245 results on '"Zheng WL"'
Search Results
2. [Analysis on trends of mortality rate and disease burden of liver cancer in Tianjin, China from 1999 to 2021].
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Wang DZ, Zhang S, Zhang H, Shen CF, Wang C, Xun LN, Zheng WL, and Jiang GH
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- Humans, China epidemiology, Female, Male, Middle Aged, Aged, Adult, Rural Population statistics & numerical data, Cost of Illness, Urban Population statistics & numerical data, Disability-Adjusted Life Years trends, Survival Rate, Young Adult, Adolescent, Child, Child, Preschool, Aged, 80 and over, Infant, Age Distribution, Mortality trends, Quality-Adjusted Life Years, Liver Neoplasms mortality, Liver Neoplasms epidemiology
- Abstract
Objective: To explore the trends and distribution of liver cancer between sexes, ages, and urban-rural areas in Tianjin, China from 1999 to 2021, and provide data for targeted prevention and control strategies of liver cancer in Tianjin. Methods: Liver cancer mortality data of Tianjin during 1999-2021 were from the Tianjin population based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC), and the population data of permanent Tianjin residents were from Tianjin Municipal Public Security Bureau. Liver cancer mortality, years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALY) were calculated using the cause of death surveillance data collected by Tianjin Centers for Disease Control and Prevention. The distributions of these data among residents of different sexes, ages, and regions were analyzed. Segi's world standard population was used for standardization. Joinpoint regression was used for trend analysis on the mortality rate of liver cancer and the disease burden. Results: The liver cancer mortality rate in Tianjin decreased by 46.75% from 1999 to 2021, with distinct phased characteristics. From 1999 to 2010, the age-sex-standardized mortality rate (SMR) decreased from 12.62/100 000 to 11.64/100 000 with an annual percent change (APC) of -1.32% ( P =0.003). From 2010 to 2021, the SMR decreased from 11.64/100 000 to 6.72/100 000 (APC=-3.89%, P <0.001). The age-sex-standardized DALY rates(SDR) decreased by 50.63% from 1999 to 2021, also with distinct phased characteristics. From 1999 to 2010, the SDR decreased from 388.67/100 000 to 349.38/100 000 (APC=-1.35%, P =0.002). From 2010 to 2021, the SDR decreased from 349.38/100 000 to 191.88/100 000 (APC=-4.43%, P <0.001). The liver cancer mortality rate declined most rapidly in the age group under 45 years; the APC for those under 35 years was -5.07% ( P <0.001), and for those aged 35-44 years, the APC was 0.63% ( P =0.707) and -8.21% ( P <0.001) before and after 2007, respectively. Both SMR and SDR were significantly higher in males than in females ( P <0.01). Both SMR and SDR were significantly higher in urban areas than in rural areas from 1999 to 2007 ( P <0.05), but they became similar after 2008. Liver cancer DALY are predominantly YLL, accounting for 99%. The median age of liver cancer deaths in Tianjin during 1999-2021 was 64-68 years old, with males lower than females ( P <0.05), and rural areas lower than urban areas ( P <0.05), generally showing an increasing trend (1999-2014: APC=0.11%, P =0.047; 2014-2021: APC=0.51%, P =0.005). Conclusions: Liver cancer mortality rate and disease burden decreased from 1999 to 2021 in Tianjin, with an especially accelerated decline after 2010. Further efforts to reduce liver cancer mortality in Tianjin are needed, and special attention should be focused on the elderly, male, and rural residents.
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- 2024
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3. Leontopodiumnyingchiense (Asteraceae), a new species from Xizang (Tibet), China.
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He WQ, Zhao FY, Chu ZF, Chai GZ, Zhao KH, Tian JQ, Zhang BX, Zhang FY, Liao ZH, Zheng WL, and Lan XZ
- Abstract
Leontopodiumnyingchiense , a new species of Asteraceae from the Xizang (Tibet) Autonomous Region of China, is described and illustrated here. Morphologically, it is most similar to L.lingianum but can be distinguished by the combination of monoecious and dioecious individuals, involucral bracts arranged in 3-5 series (with outer series herbaceous and middle to inner series membranous), fimbriate apices on female florets, rough-edged lobes on male florets, and achenes lacking costae. Phylogenetic analyses further support the separation of this new species from related taxa. Finally, we characterize this new species through both morphological comparisons and molecular analyses., Competing Interests: The authors have declared that no competing interests exist., (Wen-Qi He, Fang-Yu Zhao, Zhao-Fu Chu, Guo-Zhu Chai, Kai-Hui Zhao, Jing-Qin Tian, Bao-Xin Zhang, Fang-Yuan Zhang, Zhi-Hua Liao, Wei-Lie Zheng, Xiao-Zhong Lan.)
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- 2024
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4. Rapid context inference in a thalamocortical model using recurrent neural networks.
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Zheng WL, Wu Z, Hummos A, Yang GR, and Halassa MM
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- Humans, Animals, Neurons physiology, Cognition physiology, Neural Networks, Computer, Learning physiology, Neural Pathways physiology, Nerve Net physiology, Prefrontal Cortex physiology, Thalamus physiology, Models, Neurological, Neuronal Plasticity physiology
- Abstract
Cognitive flexibility is a fundamental ability that enables humans and animals to exhibit appropriate behaviors in various contexts. The thalamocortical interactions between the prefrontal cortex (PFC) and the mediodorsal thalamus (MD) have been identified as crucial for inferring temporal context, a critical component of cognitive flexibility. However, the neural mechanism responsible for context inference remains unknown. To address this issue, we propose a PFC-MD neural circuit model that utilizes a Hebbian plasticity rule to support rapid, online context inference. Specifically, the model MD thalamus can infer temporal contexts from prefrontal inputs within a few trials. This is achieved through the use of PFC-to-MD synaptic plasticity with pre-synaptic traces and adaptive thresholding, along with winner-take-all normalization in the MD. Furthermore, our model thalamus gates context-irrelevant neurons in the PFC, thus facilitating continual learning. We evaluate our model performance by having it sequentially learn various cognitive tasks. Incorporating an MD-like component alleviates catastrophic forgetting of previously learned contexts and demonstrates the transfer of knowledge to future contexts. Our work provides insight into how biological properties of thalamocortical circuits can be leveraged to achieve rapid context inference and continual learning., (© 2024. The Author(s).)
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- 2024
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5. The ICF2 gene Zbtb24 specifically regulates the differentiation of B1 cells via promoting heme synthesis.
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Gao H, Zhao Y, Zhao S, Dai XQ, Qin XY, Zheng WL, He TT, Zhang N, Zhu C, Wang HM, Pan W, Zhu XM, Gao XM, Dai JF, Gong FY, and Wang J
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- Animals, Mice, B-Lymphocytes immunology, B-Lymphocytes metabolism, Face abnormalities, Immunologic Deficiency Syndromes genetics, Mice, Inbred C57BL, Mice, Knockout, Repressor Proteins genetics, Repressor Proteins metabolism, Cell Differentiation, Primary Immunodeficiency Diseases genetics, Transcription Factors metabolism
- Abstract
Background: Loss-of-function mutations of ZBTB24 cause immunodeficiency, centromeric instability, and facial anomalies syndrome 2 (ICF2). ICF2 is a rare autosomal recessive disorder with immunological defects in serum antibodies and circulating memory B cells, resulting in recurrent and sometimes fatal respiratory and gastrointestinal infections. The genotype-phenotype correlation in patients with ICF2 indicates an essential role of ZBTB24 in the terminal differentiation of B cells., Methods: We used the clustered regularly interspaced short palindromic repeats (CRISPER)/Cas9 technology to generate B cell specific Zbtb24-deficient mice and verified the deletion specificity and efficiency by quantitative polymerase chain reaction (Q-PCR) and western blotting analyses in fluorescence-activated cell sorting (FACS)-sorted cells. The development, phenotype of B cells and in vivo responses to T cell dependent or independent antigens post immunization were analyzed by flow cytometry and enzyme-linked immunosorbent assay (ELISA). Adoptive transfer experiment in combination with in vitro cultures of FACS-purified B cells and RNA-Seq analysis were utilized to specifically determine the impact of Zbtb24 on B cell biology as well as the underlying mechanisms., Results: Zbtb24 is dispensable for B cell development and maintenance in naive mice. Surprisingly, B cell specific deletion of Zbtb24 does not evidently compromise germinal center reactions and the resulting primary and secondary antibody responses induced by T cell dependent antigens (TD-Ags), but significantly inhibits T cell independent antigen-elicited antibody productions in vivo. At the cellular level, Zbtb24-deficiency specifically impedes the plasma cell differentiation of B1 cells without impairing their survival, activation and proliferation in vitro. Mechanistically, Zbtb24-ablation attenuates heme biosynthesis partially through mTORC1 in B1 cells, and addition of exogenous hemin abrogates the differentiation defects of Zbtb24-null B1 cells., Conclusions: Zbtb24 seems to regulate antibody responses against TD-Ags B cell extrinsically, but it specifically promotes the plasma cell differentiation of B1 cells via heme synthesis in mice. Our study also suggests that defected B1 functions contribute to recurrent infections in patients with ICF2., (© 2024. The Author(s).)
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- 2024
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6. Early Burst Suppression Similarity Association with Structural Brain Injury Severity on MRI After Cardiac Arrest.
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Shivdat S, Zhan T, De Palma A, Zheng WL, Krishnamurthy P, Paneerselvam E, Snider S, Bevers M, O'Reilly UM, Lee JW, Westover MB, and Amorim E
- Abstract
Background: Identical bursts on electroencephalography (EEG) are considered a specific predictor of poor outcomes in cardiac arrest, but its relationship with structural brain injury severity on magnetic resonance imaging (MRI) is not known., Methods: This was a retrospective analysis of clinical, EEG, and MRI data from adult comatose patients after cardiac arrest. Burst similarity in first 72 h from the time of return of spontaneous circulation were calculated using dynamic time-warping (DTW) for bursts of equal (i.e., 500 ms) and varying (i.e., 100-500 ms) lengths and cross-correlation for bursts of equal lengths. Structural brain injury severity was measured using whole brain mean apparent diffusion coefficient (ADC) on MRI. Pearson's correlation coefficients were calculated between mean burst similarity across consecutive 12-24-h time blocks and mean whole brain ADC values. Good outcome was defined as Cerebral Performance Category of 1-2 (i.e., independence for activities of daily living) at the time of hospital discharge., Results: Of 113 patients with cardiac arrest, 45 patients had burst suppression (mean cardiac arrest to MRI time 4.3 days). Three study participants with burst suppression had a good outcome. Burst similarity calculated using DTW with bursts of varying lengths was correlated with mean ADC value in the first 36 h after cardiac arrest: Pearson's r: 0-12 h: - 0.69 (p = 0.039), 12-24 h: - 0.54 (p = 0.002), 24-36 h: - 0.41 (p = 0.049). Burst similarity measured with bursts of equal lengths was not associated with mean ADC value with cross-correlation or DTW, except for DTW at 60-72 h (- 0.96, p = 0.04)., Conclusions: Burst similarity on EEG after cardiac arrest may be associated with acute brain injury severity on MRI. This association was time dependent when measured using DTW., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)
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- 2024
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7. Transarterial Chemoembolization Combined with Tyrosine Kinase Inhibitors Plus Immune Checkpoint Inhibitors Versus Tyrosine Kinase Inhibitors Plus Immune Checkpoint Inhibitors in Unresectable Hepatocellular Carcinoma with First- or Lower-Order Portal Vein Tumor Thrombosis.
