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BackgroundBone marrow aspiration and biopsy remain the gold standard for the diagnosis of hematological diseases despite the development of flow cytometry (FCM) and molecular and gene analyses. However, the interpretation of the results is laborious and operator dependent. Furthermore, the obtained results exhibit inter- and intravariations among specialists. Therefore, it is important to develop a more objective and automated analysis system. Several deep learning models have been developed and applied in medical image analysis but not in the field of hematological histology, especially for bone marrow smear applications. ObjectiveThe aim of this study was to develop a deep learning model (BMSNet) for assisting hematologists in the interpretation of bone marrow smears for faster diagnosis and disease monitoring. MethodsFrom January 1, 2016, to December 31, 2018, 122 bone marrow smears were photographed and divided into a development cohort (N=42), a validation cohort (N=70), and a competition cohort (N=10). The development cohort included 17,319 annotated cells from 291 high-resolution photos. In total, 20 photos were taken for each patient in the validation cohort and the competition cohort. This study included eight annotation categories: erythroid, blasts, myeloid, lymphoid, plasma cells, monocyte, megakaryocyte, and unable to identify. BMSNet is a convolutional neural network with the YOLO v3 architecture, which detects and classifies single cells in a single model. Six visiting staff members participated in a human-machine competition, and the results from the FCM were regarded as the ground truth. ResultsIn the development cohort, according to 6-fold cross-validation, the average precision of the bounding box prediction without consideration of the classification is 67.4%. After removing the bounding box prediction error, the precision and recall of BMSNet were similar to those of the hematologists in most categories. In detecting more than 5% of blasts in the validation cohort, the area under the curve (AUC) of BMSNet (0.948) was higher than the AUC of the hematologists (0.929) but lower than the AUC of the pathologists (0.985). In detecting more than 20% of blasts, the AUCs of the hematologists (0.981) and pathologists (0.980) were similar and were higher than the AUC of BMSNet (0.942). Further analysis showed that the performance difference could be attributed to the myelodysplastic syndrome cases. In the competition cohort, the mean value of the correlations between BMSNet and FCM was 0.960, and the mean values of the correlations between the visiting staff and FCM ranged between 0.952 and 0.990. ConclusionsOur deep learning model can assist hematologists in interpreting bone marrow smears by facilitating and accelerating the detection of hematopoietic cells. However, a detailed morphological interpretation still requires trained hematologists.

BackgroundThe detection of dyskalemias—hypokalemia and hyperkalemia—currently depends on laboratory tests. Since cardiac tissue is very sensitive to dyskalemia, electrocardiography (ECG) may be able to uncover clinically important dyskalemias before laboratory results. ObjectiveOur study aimed to develop a deep-learning model, ECG12Net, to detect dyskalemias based on ECG presentations and to evaluate the logic and performance of this model. MethodsSpanning from May 2011 to December 2016, 66,321 ECG records with corresponding serum potassium (K+) concentrations were obtained from 40,180 patients admitted to the emergency department. ECG12Net is an 82-layer convolutional neural network that estimates serum K+ concentration. Six clinicians—three emergency physicians and three cardiologists—participated in human-machine competition. Sensitivity, specificity, and balance accuracy were used to evaluate the performance of ECG12Net with that of these physicians. ResultsIn a human-machine competition including 300 ECGs of different serum K+ concentrations, the area under the curve for detecting hypokalemia and hyperkalemia with ECG12Net was 0.926 and 0.958, respectively, which was significantly better than that of our best clinicians. Moreover, in detecting hypokalemia and hyperkalemia, the sensitivities were 96.7% and 83.3%, respectively, and the specificities were 93.3% and 97.8%, respectively. In a test set including 13,222 ECGs, ECG12Net had a similar performance in terms of sensitivity for severe hypokalemia (95.6%) and severe hyperkalemia (84.5%), with a mean absolute error of 0.531. The specificities for detecting hypokalemia and hyperkalemia were 81.6% and 96.0%, respectively. ConclusionsA deep-learning model based on a 12-lead ECG may help physicians promptly recognize severe dyskalemias and thereby potentially reduce cardiac events.

Didymocarpus pingyuanensis, endemic to the Danxia landscape in Pingyuan County, Guangdong, China, is described and illustrated here. This species can be distinguished from other members of Didymocarpus sect. Heteroboea by its calyx deeply 5-lobed to about three quarters of its length. The phylogenetic position of the new species within Didymocarpus was examined using nuclear ribosomal internal transcribed spacer (ITS) sequences. Based on phylogenetics analysis and morphological evidence, we propose two new combinations, elevating the two varieties to species level, namely D. yinzhengii and D. gamosepalus.

