treatment mode (p < 0.001) and from 59.1% to 98.1% in the Prevention mode (p < 0.001). Under the stimulation of H2O2, AME significantly up-regulated the expression of antioxidant enzymes, such as catalase, glutathione peroxidase and superoxide dismutase; promoted the production of the intracellular antioxidant; reduced glutathione; and reduced ROS generation in PC12 cells. When the acute inflammation was induced under the H2O2 stimulation, AME significantly down-regulated the pro-inflammatory cytokines and mediators (e.g., TNF-α, IL-1β, IL-6, COX-2 and iNOS). AME pretreatment could also greatly promote the production of nucleotide excision repair (NER)-related proteins, which were down-regulated by H2O2. This finding indicates that AME could repair DNA damage caused by oxidative stress. Results from this study demonstrate that AME has the potential to delay the onset and progression of oxidative stress-induced neurodegenerative diseases.

Enhanced Authenticated Key Agreement for Surgical Applications in a Tactile Internet Environment

The Tactile Internet enables physical touch to be transmitted over the Internet. In the context of electronic medicine, an authenticated key agreement for the Tactile Internet allows surgeons to perform operations via robotic systems and receive tactile feedback from remote patients. The fifth generation of networks has completely changed the network space and has increased the efficiency of the Tactile Internet with its ultra-low latency, high data rates, and reliable connectivity. However, inappropriate and insecure authentication key agreements for the Tactile Internet may cause misjudgment and improper operation by medical staff, endangering the life of patients. In 2021, Kamil et al. developed a novel and lightweight authenticated key agreement scheme that is suitable for remote surgery applications in the Tactile Internet environment. However, their scheme directly encrypts communication messages with constant secret keys and directly stores secret keys in the verifier table, making the scheme vulnerable to possible attacks. Therefore, in this investigation, we discuss the limitations of the scheme proposed by Kamil scheme and present an enhanced scheme. The enhanced scheme is developed using a one-time key to protect communication messages, whereas the verifier table is protected with a secret gateway key to mitigate the mentioned limitations. The enhanced scheme is proven secure against possible attacks, providing more security functionalities than similar schemes and retaining a lightweight computational cost.

Effects of Abelmoschus manihot Flower Extract on Enhancing Sexual Arousal and Reproductive Performance in Zebrafish

The flower of Abelmoschus manihot L. is mainly used for the treatment of chronic kidney diseases, and has been reported to have bioactivities such as antioxidant, anti-inflammatory, antiviral, and antidepressant activities. This study used wild-type adult zebrafish as an animal model to elucidate the potential bioactivity of A. manihot flower ethanol extract (AME) in enhancing their sexual and reproductive functions. Zebrafish were fed AME twice a day at doses of 0.2%, 1%, and 10% for 28 days, and were then given the normal feed for an additional 14 days. The hormone 17-β estradiol was used as the positive control. Sexual behavioral parameters such as the number of times males chased female fish, the production of fertilized eggs, and the hatching rate of the fertilized eggs were recorded at days 0.33, 7, 14, 21, 28, and 42. The expression levels of sex-related genes—including lhcgr, ar, cyp19a1a, and cyp19a1b—were also examined. The results showed that the chasing number, fertilized egg production, and hatching rate were all increased with the increase in the AME treatment dose and treatment time. After feeding with 1% and 10% AME for 28 days, the chasing number in the treated group as compared to the control group increased by 1.52 times and 1.64 times, respectively; the yield of fertilized eggs increased by 1.59 times and 2.31 times, respectively; and the hatching rate increased by 1.26 times and 1.69 times, respectively. All three parameters exhibited strong linear correlations with one another (p < 0.001). The expression of all four genes was also upregulated with increasing AME dose and treatment duration. When feeding with 0.2%, 1%, and 10% AME for 28 days, the four sex-related genes were upregulated at ranges of 1.79−2.08-fold, 2.74−3.73-fold, and 3.30−4.66-fold, respectively. Furthermore, the effect of AME was persistent, as the promotion effect continued after the treatment was stopped for at least two weeks. The present findings suggest that AME can enhance the endocrine system and may improve libido and reproductive performance in zebrafish.

Combinatory effects of current regimens and Guizhi Fuling Wan on the development of endometriosis

OBJECTIVE

Endometriosis, defined as the growth of endometrial glands and stromal cells in a heterotopic location under the cyclic influence of ovarian hormones, is a common gynecological disorder manifested by chronic pelvic pain and infertility. In traditional Chinese medicine, endometriosis is characterized by stagnation of vital energy (qi) and blood stasis. Guizhi Fuling Wan (GFW) was first described in Chinese canonical medicine to treat disorders associated with stagnation of qi and blood stasis, including endometriosis. Therefore, the current study aimed to test the effects of combining GFW with western medicine on the suppression of endometriosis.

MATERIALS AND METHODS

Endometriosis was generated by suturing endometrial tissue on the peritoneal wall of C57BL/6JNarl mice. The mice were subsequently treated with either GFW or current hormonal therapies or in combination for 28 days.

RESULTS

Endometriosis development was inhibited by GFW, Gestrinone, Visanne, GFW + Gestrinone or GFW + medroxyprogesterone acetate (MPA). The expression of intercellular adhesion molecule 1 (ICAM-1) was inhibited by GFW, Gestrinone, MPA, Visanne, GFW + Gestrinone, GFW + MPA and GFW + Visanne. Vascular endothelial growth factor (VEGF) expression was inhibited by GFW, Gestrinone, Visanne, GFW + Gestrinone and GFW + MPA. Both ICAM-1- and VEGF-reducing effects of GFW were attenuated by western medicines. Administration of GFW, MPA, Visanne, GFW + MPA and GFW + Visanne also correspondingly reduced macrophage population in peritoneal fluid. GFW, MPA, Visanne, GFW + MPA and GFW + Visanne enhanced B-cell population in peritoneal fluid.

CONCLUSION

The current study reveals the therapeutic effects of GFW on endometriosis. However, the combination of GFW and current hormonal therapies potentially impedes the efficacy of each individual agent in treating endometriosis.

Predicting the Risk Factors of Second Primary Cancer in Patients with Hepatocellular Carcinoma

Screening for cancer and improved treatments have not only improved treatment outcomes and patient survival but have also led to an increase in the number of second primary cancers (SPCs). Hepatocellular carcinoma has been a common occurrence in Taiwan over the past decade. The mortality rate is second only to malignant tumors of lung cancer, and it also represents the fourth highest cancer medical expenditure. This study aimed to use machine learning to identify the risk factors for Hepatocellular carcinoma survivors. Of 378,445 datasets, including 15,251 from patients with SPCs, were collected; 18 predictive variables were considered risk factors for SPCs based on the physician panel discussion. The machine learning techniques employed included support vector machine, C5 decision tree, and random forest. SMOTE (Synthetic Minority Oversampling Technique) sampling method was used to resolve the imbalance problem. The results showed that the top 5 risk factors for SPCs were tumor size, clinical stage, surgery, total bilirubin, and BCLC Stage. The support vector machine method had the highest predicted accuracy (0.7673). The risk factors extracted from the classification models and association rules will be used to provide valuable information for HCC therapy.