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Zhang JX, Cheng Y, Wei J, Fan WL, Liu J, Zhou CG, Liu S, Shi HB, Chu XY, Zheng WL, and Zu QQ
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Adult, Tyrosine Kinase Inhibitors, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic methods, Liver Neoplasms therapy, Portal Vein, Protein Kinase Inhibitors therapeutic use, Immune Checkpoint Inhibitors therapeutic use, Venous Thrombosis
- Abstract
Purpose: To compare the efficacy of transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) plus immune checkpoint inhibitors (ICIs) (TACE-TKI-ICI) versus TKIs plus ICIs (TKI-ICI) for unresectable hepatocellular carcinoma (HCC) with first- or lower-order portal vein tumor thrombosis (PVTT)., Materials and Methods: A retrospective study was performed in HCC patients with first- or lower-order PVTT receiving TKIs (Lenvatinib or sorafenib) plus ICIs (camrelizumab, sintilimab, or atezolizumab) with or without TACE from four institutions between January 2019 and January 2022. Propensity score-based method was performed to minimize bias by confounding factors. Tumor response, progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were evaluated and compared between the two groups., Results: After inverse probability of treatment weighting, two balanced pseudopopulations were created: 106 patients in the TACE-TKI-ICI group and 109 patients in the TKI-ICI group. The objective response rate was higher in the TACE-TKI-ICI group (50.9% vs. 28.4%, P < 0.001). The median PFS and OS were significantly longer in the TACE-TKI-ICI group than in the TKI-ICI group (PFS: 9.1 vs. 5.0 months, P = 0.005; OS: 19.1 vs. 12.7 months, P = 0.002). In Cox regression, TACE-TKI-ICI treatment was an independent predictor of favorable OS. Treatment-related grade 3/4 AEs were comparable between the two groups (22.6% vs. 17.9%, P = 0.437)., Conclusion: TACE-TKI-ICI therapy contributed to better tumor control, PFS and OS than TKI-ICI therapy in unresectable HCC patients with first- or lower-order PVTT., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)
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- 2024
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8. [Cancer survival analysis in Tianjin, 2010 to 2016].
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Wang C, Shen CF, Xun LN, Zhang S, Zhang H, Zheng WL, and Wang DZ
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- Humans, Male, Female, China epidemiology, Survival Rate, Incidence, Urban Population statistics & numerical data, Middle Aged, Aged, Adult, Adolescent, Survival Analysis, Young Adult, Kaplan-Meier Estimate, Child, Sex Factors, Registries, Neoplasms mortality, Neoplasms epidemiology, Rural Population statistics & numerical data
- Abstract
Objective: Survival analysis of cancers' incidence data in Tianjin from 2010 to 2016 was conducted to provide the basis for formulating and evaluating regional health policies on cancer prevention and treatment. Methods: Registration data in Tianjin were used between January 1, 2010 to December 31, 2016 and patients were followed-up till 31 December, 2021. Life-table method was used to calculate the observed survival rate and Edered Ⅱ was used to calculate the relative survival rate. The data were stratified by year, gender, age group and cancer sites. Difference in survival curves between group was analyzed by Kaplan-Meier method and Log rank test. Joinpoint regression model was used to analyze the trend change. Results: The 5-year relative survival rates of cancer were 41.92% to 53.65% from 2010 to 2016 for residents in Tianjin, with an increasing trend ( t =4.81 , P =0.005), and the average was 48.56%. The survival rate of females was higher than that of males (57.71%vs. 39.20%), and the survival rate of urban residents was higher than that of rural residents (49.38% vs. 47.24%). The 5-year relative survival rates were 63.14%, 78.39%, 58.25% and 32.67% in 0-14, 15-44, 45-64 and 65 and above age groups, respectively. The median relative survival times of all cancer were 2.34 to 6.00 years from 2010 to 2016 in Tianjin, with an increasing trend ( t =3.86, P =0.012). The average of median relative survival times was 4.11 years. The median survival time of females was longer than that of males (11.99 years vs. 2.03 years), and the time of urban residents were longer than that of rural residents (4.60 years vs. 3.43 years). The median relative survival time were 12.07, 11.92 and 1.34 years in 15-44, 45-64 and 65 and above age groups, respectively. Conclusions: The cumulative survival rate of cancer increased significantly from 2010 to 2016 in Tianjin, indicating that the prevention and treatment effect of cancer is obvious. The focus should be on male, rural areas, higher age group, and targeted prevention and treatment measures should be taken to lung, esophagus, liver, gallbladder and pancreatic cancer.
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- 2024
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9. [Exploring the causality between intestinal flora and hyperplastic scars of human based on two-sample Mendelian randomization analysis].
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Chen WT, Wang XX, Zheng WL, Zhang WQ, Mao LJ, Zhuo JN, Zhou ST, and Yang RH
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- Humans, Cicatrix microbiology, Cicatrix genetics, Cicatrix pathology, Hyperplasia genetics, Hyperplasia microbiology, Genotype, Mendelian Randomization Analysis, Gastrointestinal Microbiome genetics, Polymorphism, Single Nucleotide, Genome-Wide Association Study
- Abstract
Objective: To investigate the causality between intestinal flora and hypertrophic scars (HS) of human. Methods: This study was a study based on two-sample Mendelian randomization (TSMR) analysis. The data on intestinal flora ( n =18 473) and HS ( n =208 248) of human were obtained from the genome-wide association study database. Genetically variable genes at five levels (phylum, class, order, family, and genus) of known intestinal flora, i.e., single nucleotide polymorphisms (SNPs), were extracted as instrumental variables for linkage disequilibrium (LD) analysis. Human genotype-phenotype association analysis was performed using PhenoScanner V2 database to exclude SNPs unrelated to HS in intestinal flora and analyze whether the selected SNPs were weak instrumental variables. The causal relationship between intestinal flora SNPs and HS was analyzed through four methods of TSMR analysis, namely inverse variance weighted (IVW), MR-Egger regression, weighted median, and weighted mode. Scatter plots of significant results from the four aforementioned analysis methods were plotted to analyze the correlation between intestinal flora SNPs and HS. Both IVW test and MR-Egger regression test were used to assess the heterogeneity of intestinal flora SNPs, MR-Egger regression test and MR-PRESSO outlier test were used to assess the horizontal multiplicity of intestinal flora SNPs, and leave-one-out sensitivity analysis was used to determine whether HS was caused by a single SNP in the intestinal flora. Reverse TSMR analyses were performed for HS SNPs and genus Intestinimonas or genus Ruminococcus2 , respectively, to detect whether there was reverse causality between them. Results: A total of 196 known intestinal flora, belonging to 9 phyla, 16 classes, 20 orders, 32 families, and 119 genera, were obtained, and multiple SNPs were obtained from each flora as instrumental variables. LD analysis showed that the SNPs of the intestinal flora were consistent with the hypothesis that genetic variation was strongly associated with exposure factors, except for rs1000888, rs12566247, and rs994794. Human genotype-phenotype association analysis showed that none of the selected SNPs after LD analysis was excluded and there were no weak instrumental variables. IVW, MR-Egger regression, weighted median, and weighted mode of TSMR analysis showed that both genus Intestinimonas and genus Ruminococcus2 were causally associated with HS. Among them, forest plots of IVW and MR-Egger regression analyses also showed that 16 SNPs (the same SNPs number of this genus below) of genus Intestinimonas and 15 SNPs (the same SNPs number of this genus below) of genus Ruminococcus2 were protective factors for HS. Further, IVW analysis showed that genus Intestinimonas SNPs (with odds ratio of 0.62, 95% confidence interval of 0.41-0.93, P <0.05) and genus Ruminococcus2 SNPs (with odds ratio of 0.62, 95% confidence interval of 0.40-0.97, P <0.05) were negatively correlated with the risk of HS. Scatter plots showed that SNPs of genus Intestinimonas and genus Ruminococcus2 were protective factors of HS. Both IVW test and MR-Egger regression test showed that SNPs of genus Intestinimonas (with Q values of 5.73 and 5.76, respectively, P >0.05) and genus Ruminococcus2 (with Q values of 13.67 and 15.61, respectively, P >0.05) were not heterogeneous. MR-Egger regression test showed that the SNPs of genus Intestinimonas and genus Ruminococcus2 had no horizontal multiplicity (with intercepts of 0.01 and 0.06, respectively, P >0.05); MR-PRESSO outlier test showed that the SNPs of genus Intestinimonas and genus Ruminococcus2 had no horizontal multiplicity ( P >0.05). Leave-one-out sensitivity analysis showed that no single intestinal flora SNP drove the occurrence of HS. Reverse TSMR analysis showed no reverse causality between HS SNPs and genus Intestinimonas or genus Ruminococcus2 (with odds ratios of 1.01 and 0.99, respectively, 95% confidence intervals of 0.97-1.06 and 0.96-1.04, respectively, P >0.05). Conclusions: There is a causal relationship between intestinal flora and HS of human, in which genus Intestinimonas and genus Ruminococcus2 have a certain effect on inhibiting HS.
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- 2024
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10. [Injury death spectrum in children aged 0-14 years and its urban-rural difference in Tianjin, 1999-2021].
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Zhang S, Zhang H, Zheng WL, Wang DZ, and Wang Z
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- Child, Humans, Rural Population, Incidence, Population Surveillance, Seasons, China epidemiology, Urban Population, Drowning
- Abstract
Objective: To analyze the characteristics, change of injury death spectrum in children aged 0-14 years and its urban-rural difference in Tianjin. Methods: The incidence data of injury death in children aged 0-14 years in Tianjin from 1999 to 2021 were collected from the "Population Based Mortality Surveillance System in Tianjin". We calculated constituent ratio, crude and standardized mortality rates in different subgroups of the population and major injury subtypes, and compared the rural-urban differences. The Cochran-Armitage trend test was used to analyze temporal trends in cause-of-death component ratios. Joinpoint regression model was used to calculate average annual percent change (AAPC). Seasonal difference in injury mortality risk were expressed as mortality ratio and 95% confidence interval. Results: From 1999 to 2021, injury was the third cause of death in children aged 0-14 years in Tianjin. The percentage of children who died in health-care facilities in rural area was 31.08%, which was lower than 37.82% in urban area. There was a downward trend in the standardized mortality rate of injury in children (AAPC=-5.54%, P <0.001). The standardized mortality rates of drowning and road traffic injury declined in both urban area and rural area ( P <0.001). The mortality rate of accidental poisoning decreased in rural area (AAPC=-8.09%, P <0.001), but showed no significant change trend in urban area ( P >0.05). The standardized mortality rate of suicide showed no significant change trend in urban area, but there was an increasing trend in the standardized mortality rate of suicide in rural children aged 10-14 years (AAPC=4.58%). No significant change trend was observed in mortality rate of falls in urban and rural children ( P >0.05). The injury mortality rate showed obvious seasonality in children in Tianjin. Overall injury death risk and risk for drowning-caused death were highest in summer in both urban area and rural area. The risk for road traffic injury-related death was highest in autumn in urban area and in summer in rural area. The risk for death caused by accidental poisoning was highest in winter in both urban area and rural area. Conclusions: In recent decades, the injury mortality rate in children aged 0-14 years in Tianjin showed a decreasing trend. There is still a significant difference in the injury mortality level between urban area and rural area, to which close attention needs to be paid in the future policy development.
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- 2024
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11. [Effect of Water Components on Aggregation and Sedimentation of Polystyrene Nanoplastics].
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Tang DY, Zheng WL, Chen GT, Chen SL, Chen Y, Zhao XL, and Wang H
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The aggregation and sedimentation of micro/nano-plastics significantly affect their migration and distribution in the environment. This study investigated the effects of Na
+ and natural organic matter (NOM) on the aggregation and sedimentation of polystyrene nano-plastics (PS-NPs) in the aqueous phase. Six types of water, such as seawater, lake water, and domestic sewage, were used to evaluate the above effects and other potential influencing factors. The results indicated that Na+ could facilitate the sedimentation of PS-NPs when it was less than 80 mmol·L-1 , whereas it could promote the aggregation and suspension of PS-NPs when the concentration was greater than 80 mmol·L-1 . NOM molecules affected the aggregation and sedimentation of PS-NPs by changing the ζ potential and relative density of particles via forming a multilayer adsorption structure with Na+ on the particle surface. It was observed that NOM greater than 10 mg·L-1 enhanced the dispersion and suspension of PS-NPs, which might have been attributed to the decrease in relative density of the particles as a large amount of NOM was absorbed onto the surface. Compared with synthetic waters, environmental waters enhanced the aggregation of PS-NPs, which may have been related to the amino acid, protein, and other organic macro-molecules in the water.- Published
- 2024
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12. The International Cardiac Arrest Research Consortium Electroencephalography Database.