[C8H11N3O4], monoclinic, P21/c (no. 14), a = 4.5811(16) Å, b = 19.734(7) Å, c = 11.812(4) Å, β = 101.181(11)°, V = 1047.6(6) Å3, Z = 4, Rgt (F) = 0.0742, wRref (F 2) = 0.1176, T = 296(2) K.

Oreocharis leveilleana Fedde was collected in Ta-pin in 1910 and published in 1911. The collected location was verified within western Luodian County, Guizhou Province, China. However, there have been no records of the species’ collection for more than 100 years since then. After extensive investigations by our research team on the type locality and its surrounding areas, we found that it is widely distributed in western Luodian County and eastern Wangmo County, Guizhou Province, China. During further research on the original literature, type specimens and type locality of O. leveilleana, the taxonomic position of O. leveilleana, which was once treated as a synonym of O. auricula (S.Moore) C.B.Clarke, was found to have a taxonomic problem. Through morphological research combined with geographical distribution analysis, it has been determined that it should belong to the genus Petrocodon Hance and it is the same species as P. coccineus (C.Y.Wu ex H.W.Li) Yin Z.Wang. According to the regulations and suggestions of the 2018 "International Code of Nomenclature for Algae, Fungi, and Plants (Shenzhen Code)", we propose and confirm a new combination – Petrocodon leveilleanus (Fedde) X.X.Bai & F.Wen and treat P. coccineus as a synonym of the new combination. Due to its unique bright red flowers within Petrocodon, its original Chinese name has been retained.

Abstract Background Recent evidence has demonstrated that abnormal expression and regulation of circular RNA (circRNAs) are involved in the occurrence and development of a variety of tumors. The aim of this study was to investigate the effects of circ_PPAPDC1A in Osimertinib resistance in NSCLC. Methods Human circRNAs microarray analysis was conducted to identify differentially expressed (DE) circRNAs in Osimertinib-acquired resistance tissues of NSCLC. The effect of circ_PPAPDC1A on cell proliferation, invasion, migration, and apoptosis was assessed in both in vitro and in vivo. Dual-luciferase reporter assay, RT-qPCR, Western-blot, and rescue assay were employed to confirm the interaction between circ_PPAPDC1A/miR-30a-3p/IGF1R axis. Results The results revealed that circ_PPAPDC1A was significantly upregulated in Osimertinib acquired resistance tissues of NSCLC. circ_PPAPDC1A reduced the sensitivity of PC9 and HCC827 cells to Osimertinib and promoted cell proliferation, invasion, migration, while inhibiting apoptosis in Osimertinib-resistant PC9/OR and HCC829/OR cells, both in vitro and in vivo. Silencing circ_PPAPDC1A partially reversed Osimertinib resistance. Additionally, circ_PPAPDC1A acted as a competing endogenous RNA (ceRNA) by targeting miR-30a-3p, and Insulin-like Growth Factor 1 Receptor (IGF1R) was identified as a functional gene for miR-30a-3p in NSCLC. Furthermore, the results confirmed that circ_PPAPDC1A/miR-30a-3p/IGF1R axis plays a role in activating the PI3K/AKT/mTOR signaling pathway in NSCLC with Osimertinib resistance. Conclusions Therefore, for the first time we identified that circ_PPAPDC1A was significantly upregulated and exerts an oncogenic role in NSCLC with Osimertinib resistance by sponging miR-30a-3p to active IGF1R/PI3K/AKT/mTOR pathway. circ_PPAPDC1A may serve as a novel diagnostic biomarker and therapeutic target for NSCLC patients with Osimertinib resistance. Graphical Abstract

The 16-item Physical Resilience Instrument for Older Adults (PRIFOR) has good clinimetric properties; however, a shortened PRIFOR would greatly enhance physical resilience measurements in clinical settings. The current analysis aimed to reduce the number of PRIFOR while maintaining its clinimetric properties, emphasizing on its factor structure and convergent validity. A longitudinal study was conducted among 863 patients aged 65 years or older. Four PRIFOR items with high factor loadings were selected to generate the short version of PRIFOR (PRIFOR-4). The PRIFOR-4 was found to have a unidimensional structure (comparative fit index = 0.999; Tucker-Lewis index = 0.998 in the confirmatory factor analysis results) with good convergent validity with various external measures (absolute r = 0.109–0.597; p-values