Development of a Longitudinal Diagnosis and Prognosis in Patients with Chronic Kidney Disease: Intelligent Clinical Decision-Making Scheme

Previous studies on CKD patients have mostly been retrospective, cross-sectional studies. Few studies have assessed the longitudinal assessment of patients over an extended period. In consideration of the heterogeneity of CKD progression. It’s critical to develop a longitudinal diagnosis and prognosis for CKD patients. We proposed an auto Machine Learning (ML) scheme in this study. It consists of four main parts: classification pipeline, cross-validation (CV), Taguchi method and improve strategies. This study includes datasets from 50,174 patients, data were collected from 32 chain clinics and three special physical examination centers, between 2015 and 2019. The proposed auto-ML scheme can auto-select the level of each strategy to associate with a classifier which finally shows an acceptable testing accuracy of 86.17%, balanced accuracy of 84.08%, sensitivity of 90.90% and specificity of 77.26%, precision of 88.27%, and F1 score of 89.57%. In addition, the experimental results showed that age, creatinine, high blood pressure, smoking are important risk factors, and has been proven in previous studies. Our auto-ML scheme light on the possibility of evaluation for the effectiveness of one or a combination of those risk factors. This methodology may provide essential information and longitudinal change for personalized treatment in the future.

Glossogyne tenuifolia Extract Increases Nitric Oxide Production in Human Umbilical Vein Endothelial Cells

The vascular nitric oxide (NO) system has a protective effect in atherosclerosis. NO is generated from the conversion of L-arginine to L-citrulline by the enzymatic action of endothelial NO synthase (eNOS). Compounds with the effect of enhancing eNOS expression are considered to be candidates for the prevention of atherosclerosis. In this study, extracts from the aerial, root, and whole plant of Glossogyne tenuifolia (GT) were obtained with ethanol, n-hexane, ethyl acetate (EA), and methanol extraction, respectively. The effects of these GT extracts on the synthesis of NO and the expression of eNOS in human umbilical vein endothelial cells (HUVECs) were investigated. NO production was determined as nitrite by colorimetry, following the Griess reaction. The treatment of HUVECs with EA extract from the root of GT and n-hexane, methanol, and ethanol extract from the aerial, root, and whole plant of GT increased NO production in a dose-dependent manner. When at a dose of 160 μg/mL, NO production increased from 0.9 to 18.4-fold. Among these extracts, the methanol extract from the root of GT (R/M GTE) exhibited the most potent effect on NO production (increased by 18.4-fold). Furthermore, using Western blot and RT-PCR analysis, treatment of HUVECs with the R/M GTE increased both eNOS protein and mRNA expression. In addition, Western blot analysis revealed that the R/M GTE increased eNOS phosphorylation at serine¹¹⁷⁷ as early as 15 min after treatment. The chemical composition for the main ingredients was also performed by HPLC analysis. In conclusion, the present study demonstrated that GT extracts increased NO production in HUVECs and that the R/M GTE increased NO production via increasing eNOS expression and activation by phosphorylation of eNOS at serine¹¹⁷⁷.

Postpartum HPV Vaccination Rate and Differences in Background Characteristics Between HPV Vaccinated and Unvaccinated Postpartum Women: Strict Monitoring and Follow-Up of Postpartum HPV Vaccination Program

There is a need to increase the vaccine completion rates in women who have already received human papillomavirus (HPV) vaccines. With vaccines requiring multiple doses, designing a vaccination control program and increasing the proportion of women who complete vaccination are critical and remain as huge challenges. Currently, there are no published reports on the differences in the background characteristics between postpartum women who are vaccinated or unvaccinated against HPV. This study aimed to determine the vaccination rates of the second and third doses of HPV vaccination utilizing an achievable HPV vaccination program in postpartum women. In this retrospective study, 243 postpartum women attending Chiayi Chang Gung Memorial Hospital between March and September 2014 were enrolled. These women were classified into two groups: one group received the HPV vaccine under a practical, controlled postpartum HPV vaccination program, and the other group did not. The rates for the second and third rounds of HPV vaccination in postpartum women were calculated. The differences in the background characteristics between the two groups were determined using the Student’s t test, chi-square test or Fisher’s exact test, and the multiple logistic models, as appropriate. Under the controlled postpartum HPV vaccination program, the completion rate for the three doses of postpartum HPV vaccination was 97.2%. Significant differences were observed according to maternal age, gender of the newborn, and postpartum Pap smear results between the two groups in our study. In conclusion, the controlled postpartum HPV vaccination program is a reasonable method for achieving an excellent completion rate for the three doses of postpartum HPV vaccination and may be a good model for any multiple-dose vaccination protocol.

A rapid molecular diagnostic method for spinal muscular atrophy

Spinal muscular atrophy (SMA) is a common autosomal recessive disorder which has been considered as the second common cause of infant death, with an estimated prevalence of 1 in 10,000 live births. The disorder is caused by survival motor neuron 1 gene (SMN1) deficiency leading to limb weakness, difficult swallowing and abnormal breathing. Here, a fast and accurate method for SMA detection has been developed. Genomic DNA sample collected from whole blood, amniotic fluid, or dried blood spots can be analysed by using the Clarity™ Digital PCR (dPCR) System for determining the copy numbers of SMN1 and SMN2 genes. Two hundred and fourteen clinical samples determined by qPCR-based method were enrolled and used to establish the cut-off ranges for unaffected individual, SMA carrier and SMA patient categories. After setting the cut-off range for each group, 12 samples were analyzed by both dPCR-based method and MLPA (multiplex ligation-dependent probe amplification), the current testing golden standard for SMA, and 100% concordant results between the two testing methods were performed. CSB SMA Detection Kit combined with dPCR platform provides a robust and precise approach to distinguish unaffected individuals, SMA carrier and SMA patients. This rapid molecular diagnostic method can be adapted to pre-pregnancy eugenics inspection, prenatal testing as well as newborns screening and help physicians or genetic counselors to improve population SMA incidence.

Glossogyne tenuifolia Attenuates Proliferation and Migration of Vascular Smooth Muscle Cells

The proliferation and migration of vascular smooth muscle cells (VSMCs) are essential in the pathogenesis of various vascular diseases, such as atherosclerosis and restenosis. Among the mediators of VSMC during atherosclerosis development, platelet-derived growth factor (PDGF)-BB is a potent mitogen for VSMCs and greatly contributes to the intimal accumulation of VSMCs. Glossogyne tenuifolia (GT, Xiang-Ru) is a traditional antipyretic and hepatoprotective herb from Penghu Island, Taiwan. This study evaluated the inhibitory effect of GT ethanol extract (GTE) and GT water extract (GTW) on proliferative and migratory activities in PDGF-BB-induced VSMCs. The experimental results demonstrated that GTE significantly inhibited the PDGF-BB-stimulated VSMC proliferation and migration, as shown by MTT, wound healing, and Boyden chamber assays. GTE was found to have a much more potent inhibitory activity than GTW. Based on the Western blot analysis, GTE significantly blocked the PDGF-BB-induced phosphorylation of NF-κB and mitogen-activated protein kinase (MAPK) pathways, including extracellular signal-regulated kinase (ERK), p38, and JNK, in VSMCs. In addition, GTE retarded the PDGF-BB-mediated migration through the suppression of matrix metalloproteinase (MMP)-2 and MMP-9 expression in VSMCs. Three main ingredients of GT-chlorogenic acid, luteolin-7-glucoside, and luteolin-all showed significant anti-proliferative effects on PDGF-BB-induced VSMCs. As a whole, our findings indicated that GTE has the potential to be a therapeutic agent to prevent or treat restenosis or atherosclerosis.