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Amorim E, Zheng WL, Ghassemi MM, Aghaeeaval M, Kandhare P, Karukonda V, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hofmeijer J, van Putten MJAM, Sameni R, Reyna MA, Clifford GD, and Westover MB
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- Humans, Adolescent, Retrospective Studies, Prospective Studies, Electroencephalography, Coma diagnosis, Heart Arrest diagnosis
- Abstract
Objectives: To develop the International Cardiac Arrest Research (I-CARE), a harmonized multicenter clinical and electroencephalography database for acute hypoxic-ischemic brain injury research involving patients with cardiac arrest., Design: Multicenter cohort, partly prospective and partly retrospective., Setting: Seven academic or teaching hospitals from the United States and Europe., Patients: Individuals 16 years old or older who were comatose after return of spontaneous circulation following a cardiac arrest who had continuous electroencephalography monitoring were included., Interventions: Not applicable., Measurements and Main Results: Clinical and electroencephalography data were harmonized and stored in a common Waveform Database-compatible format. Automated spike frequency, background continuity, and artifact detection on electroencephalography were calculated with 10-second resolution and summarized hourly. Neurologic outcome was determined at 3-6 months using the best Cerebral Performance Category (CPC) scale. This database includes clinical data and 56,676 hours (3.9 terabytes) of continuous electroencephalography data for 1,020 patients. Most patients died ( n = 603, 59%), 48 (5%) had severe neurologic disability (CPC 3 or 4), and 369 (36%) had good functional recovery (CPC 1-2). There is significant variability in mean electroencephalography recording duration depending on the neurologic outcome (range, 53-102 hr for CPC 1 and CPC 4, respectively). Epileptiform activity averaging 1 Hz or more in frequency for at least 1 hour was seen in 258 patients (25%) (19% for CPC 1-2 and 29% for CPC 3-5). Burst suppression was observed for at least 1 hour in 207 (56%) and 635 (97%) patients with CPC 1-2 and CPC 3-5, respectively., Conclusions: The I-CARE consortium electroencephalography database provides a comprehensive real-world clinical and electroencephalography dataset for neurophysiology research of comatose patients after cardiac arrest. This dataset covers the spectrum of abnormal electroencephalography patterns after cardiac arrest, including epileptiform patterns and those in the ictal-interictal continuum., Competing Interests: Dr. van Putten is the founder of Clinical Science Systems. Dr. Westover is a co-founder of Beacon Biosignals. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Published
- 2023
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13. Identifying sex differences in EEG-based emotion recognition using graph convolutional network with attention mechanism.
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Peng D, Zheng WL, Liu L, Jiang WB, Li Z, Lu Y, and Lu BL
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Objective: Sex differences in emotions have been widely perceived via self-reports, peripheral physiological signals and brain imaging techniques. However, how sex differences are reflected in the EEG neural patterns of emotions remains unresolved. In this paper, we detect sex differences in emotional EEG patterns, investigate the consistency of such differences in various emotion datasets across cultures, and study how sex as a factor affects the performance of EEG-based emotion recognition models., Approach: We thoroughly assess sex differences in emotional EEG patterns on five public datasets, including SEED, SEED-IV, SEED-V, DEAP and DREAMER, systematically examine the sex-specific EEG patterns for happy, sad, fearful, disgusted and neutral emotions, and implement deep learning models for sex-specific emotion recognition., Main Results: (1) Sex differences exist in various emotion types and both Western and Eastern cultures; (2) The emotion patterns of females are more stable than those of males, and the patterns of happiness from females are in sharp contrast with the patterns of sadness, fear and disgust, while the energy levels are more balanced for males; (3) The key features for emotion recognition are mainly located at the frontal and temporal sites for females and distributed more evenly over the whole brain for males, and (4) The same-sex emotion recognition models outperform the corresponding cross-sex models., Significance: These findings extend efforts to characterize sex differences in emotional brain activation, provide new physiological evidence for sex-specific emotion processing, and reinforce the message that sex differences should be carefully considered in affective research and precision medicine., (© 2023 IOP Publishing Ltd.)
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- 2023
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14. Effects of biochar application and nutrient fluctuation on the growth, and cadmium and nutrient uptake of Trifolium repens with different planting densities in Cd-contaminated soils.
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Zheng WL, Wang YF, Mo J, Zeng P, Chen J, and Sun C
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Biochar has been used to remediate contaminated-soil with heavy metals, however, less is known on how biochar interacts with planting density and nutrient fluctuation to affect the remediation. A pot experiment was conducted in the greenhouse to investigate the effects of biochar application (without vs. with 1% biochar, g/g substrate), nutrient fluctuation (constant vs. pulsed) and planting density (1-, 3- and 6-individuals per pot) on the growth, and cadmium (Cd) and nutrient uptake of Trifolium repens population. Our results found that the growth of T. repens population increased significantly with increasing planting density, and the increment decreased with increasing planting density. Both the Cd and nutrient uptake were higher at higher planting density (e.g., 3- and 6-individuals) than at lower planting density (e.g., 1-individual). Biochar application increased the biomass and shoot Cd uptake, but decreased the ratio of root to shoot and root Cd uptake of T. repens population, the effects of which were significantly influenced by planting density. Although nutrient fluctuation had no effect on the growth of T. repens population, but its interaction with planting density had significant effects on Cd uptake in tissues. Overall, the effects of biochar application and nutrient fluctuation on the growth and Cd uptake were both influenced by planting density in the present study. Our findings highlight that biochar application and constant nutrient supply at an appropriate planting density, such as planting density of 3-individuals per pot in the present study, could promote the growth, and Cd and nutrient uptake of T. repens population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zheng, Wang, Mo, Zeng, Chen and Sun.)
- Published
- 2023
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15. Neurophysiology State Dynamics Underlying Acute Neurologic Recovery After Cardiac Arrest.
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Amorim E, Zheng WL, Jing J, Ghassemi MM, Lee JW, Wu O, Herman ST, Pang T, Sivaraju A, Gaspard N, Hirsch L, Ruijter BJ, Tjepkema-Cloostermans MC, Hofmeijer J, van Putten MJAM, and Westover MB
- Subjects
- Adult, Humans, Coma complications, Retrospective Studies, Neurophysiology, Electroencephalography, Heart Arrest complications, Brain Injuries complications
- Abstract
Background and Objectives: Epileptiform activity and burst suppression are neurophysiology signatures reflective of severe brain injury after cardiac arrest. We aimed to delineate the evolution of coma neurophysiology feature ensembles associated with recovery from coma after cardiac arrest., Methods: Adults in acute coma after cardiac arrest were included in a retrospective database involving 7 hospitals. The combination of 3 quantitative EEG features (burst suppression ratio [BSup], spike frequency [SpF], and Shannon entropy [En]) was used to define 5 distinct neurophysiology states: epileptiform high entropy (EHE: SpF ≥4 per minute and En ≥5); epileptiform low entropy (ELE: SpF ≥4 per minute and <5 En); nonepileptiform high entropy (NEHE: SpF <4 per minute and ≥5 En); nonepileptiform low entropy (NELE: SpF <4 per minute and <5 En), and burst suppression (BSup ≥50% and SpF <4 per minute). State transitions were measured at consecutive 6-hour blocks between 6 and 84 hours after return of spontaneous circulation. Good neurologic outcome was defined as best cerebral performance category 1-2 at 3-6 months., Results: One thousand thirty-eight individuals were included (50,224 hours of EEG), and 373 (36%) had good outcome. Individuals with EHE state had a 29% rate of good outcome, while those with ELE had 11%. Transitions out of an EHE or BSup state to an NEHE state were associated with good outcome (45% and 20%, respectively). No individuals with ELE state lasting >15 hours had good recovery., Discussion: Transition to high entropy states is associated with an increased likelihood of good outcome despite preceding epileptiform or burst suppression states. High entropy may reflect mechanisms of resilience to hypoxic-ischemic brain injury., (© 2023 American Academy of Neurology.)
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- 2023
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16. The International Cardiac Arrest Research (I-CARE) Consortium Electroencephalography Database.
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Amorim E, Zheng WL, Ghassemi MM, Aghaeeaval M, Kandhare P, Karukonda V, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hofmeijer J, van Putten MJAM, Sameni R, Reyna MA, Clifford GD, and Westover MB
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Objective: To develop a harmonized multicenter clinical and electroencephalography (EEG) database for acute hypoxic-ischemic brain injury research involving patients with cardiac arrest., Design: Multicenter cohort, partly prospective and partly retrospective., Setting: Seven academic or teaching hospitals from the U.S. and Europe., Patients: Individuals aged 16 or older who were comatose after return of spontaneous circulation following a cardiac arrest who had continuous EEG monitoring were included., Interventions: not applicable., Measurements and Main Results: Clinical and EEG data were harmonized and stored in a common Waveform Database (WFDB)-compatible format. Automated spike frequency, background continuity, and artifact detection on EEG were calculated with 10 second resolution and summarized hourly. Neurological outcome was determined at 3-6 months using the best Cerebral Performance Category (CPC) scale. This database includes clinical and 56,676 hours (3.9 TB) of continuous EEG data for 1,020 patients. Most patients died (N=603, 59%), 48 (5%) had severe neurological disability (CPC 3 or 4), and 369 (36%) had good functional recovery (CPC 1-2). There is significant variability in mean EEG recording duration depending on the neurological outcome (range 53-102h for CPC 1 and CPC 4, respectively). Epileptiform activity averaging 1 Hz or more in frequency for at least one hour was seen in 258 (25%) patients (19% for CPC 1-2 and 29% for CPC 3-5). Burst suppression was observed for at least one hour in 207 (56%) and 635 (97%) patients with CPC 1-2 and CPC 3-5, respectively., Conclusions: The International Cardiac Arrest Research (I-CARE) consortium database provides a comprehensive real-world clinical and EEG dataset for neurophysiology research of comatose patients after cardiac arrest. This dataset covers the spectrum of abnormal EEG patterns after cardiac arrest, including epileptiform patterns and those in the ictal-interictal continuum., Competing Interests: Potential Conflicts of Interest E.A., W.L.Z., M.M.G., M.A., P.K., V.K., J.W.L., L.J.H., S.T.H., A.S., N.G., R.S., M.A.R., G.D.C., and J.H. report no disclosures. M.V.P is the founder of Clinical Science Systems. Clinical Science Systems did not contribute funding nor played any role in the study. M.B.W. is a co-founder of Beacon Biosignals. Beacon Biosignals did not contribute funding nor played any role in the study.
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- 2023
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17. Development of a Strategy for L-Lactic Acid Production by Rhizopus oryzae Using Zizania latifolia Waste and Cane Molasses as Carbon Sources.
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Yin FW, Sun XL, Zheng WL, Yin LF, Luo X, Zhang YY, Wang YF, and Fu YQ
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- Canes, Industrial Waste, Lactic Acid, Carbon, Glucose, Molasses, Rhizopus oryzae
- Abstract
As a biodegradable and renewable material, polylactic acid is considered a major environmentally friendly alternative to petrochemical plastics. Microbial fermentation is the traditional method for lactic acid production, but it is still too expensive to compete with the petrochemical industry. Agro-industrial wastes are generated from the food and agricultural industries and agricultural practices. The utilization of agro-industrial wastes is an important way to reduce costs, save energy and achieve sustainable development. The present study aimed to develop a method for the valorization of Zizania latifolia waste and cane molasses as carbon sources for L-lactic acid fermentation using Rhizopus oryzae LA-UN-1. The results showed that xylose derived from the acid hydrolysis of Z. latifolia waste was beneficial for cell growth, while glucose from the acid hydrolysis of Z. latifolia waste and mixed sugars (glucose and fructose) from the acid hydrolysis of cane molasses were suitable for the accumulation of lactic acid. Thus, a three-stage carbon source utilization strategy was developed, which markedly improved lactic acid production and productivity, respectively reaching 129.47 g/L and 1.51 g/L·h after 86 h of fermentation. This work demonstrates that inexpensive Z. latifolia waste and cane molasses can be suitable carbon sources for lactic acid production, offering an efficient utilization strategy for agro-industrial wastes.