In order to study the combustion characteristics of glass fiber/phenolic resin composites, a conical calorimeter was used to explore the combustion characteristics of glass fiber/phenolic resin composites in an aircraft frame under different thermal radiation intensities, and the fire hazard of the materials was evaluated by evaluation index, and the limiting oxygen index at different temperatures was explored by combining the high temperature oxygen index meter. The test results show that when the ambient temperature increases from 20 °C to 220 °C, the limiting oxygen index first increases from 86.6 % to 93.7 %, and then decreases to 84.4 %. The oxygen consumption and CO2 release increase with the increase of thermal radiation intensity during combustion, and the release of CO decreases with the increase of thermal radiation. The heat release rate curve of the test material has only 1 enhancement peak. The heat radiation intensity increased from 50 kW/m2 to 70 kW/m2, and the peak heat release rate of the test material combustion increased from 64.7 kW/m2 to 100.7 kW/m2. The rate of mass loss of materials accelerates with the increase of thermal radiation intensity; As the intensity of thermal radiation increases, the fire hazard of the material increases.

Introduction: Nurses undertaking air ambulance service encounter environmental, equipment, and personnel limitations during their work. Moreover, they must cope with various types of injuries and illnesses, as well as changes in patient conditions. These factors pose a significant pressure on nurses. Currently, there is a lack of qualitative research on the experiences of nurses performing air ambulance tasks. The purpose of this study is to explore the experiences of nurses undertaking air ambulance service, with a focus on capturing their personal perceptions regarding this field of work. Methods: Twelve nurses were selected using purposive sampling, and semi-structured interviews were conducted to collect data. Content analysis was used to analyze the data. Results: The analysis identified three major themes: "Ambiguous and risky emergency missions," "Challenges during air transfer," and "Nurses’ personal limitations.” Eight categories were formulated within these themes, including "Mission uncertainty," “Urgency of medical conditions," “Hazards at high altitude," "Cabin environment limitations," "Inadequate equipment," "Incomprehensive operating mechanisms," "Physical discomfort," and "Recognition of professional shortcomings." Conclusions: Improving the performance and well-being of nurses engaged in air ambulance services necessitates the implementation of a psychological adaptation program. This includes the utilization of psychological stress assessment tools or engaging in role-playing activities. Successful patient rescues demand the establishment of comprehensive standard operating procedures, involving an interprofessional team. Supporting nurses in adeptly managing challenges during air ambulance services requires an expanded scope of education and training, facilitated through initiatives like situational simulation and similar approaches.

Abstract The global diagnosis rate and mortality of gastric cancer (GC) are among the highest. Ferroptosis and iron-metabolism have a profound impact on tumor development and are closely linked to cancer treatment and patient’s prognosis. In this study, we identified six PRDEGs (prognostic ferroptosis- and iron metabolism-related differentially expressed genes) using LASSO-penalized Cox regression analysis. The TCGA cohort was used to establish a prognostic risk model, which allowed us to categorize GC patients into the high- and the low-risk groups based on the median value of the risk scores. Our study demonstrated that patients in the low-risk group had a higher probability of survival compared to those in the high-risk group. Furthermore, the low-risk group exhibited a higher tumor mutation burden (TMB) and a longer 5-year survival period when compared to the high-risk group. In summary, the prognostic risk model, based on the six genes associated with ferroptosis and iron-metabolism, performs well in predicting the prognosis of GC patients.