Big Data, Decision Models, and Public Health

Unlike most daily decisions, medical decision making often has substantial consequences and trade-offs. Recently, big data analytics techniques such as statistical analysis, data mining, machine learning and deep learning can be applied to construct innovative decision models. With complex decision making, it can be difficult to comprehend and compare the benefits and risks of all available options to make a decision. For these reasons, this Special Issue focuses on the use of big data analytics and forms of public health decision making based on the decision model, spanning from theory to practice. A total of 64 submissions were carefully blind peer reviewed by at least two referees and, finally, 23 papers were selected for this Special Issue.

Antrodia cinnamomea Extraction Waste Supplementation Promotes Thermal Stress Tolerance and Tissue Regeneration Ability of Zebrafish

Antrodia cinnamomea (AC) has been shown to have anti-inflammatory, anti-tumor, and immunomodulation activities. It is estimated that hundreds of metric tons of AC extraction waste (ACEW) are produced per year in Taiwan. This study aims to assess the feasibility of applying ACEW as feed supplement in the aquaculture industry. ACEW significantly inhibited the growth of microorganisms in the water tank, by around 39.4% reduction on the fifth day with feed supplemented of 10% ACEW. The feed conversion efficiency of zebrafish with 10% ACEW supplementation for 30 days was 1.22-fold compared to that of the control. ACEW dramatically improved the tolerances of zebrafish under the heat and cold stresses. When at water temperature extremes of 38 °C or 11 °C, compared to the 100% mortality rate in the control group, the 10% ACEW diet group still had 91.7% and 83.3% survival rates, respectively. In a caudal fin amputation test, the fin recovery of zebrafish was increased from 68.4% to 93% with 10% ACEW diet after 3-week regeneration. ACEW effectively down-regulated the gene expression of TNF-α, IL-1β, IL-6, and IL-10, and up-regulated the gene expression of IL-4/13A. Additionally, the supplement of ACEW in the feed can maintain and prevent the fish’s body weight from dropping too much under enteritis. Taken together, ACEW has beneficial potential in aquaculture.

Advanced Machine Learning in Prediction of Second Primary Cancer in Colorectal Cancer

Colorectal cancer (CRC) ranked third among most commonly diagnosed cancers worldwide. The onset of second primary cancer (SPC) is an important indicator in treating CRC. We tried to use the advanced machine learning method in order to find the factors of SPC. Patients with CRC from three medical centers were identified from cancer registries in Taiwan. The classifier of A Library for Support Vector Machines (LIBSVM) and Reduced Error Pruning Tree (REPTree) were applied to analyze the relationship of clinical features with category by constructing the optimized model of every classified issue. Machine learning can be used to rank the factor affecting the secondary primary malignancy. In the clinical practice, physician should be of aware the possibility of cancer recurrence and routine checkups for early second primary malignancy detection is recommended. The accuracy rate of the may need more big data. The machine learning method is feasible in detecting/predicting potential second primary cancer in the future.

Risk Prediction for Early Chronic Kidney Disease: Results from an Adult Health Examination Program of 19,270 Individuals

Developing effective risk prediction models is a cost-effective approach to predicting complications of chronic kidney disease (CKD) and mortality rates; however, there is inadequate evidence to support screening for CKD. In this study, four data mining algorithms, including a classification and regression tree, a C4.5 decision tree, a linear discriminant analysis, and an extreme learning machine, are used to predict early CKD. The study includes datasets from 19,270 patients, provided by an adult health examination program from 32 chain clinics and three special physical examination centers, between 2015 and 2019. There were 11 independent variables, and the glomerular filtration rate (GFR) was used as the predictive variable. The C4.5 decision tree algorithm outperformed the three comparison models for predicting early CKD based on accuracy, sensitivity, specificity, and area under the curve metrics. It is, therefore, a promising method for early CKD prediction. The experimental results showed that Urine protein and creatinine ratio (UPCR), Proteinuria (PRO), Red blood cells (RBC), Glucose Fasting (GLU), Triglycerides (TG), Total Cholesterol (T-CHO), age, and gender are important risk factors. CKD care is closely related to primary care level and is recognized as a healthcare priority in national strategy. The proposed risk prediction models can support the important influence of personality and health examination representations in predicting early CKD.

Sequence-based Structural B-cell Epitope Prediction by Using Two Layer SVM Model and Association Rule Features

Background:

Immune reaction is the most important defense mechanism for destroying invading pathogens in our body, and the epitope is the position of the antigen–antibody interaction on pathogenic proteins.

Objective:

The majority of epitopes are structural; however, the existing sequence-based predicting websites still have several methods to improve the predicting performance. Therefore, in this study, we used SVM as a machine learning tool to predict the epitope-based on protein sequences.

Methods:

Firstly, we built five SVM models in the first layer according to five features, including binary composition, position-specific scoring matrix, secondary structure, accessible surface area, and association rule, and then chose the patterns that exhibited the best performance in each model. Secondly, using the confidence score of the first-layer models as the input value for the SVM model in the second layer, that SVM model was integrated into the first-layer SVM models for improving the predicting accuracy.

Results:

The final prediction model was able to achieve up to 63% accuracy in predicting epitope results, and the predicting performance was better than that achieved by the existing predicting websites.

Conclusion:

Finally, a case study using a two-subunit cytochrome c oxidase of Paracoccus denitrificans was tested, achieving an accuracy of up to 66%.

Dairy cattle with bovine leukaemia virus RNA show significantly increased leukocyte counts

Infection with bovine leukaemia virus (BLV), a retrovirus, causes dysfunction of the immune system and can have a marked economic impact on dairy industries due to decreased milk production and reduced lifespan in affected dairy cattle. The presence of proviral DNA has been the major diagnostic indicator of BLV infection. However in the course of BLV infection, the viral genome can be dormant, without detectable gene expression, resulting in limited impact on infected animals. At present, there is limited knowledge regarding haematological indices in dairy cattle that could indicate activation of the BLV genome and suggest reactivated BLV infection. In this study, BLV infection and BLV genome reactivation were evaluated based on the presence of BLV DNA and BLV env gene transcripts, respectively. BLV RNA transcription was confirmed. Among 93 whole blood samples obtained from asymptomatic dairy cattle, the prevalence of BLV proviral DNA and transcripts was 93.5% (n = 87/93) and 83.9% (n = 78/93), respectively. Between groups with and without BLV, the mean counts of white blood cells and lymphocytes in whole blood were significantly associated with the presence of BLV RNA (P < 0.05), but not with BLV proviral DNA. These results shed light on the activation status of the BLV genome and should be taken into account when evaluating the possible impact of BLV on cattle.