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- 2023
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18. [Bacterial Community Diversity in Channel Sediments of Different Disturbance Sections of the Jialing River].
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Zhu LP, Zhang T, Li JN, Wang JY, Zheng WL, Xu F, and Zhang FB
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- Humans, Bacteria genetics, Acidobacteria, Vitamins, Rivers, Sand
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In order to explore the impact of different anthropogenic disturbances on the ecological environment of natural rivers, the bacterial community in the channel sediments of the Jialing River was taken as the research object, and the high-throughput sequencing technique was used to analyze the community composition and functional changes of bacteria in the channel sediments of rivers with engineering disturbance, tributary disturbance, sand mining disturbance, reclamation disturbance, and undisturbed section. The results showed that there were significant differences in the physical and chemical properties of channel sediments and bacterial community diversity in different disturbance sections of the Jialing River ( P <0.05). The undisturbed section had the highest bacterial community diversity, whereas the sand mining disturbance and undisturbed section had the highest bacterial community uniformity, and tributary disturbance and reclamation disturbance both resulted in a decrease in bacterial community diversity and uniformity. The effect of engineering disturbance on bacterial community composition was significantly different from that of the other four disturbance sections. The dominant bacterial phyla were Proteobacteria, Actinobacteriota, Acidobacteriota, and Chloroflexi, and the dominant bacterial classes were γ -Proteobacteria, α -Proteobacteria, and Vicinamibacteria. Sand mining disturbance led to the increase in Actinobacteria, and engineering disturbance promoted the increase in Acidobacteria. Moisture content, total organic carbon, total nitrogen, and total phosphorus were the main environmental factors affecting the changes in sediment microbial communities. The bacterial communities mainly involved four categories of primary metabolic functions, including metabolism, genetic information processing, environmental information processing, and cellular processes, and 18 categories of secondary metabolic functions, such as global and overview maps, carbohydrate metabolism, amino acid metabolism, cofactor and vitamin metabolism, and energy metabolism. Human interference led to significant changes in energy metabolism, cofactor and vitamin metabolism, nucleotide metabolism, replication and repair, and translation ( P <0.05). In conclusion, anthropogenic disturbance led to the mutation of bacterial community diversity and function, which destroyed the stability of the microbial community structure in Jialing River sediments.
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- 2023
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19. Objective Depression Detection Using EEG and Eye Movement Signals Induced by Oil Paintings.
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Liu L, Peng D, Zheng WL, and Lu BL
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- Humans, Eye Movements, Emotions physiology, Electroencephalography methods, Brain physiology, Depression diagnosis
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Depression is a mental disorder characterized by persistent sadness and loss of interest, which has become one of the leading causes of disability worldwide. There are currently no objective diagnostic standards for depression in clinical practice. Previous studies have shown that depression causes both brain abnormalities and behavioral disorders. In this study, both electroencephalography (EEG) and eye movement signals were used to objectively detect depression. By presenting 40 carefully selected oil paintings-20 positive and 20 negative-as stimuli, we were able to successfully evoke emotions in 48 depressed patients (DPs) and 40 healthy controls (HCs) from three centers. We then used Transformer, a deep learning model, to conduct emotion recognition and depression detection. The experimental results demonstrate that: a) Transformer achieves the best accuracies of 89.21% and 92.19% in emotion recognition and depression detection, respectively; b) The HC group has higher accuracies than the DP group in emotion recognition for both subject-dependent and subject-independent experiments; c) The neural pattern differences do exist between DPs and HCs, and we find the consistent asymmetry of the neural patterns in DPs; d) For depression detection, using single oil painting achieves the best accuracies, and using negative oil paintings has higher accuracies than using positive oil paintings. These findings suggest that EEG and eye movement signals induced by oil paintings can be used to objectively identify depression.
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- 2023
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20. Deep Depression Detection with Resting-State and Cognitive-Task EEG.
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Peng D, Liu W, Luo Y, Mao Z, Zheng WL, and Lu BL
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- Humans, Attention physiology, Electroencephalography, Cognition, Depression diagnosis, Neural Networks, Computer
- Abstract
Depression is a common mental disorder that negatively affects physical health and personal, social and occupational functioning. Currently, accurate and objective diagnosis of depression remains challenging, and electroencephalography (EEG) provides promising clinical practice or home use due to considerable performance and low cost. This work investigates the capabilities of deep neural networks with EEG-based neural patterns from both resting states and cognitive tasks for depression detection. We collect EEG signals from 33 depressed patients and 40 healthy controls using wearable dry electrodes and build Attentive Simple Graph Convolutional network and Transformer neural network for objective depression detection. Four experiment stages, including two resting states and two cognitive tasks, are designed to characterize the alteration of relevant neural patterns in the depressed patients, in terms of decreased energy and impaired performance in sustained attention and response inhibition. The Transformer model achieves an AUC of 0.94 on the Continuous Performance Test-Identical Pairs version (sensitivity: 0.87, specificity: 0.91) and the Stroop Color Word Test (sensitivity: 0.93, specificity: 0.88), and an AUC of 0.89 on the two resting states (sensitivity: 0.85 and 0.87, specificity: 0.88 and 0.90, respectively), indicating the potential of EEG-based neural patterns in identifying depression. These findings provide new insights into the research of depression mechanisms and EEG-based depression biomarkers.
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- 2023
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21. Investigating Emotion EEG Patterns for Depression Detection with Attentive Simple Graph Convolutional Network.
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Lan YT, Peng D, Liu W, Luo Y, Mao Z, Zheng WL, and Lu BL
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- Humans, Emotions physiology, Electroencephalography, Biomarkers, Depression diagnosis, Quality of Life
- Abstract
Depression severely limits daily functioning, diminishes quality of life and possibly leads to self-harm and suicide. Noninvasive electroencephalography (EEG) has been shown effective as biomarkers for objective depression diagnose and treatment response prediction, and dry EEG electrodes further extend its availability for clinical use. Even though many efforts have been made to identify depression biomarkers, searching reliable EEG biomarkers for depression detection remains challenging. This work presents a systematic investigation of capabilities of emotion EEG patterns for depression detection using a dry EEG electrode system. We design an emotion elicitation paradigm with happy, neutral and sad emotions and collect EEG signals during film watching from 33 depressed patients and 40 healthy controls. The mean activation levels at frontal and temporal sites in the alpha, beta and gamma bands of the depressed group are different to those of the healthy group, indicating the impacts of depressive symptoms on the emotion experiences. To leverage the topology information among EEG channels for emotion recognition and depression detection, an Attentive Simple Graph Convolutional network is built. The deep depression-health classifier achieves a sensitivity of 81.93% and a specificity of 91.69% on the happy emotions, suggesting the promising use of the emotion neural patterns for distinguishing the depressed patients from the healthy controls.
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- 2023
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22. Tagging Continuous Labels for EEG-based Emotion Classification.
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Gu RF, Zhao LM, Zheng WL, and Lu BL
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- Emotions, Electroencephalography methods, Brain-Computer Interfaces
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EEG-based emotion classification has long been a critical task in the field of affective brain-computer interface (aBCI). The majority of leading researches construct supervised learning models based on labeled datasets. Several datasets have been released, including different kinds of emotions while utilizing various forms of stimulus materials. However, they adopt discrete labeling methods, in which the EEG data collected during the same stimulus material are given a same label. These methods neglect the fact that emotion changes continuously, and mislabeled data possibly exist. The imprecision of discrete labels may hinder the progress of emotion classification in concerned works. Therefore, we develop an efficient system in this paper to support continuous labeling by giving each sample a unique label, and construct a continuously labeled EEG emotion dataset. Using our dataset with continuous labels, we demonstrate the superiority of continuous labeling in emotion classification through experiments on several classification models. We further utilize the continuous labels to identify the EEG features under induced and non-induced emotions in both our dataset and a public dataset. Our experimental results reveal the learnability and generality of the relation between the EEG features and their continuous labels.
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- 2023
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23. [Endovascular therapy accompanied by spontaneous portosystemic shunts for overt hepatic encephalopathy].
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Zhao T, Huang JY, Liu CH, Chen RB, Fan WL, and Zheng WL
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- Humans, Liver Cirrhosis complications, Treatment Outcome, Gastrointestinal Hemorrhage etiology, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Hepatic Encephalopathy complications, Hypertension, Portal etiology, Esophageal and Gastric Varices etiology, Endovascular Procedures adverse effects
- Abstract
Objective: To preliminarily evaluate the safety and efficacy of shunt-related interventional therapy accompanied with spontaneous portosystemic shunts (SPSS) in patients with hepatic encephalopathy (HE). Methods: Case data on six patients who underwent interventional therapy accompanied by SPSS for HE from January 2017 to March 2021 were collected to evaluate the efficacy and postoperative complications. Results: All six patients underwent SPSS. Four patients had hepatitis B cirrhosis; one had alcoholic cirrhosis; and one had hepatic arterioportal fistula-induced portal hypertension. Child-Pugh liver function scores were C and B in three and three cases, respectively. The SPSS type was gastrorenal shunt in two cases; portal-thoracic-azygos venous in two cases; portal-umbilical-iliac venous in one case; and portal-splenic venous - inferior vena cava in one case. Two of them had previously had a transjugular intrahepatic portosystemic shunt (TIPS), and there were SPSS prior to TIPS. Five cases (5/6) successfully underwent shunt embolization, and one case (1/6) underwent stent implantation for flow restriction (portal-umbilical-iliac vein). The technical success rate was 100%. HE did not recur during hospitalization or the three-month follow-up period. However, one case had a recurrence of HE within a year after surgery and was treated symptomatically, while another experienced gastrointestinal bleeding a year after surgery.. Conclusion: SPSS embolization or flow restriction is effective and safe for improving HE patients' symptoms.
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- 2023
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24. Efficient Co-production of Docosahexaenoic Acid Oil and Carotenoids in Aurantiochytrium sp. Using a Light Intensity Gradient Strategy.
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Yin FW, Zhan CT, Huang J, Sun XL, Yin LF, Zheng WL, Luo X, Zhang YY, and Fu YQ
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- Docosahexaenoic Acids, Fermentation, beta Carotene, Carotenoids, Stramenopiles
- Abstract
Aurantiochytrium is a promising source of docosahexaenoic acid (DHA) and carotenoids, but their synthesis is influenced by environmental stress factors. In this study, the effect of different light intensities on the fermentation of DHA oil and carotenoids using Aurantiochytrium sp. TZ209 was investigated. The results showed that dark culture and low light intensity conditions did not affect the normal growth of cells, but were not conducive to the accumulation of carotenoids. High light intensity promoted the synthesis of DHA and carotenoids, but caused cell damage, resulting in a decrease of oil yield. To solve this issue, a light intensity gradient strategy was developed, which markedly improved the DHA and carotenoid content without reducing the oil yield. This strategy produced 30.16 g/L of microalgal oil with 15.11 g/L DHA, 221 µg/g astaxanthin, and 386 µg/g β-carotene. This work demonstrates that strain TZ209 is a promising DHA producer and provides an efficient strategy for the co-production of DHA oil together with carotenoids., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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25. High sodium diet intake and cardiovascular diseases: An attributable death study in Tianjin, China.