Objective To explore the impacts of Xingnaojing Injection plus ulinastatin plus continuous renal replacement therapy （CRRT） on efficacy, immune function and hemodynamics of septic patients complicated with acute kidney injury （AKI）. Methods From May 1, 2019 to May 31, 2022, 104 septic patients complicated with AKI were selected and randomized into two groups of observation （n = 52） and control （n = 52）. Control group received ulinastatin plus CRRT. And observation group had Xingnaojing injection on the basis of control group. Physiological status was evaluated by APACHE Ⅱ score; the levels of T lymphocyte subsets （CD4+/CD8+） were measured by flow cytometry before and after treatment and ratio of CD4+/CD8+ was calculated; the levels of immunoglobulin IgA, IgM and IgG were measured by one-way immunodiffusion before and after treatment; central venous pressure （CVP）, mean arterial pressure （MAP） and heart rate （HR） were monitored with an electronic monitor before and after treatment; in addition, efficacies, changes of APACHE Ⅱ score, CD4+ and CD8+ levels, CD4+/CD8+, IgA/M/G, CVP, MAP and HR were compared between two groups. Results The efficacy of observation group was significantly higher than that of control group （90.39% vs 73.08%, χ2 = 5.216, P = 0.022）. APACHE Ⅱ score of observation and control group declined markedly after treatment [（20.57 ± 3.72） points, （19.74 ± 3.51） points vs （9.67 ± 2.24） points, （13.84 ± 3.11） points] （P＜0.05） and APACHE Ⅱ score of observation group was significantly lower than that of control group after treatment （P＜0.05）. CD4+ level [（30.73 ± 6.54）%, （29.46 ± 6.28）% vs （35.82 ± 6.59）%, （32.65 ± 6.74）%] and CD4+/CD8+ [（1.10 ± 0.24）, （1.12 ± 0.26） vs （1.84±0.31）、（1.52±0.29）] spiked obviously after treatment in observation and control groups. CD8+ level declined markedly [（27.94 ± 5.75）%, （26.30 ± 5.54）% vs （19.48 ± 4.21）%, （21.45 ± 4.54）%] （P＜0.05）.After treatment, the levels of CD4+ and CD4+/CD8+ were significantly higher in observation group than those in control group; CD8+ level was significantly lower than that in control group （P＜0.05）. The levels of IgA [（1.32 ± 0.31） g/L, （1.28 ± 0.29） g/L vs （1.96 ± 0.48） g/L, （1.63 ± 0.42）g/L], IgM [（0.95 ± 0.31） g/L, （0.91 ± 0.28） g/L vs （1.96 ± 0.51） g/L, （1.37 ± 0.36） g/L] and IgG [（5.82 ± 0.81） g/L, （5.77 ± 0.76） g/L vs （9.75 ± 1.43） g/L, （7.32 ± 1.24） g/L] in observation and control groups were significant after treatment. After treatment, the levels of IgA, IgM and IgG were significantly higher in observation group than those in control group （P＜0.05）. The levels of CVP [（6.47 ± 1.24） mmH2O, （6.42 ± 1.21） mmH2O vs （12.83 ± 2.85） mmH2O, （9.54 ± 2.32） mmH2O] and MAP [（56.53 ± 5.34） mmHg, （55.87 ± 5.21） mmHg vs （87.27 ± 6.83） mmHg, （71.92 ± 6.42） mmHg, 1 mmHg = 0.133 kPa] spiked markedly in observation and control groups after treatment. HR declined markedly [（117.56 ± 12.65） beat/min, （115.73 ± 12.57） beat/min vs （83.41 ± 8.73） beat/min, （98.65 ± 10.51） beat/min] （P＜0.05）. After treatment, CVP and MAP levels were significantly higher in observation group than those in control group and HR was significantly lower than that in control group （P＜0.05）. The levels of urea nitrogen [（10.38 ± 2.31） mmol/L, （10.42 ± 2.34） mmol/L vs （14.22 ± 3.34） mmol/L, （19.14±5.27） mmol/L] and serum creatinine [（125.87 ± 26.57） μmol/L, （125.76 ± 25.68） μmol/L vs （183.55 ± 36.81） μmol/L, （241.26 ± 42.79） μmol/L] spiked obviously （P＜0.05）. After treatment, the levels of urea nitrogen and blood creatinine were significantly lower in observation group than those in control group （P＜0.05）. Conclusions Xingnaojing injection combined with ulinastatin and continuous renal replacement therapy are effective in treating patients with sepsis complicated with AKI, which can effectively improve the immune function and hemodynamics of patients, and alleviate the condition of patients.