Elevated Plasma Adiponectin Levels Are Associated with Abnormal Corrected QT Interval in Patients with Stable Angina

Low-circulating levels of adiponectin (ADPN) are associated with obesity, diabetes mellitus, and coronary artery disease. On the contrary, some studies have demonstrated a link between relatively high levels of plasma ADPN and heart failure, atrial fibrillation, and adverse outcome. However, little is known about the relationship between ADPN level and prolonged QT interval. The aim of this study was to investigate the association between plasma ADPN levels and prolonged QT interval in patients with stable angina.In this retrospective study, because the diverse disease severity and condition of the study population may have affected the results, we chose individuals with stable angina. Plasma ADPN concentrations were measured using enzyme-linked immunosorbent assays. A 12-lead ECG recording was obtained from each patient.We enrolled 479 stable-angina patients. Patients with an abnormal corrected QT (QTc) interval had higher median plasma ADPN levels than those with normal QTc intervals. Age- and sex-adjusted ADPN levels were positively associated with heart rate, QTc interval, left ventricular mass index, and creatinine but negatively associated with left ventricular ejection fraction, waist circumference, current smoking, total cholesterol, triglycerides, low-density lipoprotein cholesterol, albumin, and estimated glomerular filtration rate. A multiple logistic regression analysis revealed ADPN as an independent association factor for abnormal QTc interval. Increasing concentrations of sex-specific ADPN were independently and significantly associated with abnormal QTc interval, even after full adjustment of known biomarkers.Our results indicate that ADPN may play a role in the pathogenesis of abnormal QTc interval in patients with stable angina.

Cryptococcus neoformans var grubii meningoencephalitis in a patient on fingolimod for relapsing-remitting multiple sclerosis: Case report and review of published cases

INTRODUCTION

Fingolimod, a sphingosine-1-phosphate modulator used in the treatment of relapsing-remitting multiple sclerosis, has been associated with several cases of cryptococcosis.

CASE REPORT

We present a case of Cryptococcal meningoencephalitis attributable to Cryptococcus neoformans var. grubii, in a 58-year-old bird-keeper from Australia, after 7 years of fingolimod therapy. We discuss this in the context of previously reported cases, our understanding of fingolimod immune modulation, and known Cryptococcus pathobiology.

CONCLUSION

We suggest consideration of harm minimisation behaviours in patients requiring fingolimod, particularly in those with profound CD4 lymphopenia. Furthermore, we echo the call for improved post-marketing surveillance systems to determine the epidemiology of atypical infections with novel immunomodulatory treatments.

Circulating fatty acid-binding protein 1 (FABP1) and nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

Background: Fatty acid-binding protein 1 (FABP1) (also known as liver-type fatty acid-binding protein or LFABP) is a protein that is mainly expressed in the liver, and is associated with hepatocyte injury in acute transplant rejection. Reduced levels of FABP1 in mice livers have been shown to be effective against nonalcoholic fatty liver disease (NAFLD). In this study, we investigated the association between plasma FABP1 levels and NAFLD in patients with type 2 diabetes mellitus (T2DM). Methods: We enrolled 267 T2DM patients. Clinical and biochemical parameters were measured. The severity of NAFLD was assessed by ultrasound. FABP1 levels were determined using by enzyme-linked immunosorbent assays. Results: FABP1 levels were higher in patients with overt NAFLD, defined as more than a moderate degree of fatty liver compared to those without NAFLD. Age- and sex-adjusted analysis of FABP1 showed positive associations with body mass index (BMI), waist circumference, homeostasis model assessment estimate of β-cell function, creatinine, and fatty liver index, but showed negative associations with albumin and estimated glomerular filtration rate (eGFR). The odds ratio (OR) for the risk of overt NAFLD with increasing levels of sex-specific FABP1 was significantly increased (OR 2.63 [95% CI 1.30-5.73] vs. 4.94 [2.25-11.48]). The OR in the second and third tertiles of FABP1 remained significant after adjustments for BMI, triglycerides, high-density lipoprotein cholesterol, HbA1C, homeostasis model assessment estimate of insulin resistance, white blood cell count, hepatic enzymes, and eGFR. Conclusion: Our results indicate that FABP1 may play a role in the pathogenesis of NAFLD in patients with T2DM.

Unique Access to u-Channel Physics: Exclusive Backward-Angle Omega Meson Electroproduction

Backward-angle meson electroproduction above the resonance region, which was previously ignored, is anticipated to offer unique access to the three quark plus sea component of the nucleon wave function. In this Letter, we present the first complete separation of the four electromagnetic structure functions above the resonance region in exclusive ω electroproduction off the proton, ep→e^{'}pω, at central Q^{2} values of 1.60, 2.45  GeV^{2}, at W=2.21  GeV. The results of our pioneering -u≈-u_{min} study demonstrate the existence of a unanticipated backward-angle cross section peak and the feasibility of full L/T/LT/TT separations in this never explored kinematic territory. At Q^{2}=2.45  GeV^{2}, the observed dominance of σ_{T} over σ_{L}, is qualitatively consistent with the collinear QCD description in the near-backward regime, in which the scattering amplitude factorizes into a hard subprocess amplitude and baryon to meson transition distribution amplitudes: universal nonperturbative objects only accessible through backward-angle kinematics.

P2817Efficacy and safety of ticagrelor monotherapy in patients with complex percutaneous coronary intervention: insights from the Global Leaders trial

Background/Introduction

Purpose

Methods

The Global Leaders trial recruited 15,991 patients treated by default with a biolimus A9-eluting stent, and randomised in a 1:1 ratio either to the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) or to the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy). Complex PCI includes at least one of the following characteristics; left main and/or multivessel PCI, long stenting (defined as total stent length≥46mm), and bifurcation treatment with two stents. The present sub-analysis of the trial evaluated at two years the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code). In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years.

Results

Of 15,450 patients included in the present analysis, 5,188 (26.7%) patients underwent complex PCI. The experimental strategy, when compared with the reference one, had a significantly lower risk of the primary endpoint (3.56% vs. 5.33%, HR: 0.66; 95% CI: 0.51–0.86; p-value= 0.002; p-value for interaction= 0.019) in patients with complex PCI. Similarly, the experimental treatment was associated with a significantly reduced risk of POCE (14.41% vs. 16.88%, HR: 0.84; 95% CI: 0.74–0.97; p=0.016, p-value for interaction= 0.099) and NACE (15.77% vs. 18.37%, HR: 0.85; 95% CI: 0.74–0.97; p=0.014; p-value for interaction= 0.096). The reduction in ischemic events was predominantly observed in patients with 2 or more characteristics of complex PCI (Figure). In contrast, there was no significant difference in the risk of BARC type 3 or 5 bleeding between the two regimens (2.40% vs. 2.38%, HR: 1.01; 95% CI: 0.71–1.44; p-value=0.956; p-value for interaction= 0.935).

Central illustration

Conclusion

Together with other well-established clinical risk factors, the extent and complexity of stenting should be taken into account in tailoring antiplatelet regimens for secondary prevention. The 1-month DAPT followed by 23-month ticagrelor monotherapy reduced the ischemic events without increasing the risk of bleeding in patients who underwent complex PCI, when compared with the conventional DAPT.

Acknowledgement/Funding

The Global Leaders trial was supported by the resource from AstraZeneca, Biosensors, and The Medicines Company.