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Xue XD, Li W, Xie MQ, Wang DZ, Li DD, Xin P, Zheng WL, and Jiang GH
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- Adult, Humans, Aged, China epidemiology, Diet, Sodium, Cardiovascular Diseases epidemiology, Hypertension epidemiology, Autonomic Nervous System Diseases, Metabolic Diseases, Sodium, Dietary adverse effects
- Abstract
There is clear evidence that high sodium intake is associated with many health issues including hypertension and cardiovascular diseases (CVDs). Several national and worldwide studies have estimated deaths from CVDs attributable to high sodium. But how to evaluate the impact of high sodium intake on diseases using regional routine monitoring and investigation data is necessary and important. Our study aimed to quantitatively evaluate the high sodium intake attributed to CVDs deaths based on the routine monitoring data from China National Nutrition and Health Survey (CNNHS) in Tianjin, China. The population attributable fractions (PAF) were calculated by comparing the observed systolic blood pressure (SBP) distribution with the theoretical minimum or counterfactual distribution by sex and age groups. The results showed that CVDs deaths due to elevated SBP were 22728 (95% uncertainty intervals: 22679-23050), accounting for 62.8% of total CVDs deaths. According to sodium intake recommended by World Health Organization (WHO), PAF of CVDs deaths attributable to high sodium diet in our study was 14.6% of total CVDs deaths, accounting for 5228 (95% UI: 5005-5998) cases. The dietary sodium intake of residents is nearly three times than sodium intake recommended by WHO. If sodium intake was reduced to reference level, the potential avoidable CVD deaths attributable to the SBP-raising effect were more than 5200 among adults 25 aged and over in Tianjin. This evaluation method can be extended to other cities., (© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)
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- 2023
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26. Automated EEG-based prediction of delayed cerebral ischemia after subarachnoid hemorrhage.
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Zheng WL, Kim JA, Elmer J, Zafar SF, Ghanta M, Moura Junior V, Patel A, Rosenthal E, and Brandon Westover M
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- Brain, Cerebral Infarction, Electroencephalography adverse effects, Humans, Brain Ischemia complications, Brain Ischemia etiology, Subarachnoid Hemorrhage complications, Subarachnoid Hemorrhage diagnosis
- Abstract
Objective: Delayed cerebral ischemia (DCI) is a leading complication of aneurysmal subarachnoid hemorrhage (SAH) and electroencephalography (EEG) is increasingly used to evaluate DCI risk. Our goal is to develop an automated DCI prediction algorithm integrating multiple EEG features over time., Methods: We assess 113 moderate to severe grade SAH patients to develop a machine learning model that predicts DCI risk using multiple EEG features., Results: Multiple EEG features discriminate between DCI and non-DCI patients when aligned either to SAH time or to DCI onset. DCI and non-DCI patients have significant differences in alpha-delta ratio (0.08 vs 0.05, p < 0.05) and percent alpha variability (0.06 vs 0.04, p < 0.05), Shannon entropy (p < 0.05) and epileptiform discharge burden (205 vs 91 discharges per hour, p < 0.05) based on whole brain and vascular territory averaging. Our model improves predictions by emphasizing the most informative features at a given time with an area under the receiver-operator curve of 0.73, by day 5 after SAH and good calibration between 48-72 hours (calibration error 0.13)., Conclusions: Our proposed model obtains good performance in DCI prediction., Significance: We leverage machine learning to enable rapid, automated, multi-featured EEG assessment and has the potential to increase the utility of EEG for DCI prediction., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)
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- 2022
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27. SLC25A25-AS1 over-expression could be predicted the dismal prognosis and was related to the immune microenvironment in prostate cancer.
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Zhao YY, Xiang QM, Chen JL, Zhang L, Zheng WL, Ke D, Shi RS, and Yang KW
- Abstract
It has been established that long-chain coding RNA (lncRNA) SLC25A25-AS1 is associated with cancer progression. However, the roles and mechanisms of SLC25A25-AS1 in prostate cancer (PC) have not been reported in the literature. The present study explored the relationship between SLC25A25-AS1 expression and PC progression via comprehensive analysis. The pan-cancer expression of SLC25A25-AS1 was identified using data from The Cancer Genome Atlas (TCGA) database and tissue specimens from our hospital. The expression levels of SLC25A25-AS1 in various subgroups based on the clinical features were identified. The prognostic value of SLC25A25-AS1 and SLC25A25-AS1 co-expressed lncRNAs in PC patients was assessed by survival analysis and ROC analysis, and prognosis-related risk models of SLC25A25-AS1 were constructed. The relationship between SLC25A25-AS1 and the PC immune microenvironment was investigated using correlation analysis. SLC25A25-AS1 expression in PC was significantly increased and correlated with the T stage, clinical stage, Gleason score (GS), and dismal prognosis. SLC25A25-AS1 overexpression exhibited good performance in evaluating the prognosis of PC patients. The area under the curves (AUCs) of the 1-, 3-, and 5-year overall survival (OS) for SLC25A25-AS1 was 1, 0.876, and 0.749. Moreover, the AUCs for the 1-, 3-, and 5-year progress free interval (PFI) for SLC25A25-AS1 were 0.731, 0.701, and 0.718. SLC25A25-AS1 overexpression correlated with the infiltration of CD8 T cells, interstitial dendritic cells (IDC), macrophages and other cells. AC020558.2, ZNF32-AS2, AP4B1-AS1, AL355488.1, AC109460.3, SNHG1, C3orf35, LMNTD2-AS1, and AL365330.1 were significantly associated with SLC25A25-AS1 expression, and short OS and PFI in PC patients. The risk models of the SLC25A25-AS1-related lncRNAs were associated with a dismal prognosis in PC. Overall, SLC25A25-AS1 expression was increased in PC and related to the prognosis and PC immune microenvironment. The risk model of SLC25A25-AS1 have huge prospect for application as prognostic tools in PC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhao, Xiang, Chen, Zhang, Zheng, Ke, Shi and Yang.)
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- 2022
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28. Arthroscopy-assisted partial trapeziectomy combined with ligament reconstruction for thumb carpometacarpal joint osteoarthritis: A different technique.
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Zheng WL, Wu YC, Shen YD, Yin HW, and Xu WD
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Background: There is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious metacarpal subsidence, and decreased stability. The aim of this study is to introduce a different technique to restore the function and stability of the first carpal metacarpal joint with minimal trauma, rapid pain relief, reduced complications, and the clinical outcomes in the long-term follow-up was evaluated and statistically analyzed., Methods: This was a retrospective study of 10 patients with a mean age of 51.8 years. The surgery consisted of removing partial trapezium through arthroscopy, reconstructing the stability with flexor carpi radialis suspension and tendon interposition. The subjective assessment included visual analog scale (VAS) of pain, quick disabilities of the arm, shoulder, and hand (Quick-DASH) score, and patient satisfaction. The range of motion, grip strength, pinch strength, and radiographic assessment, which can reflect stability of the thumb, were objectively evaluated and statistically analyzed., Results: Ten patients were monitored at a mean follow-up of 6.8 years. The mean grip strength improved significantly from 16.64 to 22.57 kg after surgery. Pinch strength improved significantly from 3.72 to 5.71 kg on average. The Kapandji score improved significantly from 5.7 to 8.6 on average. 80% (8/10) of the patients were satisfied with this surgery. On objective indicators, the VAS score decreased significantly from 6.4 to 1.3 on average. The mean Quick-DASH score improved significantly from 6.1 to 28.9. Postoperative x-ray showed slight subsidence and dislocation of the first metacarpal in two patients and did not affect the function by measurement., Conclusion: Arthroscopy-assisted partial trapezium resection combined with ligament reconstruction could be a workable and promising surgical technique in patients with thumb CMC OA. It can offer the advantages of minimizing surgical injury by preserving the first carpal metacarpal joint capsule to protect its stability, with a rapid pain relief, function improvement, and satisfactory results in patients' clinical measurements., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Zheng, Wu, Shen, Yin and Xu.)
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- 2022
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29. High epileptiform discharge burden predicts delayed cerebral ischemia after subarachnoid hemorrhage.
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Kim JA, Zheng WL, Elmer J, Jing J, Zafar SF, Ghanta M, Moura V Junior, Gilmore EJ, Hirsch LJ, Patel A, Rosenthal E, and Westover MB
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- Cerebral Infarction, Humans, Periodicity, Retrospective Studies, Brain Ischemia diagnosis, Brain Ischemia epidemiology, Brain Ischemia etiology, Subarachnoid Hemorrhage complications
- Abstract
Objective: To investigate whether epileptiform discharge burden can identify those at risk for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH)., Methods: Retrospective analysis of 113 moderate to severe grade SAH patients who had continuous EEG (cEEG) recordings during their hospitalization. We calculated the burden of epileptiform discharges (ED), measured as number of ED per hour., Results: We find that many SAH patients have an increase in ED burden during the first 3-10 days following rupture, the major risk period for DCI. However, those who develop DCI have a significantly higher hourly burden from days 3.5-6 after SAH vs. those who do not. ED burden is higher in DCI patients when assessed in relation to the onset of DCI (area under the receiver operator curve 0.72). Finally, specific trends of ED burden over time, assessed by group-based trajectory analysis, also help stratify DCI risk., Conclusions: These results suggest that ED burden is a useful parameter for identifying those at higher risk of developing DCI after SAH. The higher burden rate associated with DCI supports the theory of metabolic supply-demand mismatch which contributes to this complication., Significance: ED burden is a novel biomarker for predicting those at high risk of DCI., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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30. Identification and semisynthesis of (-)-anisomelic acid as oral agent against SARS-CoV-2 in mice.
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Yu HX, Zheng N, Yeh CT, Lee CM, Zhang Q, Zheng WL, Chang Q, Li YH, Li YJ, Wu GZ, Quan JM, Zhang LQ, Tzeng YM, and Yang Z
- Abstract
(-)-Anisomelic acid, isolated from Anisomeles indica (L.) Kuntze (Labiatae) leaves, is a macrocyclic cembranolide with a trans -fused α-methylene-γ-lactone motif. Anisomelic acid effectively inhibits SARS-CoV-2 replication and viral-induced cytopathic effects with an EC
50 of 1.1 and 4.3 μM, respectively. Challenge studies of SARS-CoV-2-infected K18-hACE2 mice showed that oral administration of anisomelic acid and subcutaneous dosing of remdesivir can both reduce the viral titers in the lung tissue at the same level. To facilitate drug discovery, we used a semisynthetic approach to shorten the project timelines. The enantioselective semisynthesis of anisomelic acid from the naturally enriched and commercially available starting material (+)-costunolide was achieved in five steps with a 27% overall yield. The developed chemistry provides opportunities for developing anisomelic-acid-based novel ligands for selectively targeting proteins involved in viral infections., (© The Author(s) 2022. Published by Oxford University Press on behalf of China Science Publishing & Media Ltd.)- Published
- 2022
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31. High incidence of epileptiform activity in adults undergoing extracorporeal membrane oxygenation.
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Amorim E, Firme MS, Zheng WL, Shelton KT, Akeju O, Cudemus G, Yuval R, and Westover MB
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- Adult, Electroencephalography methods, Humans, Incidence, Prospective Studies, Retrospective Studies, Seizures epidemiology, Extracorporeal Membrane Oxygenation
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Objective: The prevalence of seizures and other types of epileptiform brain activity in patients undergoing extracorporeal membrane oxygenation (ECMO) is unknown. We aimed to estimate the prevalence of seizures and ictal-interictal continuum patterns in patients undergoing electroencephalography (EEG) during ECMO., Methods: Retrospective review of a prospective ECMO registry from 2011-2018 in a university-affiliated academic hospital. Adult subjects who had decreased level of consciousness and underwent EEG monitoring for seizure screening were included. EEG classification followed the American Clinical Neurophysiology Society criteria. Poor neurological outcome was defined as a Cerebral Performance Category of 3-5 at hospital discharge., Results: Three hundred and ninety-five subjects had ECMO, and one hundred and thirteen (28.6%) had EEG monitoring. Ninety-two (23.3%) subjects had EEG performed during ECMO and were included in the study (average EEG duration 54 h). Veno-arterial ECMO was the most common cannulation strategy (83%) and 26 (28%) subjects had extracorporeal cardiopulmonary resuscitation. Fifty-eight subjects (63%) had epileptiform activity or ictal-interictal continuum patterns on EEG, including three (3%) subjects with nonconvulsive status epilepticus, 33 (36%) generalized periodic discharges, and 4 (5%) lateralized periodic discharges. Comparison between subjects with or without epileptiform activity showed comparable in-hospital mortality (57% vs. 47%, p = 0.38) and poor neurological outcome (and 56% and 36%, p = 0.23). Twenty-seven subjects (33%) had acute neuroimaging abnormalities (stroke N = 21)., Conclusions: Seizures and ictal-interictal continuum patterns are commonly observed in patients managed with ECMO. Further studies are needed to evaluate whether epileptiform activity is an actionable target for interventions., Significance: Epileptiform and ictal-interictal continuum abnormalities are frequently observed in patients supported with ECMO undergoing EEG monitoring., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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32. Multimodal Emotion Recognition in Response to Oil Paintings.