Background:. As long-term, regular aesthetic botulinum neurotoxin A (BoNT-A) use becomes more commonplace, it is vital to understand real-world risk factors and impact of BoNT-A immunoresistance. The first Aesthetic Council on Ethical Use of Neurotoxin Delivery panel discussed issues relating to BoNT-A immunoresistance from the health care professionals’ (HCPs’) perspective. Understanding the implications of BoNT-A immunoresistance from the aesthetic patient’s viewpoint allows HCPs to better support patients throughout their aesthetic treatment journey. Methods:. A real-world consumer study surveyed 363 experienced aesthetic BoNT-A recipients across six Asia-Pacific territories. The survey mapped participants’ BoNT-A aesthetic treatment journey and characterized awareness and attitudes relating to BoNT-A immunoresistance and treatment implications. At the second Aesthetic Council on Ethical use of Neurotoxin Delivery meeting, panelists discussed survey findings and developed consensus statements relating to the impact of BoNT-A immunoresistance on the aesthetic treatment journey. Results:. Aesthetic BoNT-A patients’ depth of knowledge about BoNT-A immunoresistance remains low, and risk/benefit communications need to be more lay-friendly. The initial consultation is the most important touchpoint for HCPs to raise awareness of BoNT-A immunoresistance as a potential side effect considering increased risk with repeated high-dose treatments. HCPs should be cognizant of differences across BoNT-A formulations due to the presence of certain excipients and pharmacologically unnecessary components that can increase immunogenicity. Standardized screening for clinical signs of secondary nonresponse and a framework for diagnosing and managing immunoresistance-related secondary nonresponse were proposed. Conclusion:. These insights can help patients and HCPs make informed treatment decisions to achieve desired aesthetic outcomes while preserving future treatment options with BoNT-A.

BackgroundFinding individuals with drug-resistant tuberculosis (DR-TB) is important to control the pandemic and improve patient clinical outcomes. To our knowledge, systematic reviews assessing the effectiveness, cost-effectiveness, acceptability, and feasibility of different DR-TB case-finding strategies to inform research, policy, and practice, have not been conducted and the scope of primary research is unknown. ObjectiveWe therefore assessed the available literature on DR-TB case-finding strategies. MethodsWe looked at systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary research that sought to improve DR-TB case detection specifically. We excluded studies that included patients seeking care for tuberculosis (TB) symptoms, patients already diagnosed with TB, or were laboratory-based. We searched the academic databases of MEDLINE, Embase, The Cochrane Library, Africa-Wide Information, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Epistemonikos, and PROSPERO (The International Prospective Register of Systematic Reviews) using no language or date restrictions. We screened titles, abstracts, and full-text articles in duplicate. Data extraction and analyses were carried out in Excel (Microsoft Corp). ResultsWe screened 3646 titles and abstracts and 236 full-text articles. We identified 6 systematic reviews and 61 primary studies. Five reviews described the yield of contact investigation and focused on household contacts, airline contacts, comparison between drug-susceptible tuberculosis and DR-TB contacts, and concordance of DR-TB profiles between index cases and contacts. One review compared universal versus selective drug resistance testing. Primary studies described (1) 34 contact investigations, (2) 17 outbreak investigations, (3) 3 airline contact investigations, (4) 5 epidemiological analyses, (5) 1 public-private partnership program, and (6) an e-registry program. Primary studies were all descriptive and included cross-sectional and retrospective reviews of program data. No trials were identified. Data extraction from contact investigations was difficult due to incomplete reporting of relevant information. ConclusionsExisting descriptive reviews can be updated, but there is a dearth of knowledge on the effectiveness, cost-effectiveness, acceptability, and feasibility of DR-TB case-finding strategies to inform policy and practice. There is also a need for standardization of terminology, design, and reporting of DR-TB case-finding studies.

Background: Patterns of physical activity and sedentary behavior among postmenopausal women are not well characterized. Objectives: To describe the patterns of accelerometer-assessed physical activity and sedentary behavior among postmenopausal women. Design: Cross-sectional study. Methods: Women 63–97 years (n = 6126) wore an ActiGraph GT3X + accelerometer on their hip for 1 week. Latent class analysis was used to classify women by patterns of percent of wake time in physical activity and sedentary behavior over the week. Results: On average, participants spent two-thirds of their day in sedentary behavior (62.3%), 21.1% in light low, 11.0% in light high, and 5.6% in moderate-to-vigorous physical activity. Five classes emerged for each single-component model for sedentary behavior and light low, light high, and moderate-to-vigorous physical activity. Six classes emerged for the multi-component model that simultaneously considered the four behaviors together. Conclusion: Unique profiles were identified in both single- and multi-component models that can provide new insights into habitual patterns of physical activity and sedentary behavior among postmenopausal women. Implications: The multi-component approach can contribute to refining public health guidelines that integrate recommendations for both enhancing age-appropriate physical activity levels and reducing time spent in sedentary behavior.