P2695ABSORB bioresorbable scaffold versus Xience metallic stent in acute coronary syndromes with treated with percutaneous coronary intervention. A subanalysis of the COMPARE-ABSORB trial

Background

The safety and efficacy of the ABSORB scaffold in ACS patients remain unclear. The COMPARE-ABSORB trial compares the ABSORB to the Xience stent in lesions and patients at high risk for restenosis Patients with STEMI and urgent PCI for non-STEMI were not excluded.

Methods

Patients included in the COMPARE-ABSORB trial undergoing PCI for ACS were eligible. Predefined implantation techniques for ABSORB was mandatory. Primary endpoint is target lesion failure (TLF) at 1 year, defined as a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularization.

Results

Of 1670 patients, 842 were treated for ACS. At 1-year, TLF occurred in 22 patients (5.0%) of the ABSORB group and in 14 patients (3.5%) of the Xience group (HR 1.44%; 95% CI 0.74%-2.82%, P=0.284). Definite device thrombosis occurred in 9 patients (2.0%) of the ABSORB group and in 2 patients (0.5%) of the Xience group (HR 4.10%; 95% CI 0.89%-18.9%, P=0.071).

Baseline characteristics ABSORB (n=442) XIENCE (n=400) Age, years (SD) 60.7 (9.6) 61.3 (9.1) Male 350/442 (79.2%) 313/400 (78.3%) Current smoker 159/439 (36.2%) 126/397 (31.7%) Diabetes mellitus 152/440 (34.5%) 138/399 (34.6%) Hypertension 298/442 (67.4%) 266/400 (66.5%) Hypercholesterolemia 255/442 (57.7%) 232/400 (58.0%) Family history of coronary artery disease 147/442 (33.3%) 103/400 (25.8%) Previous MI 61/442 (13.8%) 67/400 (16.8%) Established Peripheral Vascular Disease 27/442 (6.1%) 15/400 (3.8%) Previous PCI 83/442 (18.8%) 86/400 (21.5%) Previous CABG 1/442 (0.2%) 4/400 (1.0%) Previous stroke 15/442 (3.4%) 21/400 (5.3%) Renal Insufficiency 9/442 (2.0%) 13/400 (3.3%) Clinical presentation   Unstable angina 149/442 (33.7%) 141/400 (35.3%)   Non-ST elevation myocardial infarction 183/442 (41.4%) 156/400 (39.0%)   ST elevation myocardial infarction 110/442 (24.9%) 103/400 (25.7%)

KM plot for target lesion failure

Conclusion

The COMPARE-ABSORB trial showed no difference in the primary endpoint at one year for the ACS subgroup. The signal for increased thrombosis remained, even with the optimized implantation protocol

Acknowledgement/Funding

Maasstad Hospital, Rotterdam, the Netherlands

P2811Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: insights from the Global Leaders trial

Background/Introduction

Data on the efficacy and safety of different antiplatelet regimens are limited in patients with increasing total stent length (TSL).

Purpose

To evaluate the impact of the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with increasing TSL.

Methods

The present post-hoc analysis of the Global Leaders trial evaluated the primary endpoint (the composite of the all-cause death and new Q-wave myocardial infarction [MI]) at two years in patients with increasing TSL. In addition, the patient-oriented composite endpoint (POCE) (the composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (the composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also assessed.

Results

The cohort of 15,450 patients treated with a biolimus-eluting biodegradable polymer stents were included in this analysis. In the longer TSL group (≥46mm), the experimental strategy significantly reduced the risk of the primary endpoint (3.78% vs. 5.68%, hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.49–0.90, p=0.008, P interaction=0.042) as well as POCE (14.57% vs. 18.11%, HR: 0.79, 95% CI: 0.67–0.92, p=0.003, P interaction=0.010) and NACE (16.07% vs. 19.64%, HR: 0.80, 95% CI: 0.69–0.93, p=0.004, P interaction=0.012) at two years. The risk of BARC type 3 or 5 bleeding at two years was similar between the two antiplatelet regimens.

KM in patients with long stenting

Conclusion

Ticagrelor monotherapy significantly reduced the risk of the primary endpoint, POCE and NACE with a similar risk of BARC type 3 or 5 bleeding at two years in patients with the longer TSL.

Acknowledgement/Funding

The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R

P2812Ischemic efficacy and bleeding safety of ticagrelor monotherapy in patients with multivessel percutaneous coronary intervention: insights from the Global Leaders trial

Background/Introduction

The optimal duration of DAPT after coronary stent implantation remains a matter of debate and a novel antiplatelet regimen without an increased risk of bleeding while maintaining an anti-ischemic efficacy is of paramount importance in patients at higher risk of ischemia.

Purpose

The aim of the present sub-study of the Global Leaders trial is to evaluate the efficacy and safety of the experimental antiplatelet strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with multivessel percutaneous coronary intervention (PCI).

Methods

The Global Leaders trial enrolled 15,991 patients treated by default with a biolimus A-9 eluting stent. The present sub-study of the trial sought to evaluate the impact of the long-term ticagrelor monotherapy on the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code) at two years. In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years.

Results

A total of 15,845 patients was included in this analysis, of whom 3,576 patients received multivessel PCI. At two years, the experimental strategy significantly reduced a risk of the primary endpoint (the composite of all-cause death and new Q-wave myocardial infarction [MI]) (3.05% vs. 4.85%, HR: 0.62, 95% CI: 0.44–0.88, p=0.006, Pinteraction=0.031) in patients with multivessel PCI. Similarly, the experimental treatment had a significant risk reduction in the patient-oriented composite endpoint (POCE), defined as the composite of all-cause death, any stroke, any MI, and any revascularization (13.37% vs. 16.74%, HR: 0.78, 95% CI: 0.66–0.93, p=0.005, Pinteraction=0.020) and the net adverse clinical events (NACE), defined as the composite of POCE and Bleeding Academic Research Consortium [BARC] defined bleeding type 3 or 5 (14.65% vs. 18.38%, HR: 0.78, 95% CI: 0.66–0.92, p=0.003, Pinteraction=0.014) at two years. There was no significant difference in BARC type 3 or 5 bleeding (2.44% vs. 2.65%, HR: 0.92, 95% CI: 0.61–1.39, p=0.685, Pinteraction=0.754) at two years between the two regimens.

KM in patients with multivessel PCI

Conclusion

The present study has demonstrated the experimental antiplatelet strategy, when compared with the reference regimen, could potentially have a favourable balance between ischemic efficacy and bleeding safety in patients who underwent multivessel PCI.

Acknowledgement/Funding

The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R

Patients with chronic urticaria have a higher risk of psychiatric disorders: a population-based study

BACKGROUND

The prevalence of psychiatric comorbidities in patients with chronic urticaria (CU) in a national population is largely unknown.

OBJECTIVES

To investigate the prevalence of psychiatric disorders and psychiatric medication use in patients with CU in Taiwan.