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Luo S, Lan YT, Peng D, Li Z, Zheng WL, and Lu BL
- Subjects
- Emotions, Humans, Neural Networks, Computer, Music, Paintings
- Abstract
Most previous affective studies use facial expression pictures, music or movie clips as emotional stimuli, which are either too simplified without contexts or too dynamic for emotion annotations. In this work, we evaluate the effectiveness of oil paintings as stimuli. We develop an emotion stimuli dataset with 114 oil paintings selected from subject ratings to evoke three emotional states (i.e., negative, neutral and positive), and acquire both EEG and eye tracking data from 20 subjects while watching the oil paintings. Furthermore, we propose a novel affective model for multimodal emotion recognition by 1) extracting informative features of EEG signals from both the time domain and the frequency domain, 2) exploring topological information embedded in EEG channels with graph neural networks (GNNs), and 3) combining EEG and eye tracking data with a deep autoencoder neural network. From the exper-iments, our model obtains an averaged classification accuracy of 94.72 % ± 1.47 %, which demonstrates the feasibility of using oil paintings as emotion elicitation material.
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- 2022
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33. Blood Pressure Trajectories From Childhood to Youth and Arterial Stiffness in Adulthood: A 30-Year Longitudinal Follow-Up Study.
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Chu C, Liao YY, He MJ, Ma Q, Zheng WL, Yan Y, Hu JW, Xu XJ, Fan YN, Yang RH, and Mu JJ
- Abstract
Background: This study aimed to identify the subgroups of individuals sharing similar blood pressure (BP) trajectories from childhood to youth and explore the associations of these trajectories with arterial stiffness in adulthood., Methods: A group-based trajectory model was used to identify BP trajectories among 2,082 individuals in the Hanzhong adolescent hypertension cohort by using BP values repeatedly measured at four visits from childhood (6-15 years) to youth (14-23 years). The brachial-ankle pulse wave velocity (baPWV) was examined 30 years after the baseline survey. Mixed linear regression models were used to examine the associations of these trajectories with adult baPWV., Results: Among the 2,082 individuals, three trajectory groups of systolic BP were identified as follows: the low-level group ( n = 889), medium-level group ( n = 1,021), and high-level group ( n = 172). The baPWV in adulthood was higher in medium-level and high-level groups compared with the low-level group (1271.4 ± 224.7 cm/s, 1366.1 ± 249.8 cm/s vs. 1190.1 ± 220.3 cm/s, all p < 0.001). After adjustment for potential confounding factors, the association between baPWV and systolic BP trajectories was statistically significant (adjusted β = 49.4 cm/s; p < 0.001 for the medium-level group and β = 107.6 cm/s; p < 0.001 for the high-level group compared with the low-level group). Similar results were obtained for the association of baPWV with the trajectories of diastolic BP and mean arterial pressure (MAP), except for pulse pressure., Conclusion: Our investigation demonstrates different BP trajectories from childhood to youth and shows the trajectories of systolic BP, diastolic BP, and MAP are significant predictors of arterial stiffness in adulthood., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chu, Liao, He, Ma, Zheng, Yan, Hu, Xu, Fan, Yang and Mu.)
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- 2022
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34. [Study on the effect of AIDS preventive cascade services provided by social organizations for men who have sex with men in China].
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Sha S, Dai SY, Zheng WL, Jin JY, Yang WH, Li JF, Mao CJ, and Wang P
- Subjects
- Antiviral Agents, China epidemiology, Homosexuality, Male, Humans, Male, Acquired Immunodeficiency Syndrome prevention & control, HIV Infections diagnosis, HIV Infections prevention & control, Sexual and Gender Minorities
- Abstract
Objective: To analyze the effect and main gaps of each stage in the AIDS prevention cascade for men who have sex with men (MSM) provided in intervention projects supported by the China AIDS Fund for non-governmental organizations (CAFNGO) and provide suggestions to improve the quality of cascade services and project management. Methods: Data were collected through the CAFNGO management information system and field interviews to analyze the differences in the number of MSM receiving HIV testing and confirming tests, the newly reported patients, and the number of antiviral treatment (ART) referrals of newly established reported patients among different social organization service areas. A service chain chart was also drawn. Results: Between 2016 and 2020, 1 508 MSM intervention projects were funded by CAFNGO, including 1 183 234 MSM being mobilized to receive HIV testing. However, only 68.8% (1 183 234/1 719 139) of the testing capacity of social organizations was covered by these projects. As a result, 55 783 HIV-positive MSM were detected in preliminary screening, and only 86.6% (48 327/55 783) received confirming tests. The proportion of newly reported infections was 3.8% (45 347/1 183 234). The ratio of antiviral treatment (ART) referrals for newly reported patients between 2017 and 2020 was 89.8% (32 719/36 444). 75.8%(1 143/1 508) of total MSM intervention projects were implemented by community-based organizations (Non-registered civil affairs departments). In comparison, organizations registered in civil affairs departments took up 24.2% (365/1 508) of the total MSM intervention projects. No significant difference was noticed in the proportion of newly reported infected (3.8% and 3.8%) and the ratio of ART referrals (89.7% and 89.9%) between community-based organizations and registered organizations' projects. But these two proportions are significantly different between these two types of organizations in some areas in China. Conclusions: The AIDS prevention cascade established in CAFNGO has effectively promoted the early detection and treatment of infected MSM. However, CAFNGO needs more financial support to extend testing coverage for MSM. Meanwhile, confirmation testing for positives in preliminary screening and ART referrals needs to be improved for newly reported patients. In addition, various capacity building needs to be provided for different social organizations.
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- 2022
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35. Measuring expertise in identifying interictal epileptiform discharges.
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Harid NM, Jing J, Hogan J, Nascimento FA, Ouyang A, Zheng WL, Ge W, Zafar SF, Kim JA, Alice DL, Herlopian A, Maus D, Karakis I, Ng M, Hong S, Yu Z, Kaplan PW, Cash S, Shafi M, Martz G, Halford JJ, and Westover MB
- Subjects
- Humans, Time, Electroencephalography methods, Epilepsy diagnosis
- Abstract
Objective: Interictal epileptiform discharges on EEG are integral to diagnosing epilepsy. However, EEGs are interpreted by readers with and without specialty training, and there is no accepted method to assess skill in interpretation. We aimed to develop a test to quantify IED recognition skills., Methods: A total of 13,262 candidate IEDs were selected from EEGs and scored by eight fellowship-trained reviewers to establish a gold standard. An online test was developed to assess how well readers with different training levels could distinguish candidate waveforms. Sensitivity, false positive rate and calibration were calculated for each reader. A simple mathematical model was developed to estimate each reader's skill and threshold in identifying an IED, and to develop receiver operating characteristics curves for each reader. We investigated the number of IEDs needed to measure skill level with acceptable precision., Results: Twenty-nine raters completed the test; nine experts, seven experienced non-experts and thirteen novices. Median calibration errors for experts, experienced non-experts and novices were -0.056, 0.012, 0.046; median sensitivities were 0.800, 0.811, 0.715; and median false positive rates were 0.177, 0.272, 0.396, respectively. The number of test questions needed to measure those scores was 549. Our analysis identified that novices had a higher noise level (uncertainty) compared to experienced non-experts and experts. Using calculated noise and threshold levels, receiver operating curves were created, showing increasing median area under the curve from novices (0.735), to experienced non-experts (0.852) and experts (0.891)., Significance: Expert and non-expert readers can be distinguished based on ability to identify IEDs. This type of assessment could also be used to identify and correct differences in thresholds in identifying IEDs.
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- 2022
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36. Multimodal Vigilance Estimation Using Deep Learning.
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Wu W, Sun W, Wu QMJ, Yang Y, Zhang H, Zheng WL, and Lu BL
- Subjects
- Electroencephalography, Electrooculography methods, Deep Learning, Wakefulness
- Abstract
The phenomenon of increasing accidents caused by reduced vigilance does exist. In the future, the high accuracy of vigilance estimation will play a significant role in public transportation safety. We propose a multimodal regression network that consists of multichannel deep autoencoders with subnetwork neurons (MCDAE
sn ). After we define two thresholds of "0.35" and "0.70" from the percentage of eye closure, the output values are in the continuous range of 0-0.35, 0.36-0.70, and 0.71-1 representing the awake state, the tired state, and the drowsy state, respectively. To verify the efficiency of our strategy, we first applied the proposed approach to a single modality. Then, for the multimodality, since the complementary information between forehead electrooculography and electroencephalography features, we found the performance of the proposed approach using features fusion significantly improved, demonstrating the effectiveness and efficiency of our method.- Published
- 2022
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37. Predicting Neurological Outcome From Electroencephalogram Dynamics in Comatose Patients After Cardiac Arrest With Deep Learning.
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Zheng WL, Amorim E, Jing J, Wu O, Ghassemi M, Lee JW, Sivaraju A, Pang T, Herman ST, Gaspard N, Ruijter BJ, Tjepkema-Cloostermans MC, Hofmeijer J, van Putten MJAM, and Westover MB
- Subjects
- Coma diagnosis, Coma etiology, Electroencephalography, Humans, Prospective Studies, Deep Learning, Heart Arrest complications, Heart Arrest diagnosis
- Abstract
Objective: Most cardiac arrest patients who are successfully resuscitated are initially comatose due to hypoxic-ischemic brain injury. Quantitative electroencephalography (EEG) provides valuable prognostic information. However, prior approaches largely rely on snapshots of the EEG, without taking advantage of temporal information., Methods: We present a recurrent deep neural network with the goal of capturing temporal dynamics from longitudinal EEG data to predict long-term neurological outcomes. We utilized a large international dataset of continuous EEG recordings from 1,038 cardiac arrest patients from seven hospitals in Europe and the US. Poor outcome was defined as a Cerebral Performance Category (CPC) score of 3-5, and good outcome as CPC score 0-2 at 3 to 6-months after cardiac arrest. Model performance is evaluated using 5-fold cross validation., Results: The proposed approach provides predictions which improve over time, beginning from an area under the receiver operating characteristic curve (AUC-ROC) of 0.78 (95% CI: 0.72-0.81) at 12 hours, and reaching 0.88 (95% CI: 0.85-0.91) by 66 h after cardiac arrest. At 66 h, (sensitivity, specificity) points of interest on the ROC curve for predicting poor outcomes were (32,99)%, (55,95)%, and (62,90)%, (99,23)%, (95,47)%, and (90,62)%; whereas for predicting good outcome, the corresponding operating points were (17,99)%, (47,95)%, (62,90)%, (99,19)%, (95,48)%, (70,90)%. Moreover, the model provides predicted probabilities that closely match the observed frequencies of good and poor outcomes (calibration error 0.04)., Conclusions and Significance: These findings suggest that accounting for EEG trend information can substantially improve prediction of neurologic outcomes for patients with coma following cardiac arrest.
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- 2022
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38. Identifying similarities and differences in emotion recognition with EEG and eye movements among Chinese, German, and French People.