METHODS

Data were sourced from Taiwan's National Health Insurance Research Database for 2011. Patients who had a primary/secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 708·1, 708·8 or 708·9 during 2011 with at least two outpatient visits and an antihistamine prescription were identified as CU cases. Patients with CU were classified into three disease severity groups according to their medication types. Psychiatric disorders were identified by patients having three outpatient visits with a primary or secondary diagnosis of a given psychiatric disease. Psychiatric medication use was defined by having at least four outpatient visits with prescriptions for anxiolytics, antidepressants or sleeping pills in 2010 or 2011.

RESULTS

Of the 167 132 patients with CU, 82·5% had mild CU, 17·0% had moderate CU and 0·4% had severe CU. Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication prescription than control groups. The relative risk (RR) of psychiatric disorders was 1·43 for patients with mild, 1·50 for patients with moderate and 2·32 for patients with severe CU vs. the controls (P < 0·001). For psychiatric medication prescription, the RRs were 1·95, 2·70 and 2·09, respectively, vs. controls (P < 0·001).

CONCLUSIONS

Patients with CU had a higher prevalence and risk of psychiatric disorders and psychiatric medication prescription than control groups. What's already known about this topic? Previous studies have shown a high prevalence of psychiatric comorbidities in patients with chronic urticaria (CU), with rates ranging from 35% to 60%. Anxiety, depression and somatoform disorders have been reported as the most prevalent mental disorders in patients with CU. What does this study add? Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication use than control groups in the general population. The relative risk (RR) of psychiatric disorders was 1·43 for those with mild CU, 1·50 for those with moderate CU and 2·32 for those with severe CU vs. controls. The RR for psychiatric medication use was 1·95 for those with mild CU, 2·70 for those with moderate CU and 2·09 for those with severe CU vs. controls. Mental health evaluations and management are important elements in CU management.

Developing a Novel Machine Learning-Based Classification Scheme for Predicting SPCs in Breast Cancer Survivors

Due to the high effectiveness of cancer screening and therapies, the diagnosis of second primary cancers (SPCs) has increased in women with breast cancer. The present study was conducted to develop a novel machine learning-based classification scheme for predicting the risk factors of SPCs in breast cancer survivors. The proposed scheme was based on the XGBoost classifier with the following four comparable strategies: transformation, resampling, clustering, and ensemble learning, to improve the training balanced accuracy. Results suggested that the best prediction accuracy for an empirical case is the XGBoost associated with the strategies of resampling and clustering. The experimental results showed that age, sequence of radiotherapy and surgery, surgical margins of the primary site, human epidermal growth factor, high-dose clinical target volume, and estrogen receptors are relatively more important risk factors associated with SPCs in patients with breast cancer. These risk factors should be monitored for the early detection of breast cancer. In conclusion, the proposed scheme can support the important influence of personality and clinical symptom representations in all phases of the primary treatment trajectory. Our results further suggested that adaptive machine learning techniques require the incorporation of significant variables for optimal predictions.

Conservation region finding for influenza A viruses by machine learning methods of N-linked glycosylation sites and B-cell epitopes

Influenza type A, a serious infectious disease of the human respiratory tract, poses an enormous threat to human health worldwide. It leads to high mortality rates in poultry, pigs, and humans. The primary target identity regions for the human immune system are hemagglutinin (HA) and neuraminidase (NA), two surface proteins of the influenza A virus. Research and development of vaccines is highly complex because the influenza A virus evolves rapidly. This study focused on three genetic features of viral surface proteins: ribonucleic acid (RNA) sequence conservation, linear B-cell epitopes, and N-linked glycosylation. On the basis of these three properties, we analyzed 12,832 HA and 9487 NA protein sequences, which we retrieved from the influenza virus database. We classified the viral surface protein sequences into the 18 HA and 11 NA subtypes that have been identified thus far. Using available analytic tools, we searched for the representative strain of each virus subtype. Furthermore, using machine learning methods, we looked for conservation regions with sequences showing linear B-cell epitopes and N-linked glycosylation. Compared to the prediction of the Immune Epitope Database (IEDB) antibody neutralization response (i.e., screening of antibody sequence regions), in this study, the virus sequence coverage was large and accurate and contained N-linked glycosylation sites. The results of this study proved that we can use the machine learning-based prediction method to solve the problem of vaccine invalidation that occurred during the rapid evolution of the influenza A virus and also as a prevaccine assessment. In addition, the screening fragments can be used as a universal influenza vaccine design reference in the future.

Skin eruption induced by dieting - an underdiagnosed skin disease in Malaysia

Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.

k-Skip-n-Gram-RF: A Random Forest Based Method for Alzheimer's Disease Protein Identification

In this paper, a computational method based on machine learning technique for identifying Alzheimer's disease genes is proposed. Compared with most existing machine learning based methods, existing methods predict Alzheimer's disease genes by using structural magnetic resonance imaging (MRI) technique. Most methods have attained acceptable results, but the cost is expensive and time consuming. Thus, we proposed a computational method for identifying Alzheimer disease genes by use of the sequence information of proteins, and classify the feature vectors by random forest. In the proposed method, the gene protein information is extracted by adaptive k-skip-n-gram features. The proposed method can attain the accuracy to 85.5% on the selected UniProt dataset, which has been demonstrated by the experimental results.

MADS-Box Gene Classification in Angiosperms by Clustering and Machine Learning Approaches

The MADS-box gene family is an important transcription factor family involved in floral organogenesis. The previously proposed ABCDE model suggests that different floral organ identities are controlled by various combinations of classes of MADS-box genes. The five-class ABCDE model cannot cover all the species of angiosperms, especially the orchid. Thus, we developed a two-stage approach for MADS-box gene classification to advance the study of floral organogenesis of angiosperms. First, eight classes of reference datasets (A, AGL6, B12, B34, BPI, C, D, and E) were curated and clustered by phylogenetic analysis and unsupervised learning, and they were confirmed by the literature. Second, feature selection and multiple prediction models were curated according to sequence similarity and the characteristics of the MADS-box gene domain using support vector machines. Compared with the BindN and COILS features, the local BLAST model yielded the best accuracy. For performance evaluation, the accuracy of Phalaenopsis aphrodite MADS-box gene classification was 93.3%, which is higher than 86.7% of our previous classification prediction tool, iMADS. Phylogenetic tree construction – the most common method for gene classification yields classification errors and is time-consuming for analysis of massive, multi-species, or incomplete sequences. In this regard, our new system can also confirm the classification errors of all the random selection that were incorrectly classified by phylogenetic tree analysis. Our model constitutes a reliable and efficient MADS-box gene classification system for angiosperms.

An Efficient Classifier for Alzheimer's Disease Genes Identification

Alzheimer’s disease (AD) is considered to one of 10 key diseases leading to death in humans. AD is considered the main cause of brain degeneration, and will lead to dementia. It is beneficial for affected patients to be diagnosed with the disease at an early stage so that efforts to manage the patient can begin as soon as possible. Most existing protocols diagnose AD by way of magnetic resonance imaging (MRI). However, because the size of the images produced is large, existing techniques that employ MRI technology are expensive and time-consuming to perform. With this in mind, in the current study, AD is predicted instead by the use of a support vector machine (SVM) method based on gene-coding protein sequence information. In our proposed method, the frequency of two consecutive amino acids is used to describe the sequence information. The accuracy of the proposed method for identifying AD is 85.7%, which is demonstrated by the obtained experimental results. The experimental results also show that the sequence information of gene-coding proteins can be used to predict AD.

Heavy Physics Contributions to Neutrinoless Double Beta Decay from QCD

Observation of neutrinoless double beta decay, a lepton number violating process that has been proposed to clarify the nature of neutrino masses, has spawned an enormous world-wide experimental effort. Relating nuclear decay rates to high-energy, beyond the standard model (BSM) physics requires detailed knowledge of nonperturbative QCD effects. Using lattice QCD, we compute the necessary matrix elements of short-range operators, which arise due to heavy BSM mediators, that contribute to this decay via the leading order π^{-}→π^{+} exchange diagrams. Utilizing our result and taking advantage of effective field theory methods will allow for model-independent calculations of the relevant two-nucleon decay, which may then be used as input for nuclear many-body calculations of the relevant experimental decays. Contributions from short-range operators may prove to be equally important to, or even more important than, those from long-range Majorana neutrino exchange.

The effect of antibiotic prophylaxis for acute pelvic inflammatory disease after hysterosalpingography: a retrospective cohort study

AIMS

Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG.

METHODS

Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics.

RESULTS

The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19-0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04-0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18-0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients.

CONCLUSIONS

Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.

Aging may negatively impact movement smoothness during stair negotiation

Stairs represent a barrier to safe locomotion for some older adults, potentially leading to the adoption of a cautious gait strategy that may lack fluidity. This strategy may be characterized as unsmooth; however, stair negotiation smoothness has yet to be quantified. The aims of this study were to assess age- and task-related differences in head and body center of mass (COM) acceleration patterns and smoothness during stair negotiation and to determine if smoothness was associated with the timed "Up and Go" (TUG) test of functional movement. Motion data from nineteen older and twenty young adults performing stair ascent, stair descent, and overground straight walking trials were analyzed and used to compute smoothness based on the log-normalized dimensionless jerk (LDJ) and the velocity spectral arc length (SPARC) metrics. The associations between TUG and smoothness measures were evaluated using Pearson's correlation coefficient (r). Stair tasks increased head and body COM acceleration pattern differences across groups, compared to walking (p < 0.05). LDJ smoothness for the head and body COM decreased in older adults during stair descent, compared to young adults (p ≤ 0.015) and worsened with increasing TUG for all tasks (-0.60 ≤ r ≤ -0.43). SPARC smoothness of the head and body COM increased in older adults, regardless of task (p < 0.001), while correlations showed improved SPARC smoothness with increasing TUG for some tasks (0.33 ≤ r ≤ 0.40). The LDJ outperforms SPARC in identifying age-related stair negotiation adaptations and is associated with performance on a clinical test of gait.

Anesthesia for patients with tracheal bronchus

Tracheal bronchus is a congenital anatomical variant of patients with accessory bronchus in the right upper lobe deriving directly from the supracarinal trachea. Pre-operative consultation with the anesthesiologist is important for patient safety and can avoid adverse effects induced by endotracheal intubation. In this report, we described a case of tracheal bronchus in which general anesthesia was performed for video-assisted thoracoscopic surgery. We discussed some of the issues surrounding to complications in tracheal bronchus.

Continuous ambulatory hand force monitoring during manual materials handling using instrumented force shoes and an inertial motion capture suit

Hand forces (HFs) are commonly measured during biomechanical assessment of manual materials handling; however, it is often a challenge to directly measure HFs in field studies. Therefore, in a previous study we proposed a HF estimation method based on ground reaction forces (GRFs) and body segment accelerations and tested it with laboratory equipment: GFRs were measured with force plates (FPs) and segment accelerations were measured using optical motion capture (OMC). In the current study, we evaluated the HF estimation method based on an ambulatory measurement system, consisting of inertial motion capture (IMC) and instrumented force shoes (FSs). Sixteen participants lifted and carried a 10-kg crate from ground level while 3D full-body kinematics were measured using OMC and IMC, and 3D GRFs were measured using FPs and FSs. We estimated 3D hand force vectors based on: (1) FP+OMC, (2) FP+IMC and (3) FS+IMC. We calculated the root-mean-square differences (RMSDs) between the estimated HFs to reference HFs calculated based on crate kinematics and the GRFs of a FP that the crate was lifted from. Averaged over subjects and across 3D force directions, the HF RMSD ranged between 10-15N when using the laboratory equipment (FP + OMC), 11-18N when using the IMC instead of OMC data (FP+IMC), and 17-21N when using the FSs in combination with IMC (FS + IMC). This error is regarded acceptable for the assessment of spinal loading during manual lifting, as it would results in less than 5% error in peak moment estimates.

Inhibitory Effects of Siegesbeckia orientalis Extracts on Advanced Glycation End Product Formation and Key Enzymes Related to Metabolic Syndrome

Metabolic syndrome typically includes Type 2 diabetes associated with hyperglycemia, central obesity, dyslipidemia and hypertension. It is highly related to oxidative stress, formation of advanced glycated end products (AGEs) and key enzymes, such as carbohydrate digesting enzymes like pancreatic α-amylase and intestinal α-glucosidase, pancreatic lipase and angiotensin I-converting enzyme (ACE). This study used an in vitro approach to assess the potential of four extracts of Siegesbeckia orientalis linne on key enzymes relevant to metabolic syndrome. In this research, S. orientailis was firstly extracted by ethanol. The ethanol extract (SE) was then partitioned sequentially with hexane, ethyl acetate and methanol, and these extracts were named SE-Hex, SE-EA and SE-MeOH, respectively. The experimental results showed that SE-EA had the highest total phenolic content (TPC, 76.9 ± 1.8 mg/g) and the total flavonoids content (TFC, 5.3 ± 0.3 mg/g). This extract exhibited the most significant antioxidant activities, including DPPH radical-scavenging capacity (IC₅₀ = 161.8 ± 2.4 μg/mL), ABTS radical-scavenging capacity (IC₅₀ = 13.9 ± 1.5 μg/mL) and reducing power. For anti-glycation activities, SE-EA showed the best results in the inhibition of AGEs, as well as inhibitory activities against α-glucosidase (IC₅₀ = 362.3 ± 9.2 μg/mL) and α-amylase (IC₅₀ = 119.0 ± 17.7 μg/mL). For anti-obesity activities, SE-EA indicated the highest suppression effect on pancreatic lipase (IC₅₀ = 3.67 ± 0.52 mg/mL). Finally, for anti-hypertension activity, SE-EA also demonstrated the strongest inhibitory activity on ACE (IC₅₀ = 626.6 ± 15.0 μg/mL). Close relationships were observed among the parameters of TPC, antioxidant activities, inhibitory activities on α-amylase, α-glucosidase, lipase and ACE (R > 0.9). Moderate correlations were found among the parameters of TFC, antioxidant activities, and suppression of dicarbonyl compounds formation (R = 0.5-0.9). Taken together these in vitro studies reveal the therapeutic potential of SE-EA extract in the prevention and treatment of metabolic disorders.