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Liu W, Zheng WL, Li Z, Wu SY, Gan L, and Lu BL
- Subjects
- China epidemiology, Emotions, Humans, Machine Learning, Electroencephalography methods, Eye Movements
- Abstract
Objective. Cultures have essential influences on emotions. However, most studies on cultural influences on emotions are in the areas of psychology and neuroscience, while the existing affective models are mostly built with data from the same culture. In this paper, we identify the similarities and differences among Chinese, German, and French individuals in emotion recognition with electroencephalogram (EEG) and eye movements from an affective computing perspective. Approach. Three experimental settings were designed: intraculture subject dependent, intraculture subject independent, and cross-culture subject independent. EEG and eye movements are acquired simultaneously from Chinese, German, and French subjects while watching positive, neutral, and negative movie clips. The affective models for Chinese, German, and French subjects are constructed by using machine learning algorithms. A systematic analysis is performed from four aspects: affective model performance, neural patterns, complementary information from different modalities, and cross-cultural emotion recognition. Main results. From emotion recognition accuracies, we find that EEG and eye movements can adapt to Chinese, German, and French cultural diversities and that a cultural in-group advantage phenomenon does exist in emotion recognition with EEG. From the topomaps of EEG, we find that the γ and β bands exhibit decreasing activities for Chinese, while for German and French, θ and α bands exhibit increasing activities. From confusion matrices and attentional weights, we find that EEG and eye movements have complementary characteristics. From a cross-cultural emotion recognition perspective, we observe that German and French people share more similarities in topographical patterns and attentional weight distributions than Chinese people while the data from Chinese are a good fit for test data but not suitable for training data for the other two cultures. Significance. Our experimental results provide concrete evidence of the in-group advantage phenomenon, cultural influences on emotion recognition, and different neural patterns among Chinese, German, and French individuals., (© 2022 IOP Publishing Ltd.)
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- 2022
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39. Cost-effectiveness of artificial intelligence screening for diabetic retinopathy in rural China.
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Huang XM, Yang BF, Zheng WL, Liu Q, Xiao F, Ouyang PW, Li MJ, Li XY, Meng J, Zhang TT, Cui YH, and Pan HW
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- Artificial Intelligence, China epidemiology, Cost-Benefit Analysis, Humans, Mass Screening, Quality-Adjusted Life Years, Diabetes Mellitus, Diabetic Retinopathy diagnosis
- Abstract
Background: Diabetic retinopathy (DR) has become a leading cause of global blindness as a microvascular complication of diabetes. Regular screening of diabetic retinopathy is strongly recommended for people with diabetes so that timely treatment can be provided to reduce the incidence of visual impairment. However, DR screening is not well carried out due to lack of eye care facilities, especially in the rural areas of China. Artificial intelligence (AI) based DR screening has emerged as a novel strategy and show promising diagnostic performance in sensitivity and specificity, relieving the pressure of the shortage of facilities and ophthalmologists because of its quick and accurate diagnosis. In this study, we estimated the cost-effectiveness of AI screening for DR in rural China based on Markov model, providing evidence for extending use of AI screening for DR., Methods: We estimated the cost-effectiveness of AI screening and compared it with ophthalmologist screening in which fundus images are evaluated by ophthalmologists. We developed a Markov model-based hybrid decision tree to analyze the costs, effectiveness and incremental cost-effectiveness ratio (ICER) of AI screening strategies relative to no screening strategies and ophthalmologist screening strategies (dominated) over 35 years (mean life expectancy of diabetes patients in rural China). The analysis was conducted from the health system perspective (included direct medical costs) and societal perspective (included medical and nonmedical costs). Effectiveness was analyzed with quality-adjusted life years (QALYs). The robustness of results was estimated by performing one-way sensitivity analysis and probabilistic analysis., Results: From the health system perspective, AI screening and ophthalmologist screening had incremental costs of $180.19 and $215.05 but more quality-adjusted life years (QALYs) compared with no screening. AI screening had an ICER of $1,107.63. From the societal perspective which considers all direct and indirect costs, AI screening had an ICER of $10,347.12 compared with no screening, below the cost-effective threshold (1-3 times per capita GDP of Chinese in 2019)., Conclusions: Our analysis demonstrates that AI-based screening is more cost-effective compared with conventional ophthalmologist screening and holds great promise to be an alternative approach for DR screening in the rural area of China., (© 2022. The Author(s).)
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- 2022
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40. A plug-and-play optical fiber SPR sensor for simultaneous measurement of glucose and cholesterol concentrations.
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Zheng WL, Zhang YN, Li LK, Li XG, and Zhao Y
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- Cholesterol, Fiber Optic Technology, Glucose, Gold, Optical Fibers, Surface Plasmon Resonance, Biosensing Techniques, Metal Nanoparticles
- Abstract
A plug-and-play surface plasmon resonance (SPR) dual-parameter optical fiber biosensor is reported, in which Au film was firstly coated on the fiber surface for exciting SPR and the end half of the Au film was modified with Au nanoparticles to generate double SPR resonance valleys. For simultaneous detecting of glucose and cholesterol concentrations, modified P-mercaptophenylboronic acid (PMBA) and β-cyclodextrin (β-CD) were subsequently coated on the surface of sensor probe. Due to the cis-diol structure of glucose, it can interact with PMBA, leading to a red shift of one SPR resonant valley, whose maximum wavelength shift is 11.228 nm in the range of 0-1.7 mM glucose concentration. On the same time, the cholesterol molecules can realize the host-guest combination with β-CD, leading to a red shift of another SPR resonant valley, and the maximum wavelength shift is 18.893 nm in the cholesterol concentration range of 0-300 nM. The detection limits of the sensor to glucose and cholesterol are 0.00078 mM and 0.012 nM, respectively. The enhances the practical value of the dual-parameter sensor. Both theory and experiment results verify the feasibility of the "plug-and-play" sensor to measure the dual biomass of glucose and cholesterol with ultra-low detection limit and good selectivity. The proposed method provides a huge research value for the optical fiber sensor in multi-parameter measurement., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2022
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41. Investigating EEG-based functional connectivity patterns for multimodal emotion recognition.
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Wu X, Zheng WL, Li Z, and Lu BL
- Subjects
- Arousal, Brain, Emotions, Electroencephalography, Neural Networks, Computer
- Abstract
Objective. Previous studies on emotion recognition from electroencephalography (EEG) mainly rely on single-channel-based feature extraction methods, which ignore the functional connectivity between brain regions. Hence, in this paper, we propose a novel emotion-relevant critical subnetwork selection algorithm and investigate three EEG functional connectivity network features: strength, clustering coefficient, and eigenvector centrality. Approach. After constructing the brain networks by the correlations between pairs of EEG signals, we calculated critical subnetworks through the average of brain network matrices with the same emotion label to eliminate the weak associations. Then, three network features were conveyed to a multimodal emotion recognition model using deep canonical correlation analysis along with eye movement features. The discrimination ability of the EEG connectivity features in emotion recognition is evaluated on three public datasets: SEED, SEED-V, and DEAP. Main results . The experimental results reveal that the strength feature outperforms the state-of-the-art features based on single-channel analysis. The classification accuracies of multimodal emotion recognition are95.08±6.42%on the SEED dataset,84.51±5.11%on the SEED-V dataset, and85.34±2.90%and86.61±3.76%for arousal and valence on the DEAP dataset, respectively, which all achieved the best performance. In addition, the brain networks constructed with 18 channels achieve comparable performance with that of the 62-channel network and enable easier setups in real scenarios. Significance. The EEG functional connectivity networks combined with emotion-relevant critical subnetworks selection algorithm we proposed is a successful exploration to excavate the information between channels., (© 2022 IOP Publishing Ltd.)
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- 2022
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42. Association of body mass index changes from childhood to adulthood with dyslipidemia in adults: Hanzhong adolescent cohort study.
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Liao YY, Chu C, Wang Y, Zheng WL, Ma Q, Hu JW, Yan Y, Wang KK, Yuan Y, Chen C, and Mu JJ
- Subjects
- Adolescent, Adult, Body Mass Index, Child, Cohort Studies, Humans, Obesity, Risk Factors, Young Adult, Dyslipidemias epidemiology, Overweight
- Abstract
Background: Dyslipidemia is a disorder of lipid metabolism and associated with insulin resistance. The relationship between longitudinal body mass index (BMI) changes from childhood to adulthood and long-term dyslipidemia was explored in this study., Methods: We assessed the longitudinal relationship between BMI changes since childhood and dyslipidemia among 1738 participants in rural areas of Hanzhong City, Shaanxi. All participants were initially examined between the ages of 6 and 15 years in 1987 and were reexamined in 1995, 2013 and 2017; the total follow-up duration was 30 years. Anthropometric measurements and blood biochemistry indexes were measured., Results: We found that gradual progression of normal weight to overweight (OR = 1.65; 95% CI = 1.27, 2.15) or persistent overweight (OR = 2.45; 95% CI = 1.52, 3.96) from childhood to adulthood was associated with an increased risk of dyslipidemia in adulthood. And these risks were largely disappeared if the overweight or obesity during childhood was resolved by adulthood. The higher the BMI in adulthood and the younger the age at which overweight begins, the higher the risk of dyslipidemia., Conclusions: Early weight loss and any degree of weight loss from childhood to adulthood can help improve dyslipidemia in adulthood. We further emphasize the importance of weight management and control in public health primary prevention., (© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2021
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43. External validation and comparison of two versions of simplified sequential organ failure assessment scores to predict prognosis of septic patients.
- Author
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Shi QF, Xu Y, Zhang BY, Qu W, Wang SY, Zheng WL, and Sheng Y
- Subjects
- Hospital Mortality, Humans, Intensive Care Units, Prognosis, ROC Curve, Retrospective Studies, Organ Dysfunction Scores, Sepsis diagnosis
- Abstract
Background: Evidence shows that simplified SOFA scoring system has better clinical practice., Objective: This study aimed to validate and compare the scores acquired with simplified organ dysfunction criteria optimized for electronic health records (eSOFA), and simplified and accurate sequential organ failure assessment (sa-SOFA) for their accuracies in predicting the prognosis of septic patients., Methods: This retrospective observational study was conducted at three major academic hospitals. Clinical data from 574 patients diagnosed with sepsis following the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)were retrospectively retrieved and analysed. Scores from the quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) were used as reference scores. The area under the receiver operating characteristic curve (AUROC) was used to assess the performance of eSOFA and sa-SOFA scores in predicting in-hospital mortality., Results: AUROC analysis demonstrated the predictability of the four scoring systems for sepsis surveillance, listed in descending order as: sa-SOFA, 0.790 (95% confidence interval [CI]: 0.754-0.822); SOFA, 0.774 (95% CI: 0.738-0.808); eSOFA, 0.729 (95% CI: 0.691-0.765); and qSOFA, 0.618 (95% CI: 0.577-0.658). Moreover, sa-SOFA and SOFA scores (Z = 1.950, P = .051) did not significantly differ from each other in discriminatory power, but the sa-SOFA score had a higher power than eSOFA score (P values < .001)., Conclusion: sa-SOFA appeared to have performed better than eSOFA score for predicting in-hospital mortality in patients' sepsis. Further large prospective studies are needed to externally validate., (© 2021 John Wiley & Sons Ltd.)
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- 2021
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44. Predicting neurological outcome in comatose patients after cardiac arrest with multiscale deep neural networks.
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Zheng WL, Amorim E, Jing J, Ge W, Hong S, Wu O, Ghassemi M, Lee JW, Sivaraju A, Pang T, Herman ST, Gaspard N, Ruijter BJ, Sun J, Tjepkema-Cloostermans MC, Hofmeijer J, van Putten MJAM, and Westover MB
- Subjects
- Electroencephalography, Humans, Neural Networks, Computer, Prognosis, Prospective Studies, Coma diagnosis, Coma etiology, Heart Arrest complications, Heart Arrest therapy
- Abstract
Objective: Electroencephalography (EEG) is an important tool for neurological outcome prediction after cardiac arrest. However, the complexity of continuous EEG data limits timely and accurate interpretation by clinicians. We develop a deep neural network (DNN) model to leverage complex EEG trends for early and accurate assessment of cardiac arrest coma recovery likelihood., Methods: We developed a multiscale DNN combining convolutional neural networks (CNN) and recurrent neural networks (long short-term memory [LSTM]) using EEG and demographic information (age, gender, shockable rhythm) from a multicenter cohort of 1,038 cardiac arrest patients. The CNN learns EEG feature representations while the multiscale LSTM captures short-term and long-term EEG dynamics on multiple time scales. Poor outcome is defined as a Cerebral Performance Category (CPC) score of 3-5 and good outcome as CPC score 1-2 at 3-6 months after cardiac arrest. Performance is evaluated using area under the receiver operating characteristic curve (AUC) and calibration error., Results: Model performance increased with EEG duration, with AUC increasing from 0.83 (95% Confidence Interval [CI] 0.79-0.87 at 12h to 0.91 (95%CI 0.88-0.93) at 66h. Sensitivity of good and poor outcome prediction was 77% and 75% at a specificity of 90%, respectively. Sensitivity of poor outcome was 50% at a specificity of 99%. Predicted probability was well matched to the observation frequency of poor outcomes, with a calibration error of 0.11 [0.09-0.14]., Conclusions: These results demonstrate that incorporating EEG evolution over time improves the accuracy of neurologic outcome prediction for patients with coma after cardiac arrest., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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45. Clinical characteristics and prognosis in patients with urosepsis from intensive care unit in Shanghai, China: a retrospective bi-centre study.
- Author
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Sheng Y, Zheng WL, Shi QF, Zhang BY, and Yang GY
- Subjects
- Age Distribution, Aged, China epidemiology, Critical Illness, Female, Humans, Intensive Care Units, Lactic Acid blood, Male, Patient Acuity, Prognosis, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology, Respiration, Artificial statistics & numerical data, Retrospective Studies, Risk Factors, Sepsis diagnosis, Sex Distribution, Survival Analysis, Urinary Tract Infections diagnosis, Sepsis blood, Sepsis epidemiology, Urinary Tract Infections blood, Urinary Tract Infections epidemiology
- Abstract
Background: The purpose of this study was to retrospectively analyze clinical characteristics and prognostic risk factors of urosepsis patients admitted to two intensive care units in Shanghai, China., Methods: Clinical data from patients diagnosed with urosepsis were retrospectively retrieved and analyzed from ICU in two regional medical centers from January 2015 to December 2019., Results: Two hundred two patients were included in the subsequent analysis eventually, with an average age of 72.02 ± 9.66 years, 79.21% of the patients were female and the mortality rate of 15.84%.The proportion of patients with chronic underlying diseases such as diabetes and hypertension was relatively high (56.44, 49.50%, respectively), and the incidence of shock was also high (41.58%) correspondingly. The most common pathogen isolated was Escherichia coli (79.20%), of which the extended-spectrumβ-lactamases (ESBLs)(+) accounted for 42.57%. In multivariate analysis, the strongest predictors for death were mechanical ventilation (OR 7.260, 95% CI 2.200-23.963; P = 0.001),chronic kidney disease (CKD) (OR 5.140, 95% CI 1.596-16.550; P = 0.006), APACHE II score (OR 1.321, 95% CI 1.184-1.473; P < 0.001) and lactate (OR 1.258, 95% CI 1.037-1.527; P = 0.020). Both APACHE II score and lactate had the ideal predictive value, with the area under the ROC curve (AUC) of 0.858 and 0.805 respectively., Conclusion: The patients with urosepsis were characterized by a higher proportion of female, older age, more percentage of comorbidities in this region, and patients with ESBLs (+) Escherichia coli infection were more prone to shock. Mechanical ventilation, comorbidity with CKD, APACHE II score and lactate were independent risk factors for death in urosepsis patient, but lactate level and APACHE II score had better predictive value for prognosis., (© 2021. The Author(s).)
- Published
- 2021
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46. Changes in Conjunctival Microbiota Associated With HIV Infection and Antiretroviral Therapy.
- Author
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Liu Q, Xu ZY, Wang XL, Huang XM, Zheng WL, Li MJ, Xiao F, Ouyang PW, Yang XH, Cui YH, and Pan HW
- Subjects
- Adult, Bacteria metabolism, Conjunctiva pathology, Cross-Sectional Studies, DNA, Viral analysis, Female, Follow-Up Studies, HIV, HIV Infections virology, Humans, Male, Middle Aged, RNA, Ribosomal, 16S metabolism, Anti-Retroviral Agents therapeutic use, Antiretroviral Therapy, Highly Active methods, Bacteria genetics, Conjunctiva microbiology, Gastrointestinal Microbiome physiology, HIV Infections drug therapy, RNA, Ribosomal, 16S genetics
- Abstract
Purpose: HIV infection is associated with a variety of ocular surface diseases. Understanding the difference of the ocular microbiota between HIV-infected and healthy individuals as well as the influence of antiretroviral therapy will help to investigate the pathogenesis of these conditions., Methods: A cross-sectional study was conducted on subjects including HIV-negative individuals, untreated HIV-infected individuals, and HIV-infected individuals with antiretroviral therapy. Conjunctival microbiota was assessed by bacterial 16S rRNA sequencing of the samples obtained from the conjunctival swab., Results: The microbial richness in ocular surface was similar in HIV-negative, untreated HIV-positive, and highly active antiretroviral therapy (HAART) subjects. The bacterial compositions were similar in the two HIV infection groups but were significantly different from the HIV-negative group. HAART changed the beta diversity of bacterial community as determined by Shannon index. CD4+ T cell count had no significant influence on the diversity of ocular microbiota in HIV-infected individuals., Conclusions: The data revealed the compositional and structural difference in conjunctival microbial community in subjects with and without HIV infection, indicating that HIV infection or its treatment, may contribute to ocular surface dysbiosis.
- Published
- 2021
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47. Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching.
- Author
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Hsieh HC, Lee CI, Lai EY, Su JY, Huang YT, Zheng WL, Chen CH, Huang CC, Lin PY, Lee MS, Liu M, and Huang YT
- Subjects
- Adult, Embryo Transfer methods, Female, Fertilization in Vitro methods, Fertilization in Vitro statistics & numerical data, Humans, Live Birth, Pregnancy, Propensity Score, Retrospective Studies, Taiwan, Embryo Implantation physiology, Embryo Transfer statistics & numerical data
- Abstract
Background: For women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication., Methods: We conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women's Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH)., Results: Our analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant., Conclusions: We conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate., (© 2021. The Author(s).)
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- 2021
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48. Study on environmental performance evaluation of different linkage development types of the logistics and manufacturing industries considering the unexpected output.
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Zheng WL, Wang JW, Jiang AD, Rehman Khan SA, Yang XQ, Zhang X, and Zhang ZY
- Subjects
- China, Efficiency, Industry, Transportation, Manufacturing Industry, Rivers
- Abstract
According to the different organizational forms of logistics in manufacturing, the types of linkage development between the logistics and manufacturing industries include two different logistics service modes: logistics outsourcing and logistics self-operation. This study considers two manufacturing clusters for comparison: the northeast region in China, mainly state-owned and self-operated, and the Yangtze River Delta region in China, mainly focusing on logistics outsourcing services. First, we construct a parallel network system considering heterogeneity and an unexpected super-efficiency slacks-based measure: the Grey Relational Analysis model. Second, considering the unexpected output, this study evaluates the environmental performance of the linkage development of the logistics and manufacturing industries and explains the types of linkage development between them. Finally, the spatial and temporal characteristics of linkage efficiency under different linkage modes are studied using an exploratory spatial data analysis method. The research results show that the efficiency of the two-industry linkage in different linkage types that consider the unexpected output presents different development characteristics. Regarding time characteristics and trends, we compare the development efficiency of the two-industry linkage at the overall level of the northeast and the Yangtze River Delta regions from 2009 to 2016. The Yangtze River Delta region showed a higher state of linkage while the northeast region showed a medium linkage state. Regarding spatial pattern evolution, the effect of the technical efficiency of the linkage between the two industries in the three northeastern provinces showed continuous evolution from the medium linkage stage to the weak linkage stage, and the Yangtze River Delta showed continuous evolution from the medium linkage to the strong linkage stage. Implications : Due to data availability, references to the relevant achievements of the research on the linkage between the manufacturing and logistics industries, the transportation industry, warehousing, and postal and telecommunications industry data are generally used as logistics industry data. Manufacturing data are replaced by industrial data. The manufacturing industry is the core industry of industrial systems. Its output value accounts for more than 90% of the industrial output. Thus, it can reflect the development trend of the manufacturing industry in general.
- Published
- 2021
- Full Text
- View/download PDF
49. [Study of influence of birth weight on risk of chronic diseases and blood uric acid in adulthood].
- Author
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Xin P, Jiang GH, Zheng WL, Fan LL, Li CK, and Wang DZ
- Subjects
- Adult, Birth Weight, Body Mass Index, Chronic Disease, Female, Humans, Male, Pregnancy, Risk Factors, Fetal Macrosomia, Uric Acid
- Abstract
Objective: To understand the influence of birth weight on the risk of chronic diseases, such as hypertension and diabetes, and the relationship between birth weight and serum uric acid in adulthood. Methods: According to the Chinese Adult Chronic Disease and Nutrition Surveillance Program, a total of 1 131 residents aged 18 years and above were enrolled from Hexi, Nankai, Hongqiao, Wuqing, Jinnan, Baodi and Jizhou districts of Tianjin. The data of birth weight and blood pressure of the residents were collected, and fasting venous blood samples were collected from them to detect uric acid, blood glucose and blood lipids levels. The distribution of birth weight of the surveyed population was described, and the relationship between birth weight and chronic diseases, such as hypertension and diabetes, and the blood uric acid level in adulthood were analyzed. Results: The average birth weight of the surveyed population in Tianjin was 3.37 kg, which was higher in males than in females. No matter overweight/obesity, hypertension or diabetes, the prevalence rate of normal birth weight was the lowest in adulthood. After univariate logistic regression analysis and adjusting for age, sex, smoking and drinking status, it was found that compared with normal birth weight, low birth weight had a stronger correlation with diabetes ( OR =2.91,95% CI :1.46-5.76) and dyslipidemia ( OR =1.79,95% CI :1.01-3.19) in adulthood. Macrosomia was strongly associated with overweight/obesity in adulthood ( OR =1.47, 95% CI :1.08-2.01). There was no significant difference in serum uric acid level among the residents with different birth weights. Conclusions: The low birth weight of the surveyed population in Tianjin was closely related to the risk of diabetes and dyslipidemia in adulthood, and the macrosomia was closely related to the risk of overweight/obesity in adulthood.
- Published
- 2021
- Full Text
- View/download PDF
50. End-to-end deep learning for recognition of ploidy status using time-lapse videos.
- Author
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Lee CI, Su YR, Chen CH, Chang TA, Kuo EE, Zheng WL, Hsieh WT, Huang CC, Lee MS, and Liu M
- Subjects
- Adult, Area Under Curve, Blastocyst, Calibration, Diploidy, Female, Fertilization in Vitro, Humans, Image Processing, Computer-Assisted methods, Retrospective Studies, Aneuploidy, Deep Learning, Preimplantation Diagnosis methods, Time-Lapse Imaging methods
- Abstract
Purpose: Our retrospective study is to investigate an end-to-end deep learning model in identifying ploidy status through raw time-lapse video., Methods: By randomly dividing the dataset of time-lapse videos with known outcome of preimplantation genetic testing for aneuploidy (PGT-A), a deep learning model on raw videos was trained by the 80% dataset, and used to test the remaining 20%, by feeding time-lapse videos as input and the PGT-A prediction as output. The performance was measured by an average area under the curve (AUC) of the receiver operating characteristic curve., Result(s): With 690 sets of time-lapse video image, combined with PGT-A results, our deep learning model has achieved an AUC of 0.74 from the test dataset (138 videos), in discriminating between aneuploid embryos (group 1) and others (group 2, including euploid and mosaic embryos)., Conclusion: Our model demonstrated a proof of concept and potential in recognizing the ploidy status of tested embryos. A larger scale and further optimization on the exclusion criteria would be included in our future investigation, as well as prospective approach., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2021
- Full Text
- View/download PDF
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