A critical period for antidepressant-induced acceleration of neuronal maturation in adult dentate gyrus

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used medications for mood and anxiety disorders, and adult neurogenesis in the dentate gyrus has been shown to be involved in the behavioral effects of SSRIs in mice. Studies have shown the varied effects of chronic treatment with SSRIs on adult neurogenesis. One such effect is the acceleration of neuronal maturation, which affects the functional integration of new neurons into existing neuronal circuitry. In this study, we labeled new neurons by using GFP-expressing retroviral vectors in mice and investigated the effect of an SSRI, fluoxetine, on these neurons at different time points after neuronal birth. Chronic treatment with fluoxetine accelerated the dendritic development of the newborn neurons and shifted the timing of the expression of the maturational marker proteins, doublecortin and calbindin. This accelerated maturation was observed even after sub-chronic treatment, only when fluoxetine was administered during the second week of neuronal birth. These results suggest the existence of a 'critical period' for the fluoxetine-induced maturation of new neurons. We propose that the modified functional integration of new neurons in the critical period may underlie the behavioral effects of fluoxetine by regulating anxiety-related decision-making processes.

[Analysis of the correlation between deep medullary veins and clinical prognosis of middle cerebral artery stroke]

Objective: To investigate the relativity between the distribution of deep medullary vein (DMV) in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging (SWI). Methods: A total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists. Results:Kappa value in DMV symmetry and DMV type were 0.875 and 0.852. Chi-square test analysis revealed a statistically significant difference of DMV symmetry between healthy control and stroke group(χ(2)=31.046, P=0.000). There was correlation between DMV type and NIHSS score in stroke group (r(s)=0.208, P=0.025). There was no statistically significant difference of DMV distribution in the different periods of stroke group (P=0.110). But there was statistically significant difference of DMV distribution between acute and chronic stroke (P=0.018). Among 30 follow-up cases, 18 cases with asymmetry DMV changed into symmetry after stroke therapy. In 8 cases with symmetry DMV, the diameter of DMV became smaller after treatment. In 4 cases, DMV had no changes. Conclusions: DMV in patients of MCA stroke are mostly asymmetry distribution. DMV classification can be used as an imaging standard to predict the prognosis of stroke patients.

[Preliminary study on assessment of lexiscan-induced blood-brain barrier opening and its level by CT perfusion imaging]

Objective: To evaluate the level of lexiscan-induced blood-brain barrier opening of healthy rabbits via CT perfusion weighted imaging (PWI) scan. Methods: Between November 2014 and May 2015, thirty New Zealand white rabbits were randomly assigned into three groups: the experimental group A1 which received one injection of lexiscan(1 ml/kg); the experimental group A2 which received three times injection of lexiscan(total dose: 1.5 ml/kg), finished within 15 minutes; the control group B which was injected the same volume normal saline(1 ml/kg), after 30 minutes, CT PWI scan was performed. Then cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and permeability surface(PS) of the region of interest of each group were acquired and compared statistically. Five cases of each group were injected with 2% Evans blue intravenously posterior to imaging. After one hour of infusion, all the animals were killed. Their brains were examined for the determination of Evans blue distribution. Results: Both the values of CBF and CBV and the staining with Evans blue of the group A1(CBF: (89.88±2.21), (81.42±4.28) ml·(100 g)^-1·min^-1; CBV: (3.97±0.43), (3.66±0.16) ml/g)and group A2 (CBF: (75.16±0.84), (63.66±7.21) ml·(100 g)^-1·min^-1; CBV: (4.07±0.01), (3.75±0.05) ml/g) were higher than those of the group B(CBF: (20.08±5.08), (14.58±8.62) ml·(100 g)^-1·min^-1; CBV: (0.85±0.04), (0.65±0.17) ml/g), the differences were all statistically significant (all P<0.01). While there was no statistically difference between group A1 and group A2(P>0.05). The value of PS of the group A2((22.43±8.09), (20.20±7.01)ml·(100 g)^-1·min^-1 )was higher than that of group A1((13.82±4.44), (10.12±2.44)ml·(100 g)^-1·min^-1) and group B(0.00, 0.00)(the lowest one), the differences were all statistically significant(all P<0.01). The value of MTT of the group A1((2.50±0.82, 2.47±0.10) s) had no statistical difference with group A2 and group B, while the value of group A2((4.50±0.17), (4.72±0.15) s) was higher than that of group B((1.88±0.09), (1.99±0.00) s), the differences were all statistically significant (P<0.05). Conclusion: Changes in hemodynamics of lexiscan-induced blood-brain barrier opening can be monitored by CT PWI scan. When the total dose of lexiscan increasing, the level of the BBB opening is higher with significantly increased CBF, CBV, PS and MTT.

Risk of infective endocarditis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study

Objectives Patients with systemic lupus erythematosus are considered vulnerable to infective endocarditis and prophylactic antibiotics are recommended before an invasive dental procedure. However, the evidence is insufficient. This nationwide population-based study evaluated the risk and related factors of infective endocarditis in systemic lupus erythematosus. Methods We identified 12,102 systemic lupus erythematosus patients from the National Health Insurance research-oriented database, and compared the incidence rate of infective endocarditis with that among 48,408 non-systemic lupus erythematosus controls. A Cox multivariable proportional hazards model was employed to evaluate the risk of infective endocarditis in the systemic lupus erythematosus cohort. Results After a mean follow-up of more than six years, the systemic lupus erythematosus cohort had a significantly higher incidence rate of infective endocarditis (42.58 vs 4.32 per 100,000 person-years, incidence rate ratio = 9.86, p < 0.001) than that of the control cohort. By contrast, the older systemic lupus erythematosus cohort had lower risk (adjusted hazard ratio 11.64) than that of the younger-than-60-years systemic lupus erythematosus cohort (adjusted hazard ratio 15.82). Cox multivariate proportional hazards analysis revealed heart disease (hazard ratio = 5.71, p < 0.001), chronic kidney disease (hazard ratio = 2.98, p = 0.034), receiving a dental procedure within 30 days (hazard ratio = 36.80, p < 0.001), and intravenous steroid therapy within 30 days (hazard ratio = 39.59, p < 0.001) were independent risk factors for infective endocarditis in systemic lupus erythematosus patients. Conclusions A higher risk of infective endocarditis was observed in systemic lupus erythematosus patients. Risk factors for infective endocarditis in the systemic lupus erythematosus cohort included heart disease, chronic kidney disease, steroid pulse therapy within 30 days, and a recent invasive dental procedure within 30 days.

Modelling end-pumped passively Q-switched Nd-doped crystal lasers: manifestation by a Nd:YVO4/Cr4+:YAG system with a concave-convex resonator

A theoretical model for the passively Q-switched (PQS) operation which includes the spatial overlapping between the pump and lasing modes under the thermal lensing effect is developed to give a transcendental equation that can directly determine the critical parameters such as pulse energy, pulse repetition rate, and pulse width for the PQS performance. More importantly, an analytical function which gives the approximate solution for the transcendental equation as well as a specific critical criterion for good PQS operation are derived for practical analyses and design. A Nd:YVO₄/Cr⁴⁺:YAG system with a concave-convex resonator which can achieve fairly stable PQS pulse trains even at a high pump level is further exploited to manifest the proposed spatially dependent model. The good agreement between the experimental results and the theoretical predictions is verified to show the feasibility of the proposed model for designing high-power PQS lasers with high accuracy.