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Dong J, Zhang H, Ai X, Dong Q, Shi X, Zhao X, Zhong C, Yu H. Improving chilling tolerance of peanut seedlings by enhancing antioxidant-modulated ROS scavenging ability, alleviating photosynthetic inhibition, and mobilizing nutrient absorption. PLANT BIOLOGY (STUTTGART, GERMANY) 2024; 26:532-543. [PMID: 38597809 DOI: 10.1111/plb.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
Peanut production is threatened by climate change. Damage to seedlings from low temperatures in early spring can limit yield. Plant adaptations to chilling stress remain unclear in peanut seedlings. It is essential to understand how peanut acquires chilling tolerance. We evaluated effects of chilling stress on growth and recovery of peanut seedlings. We compared and analysed biological characteristics, antioxidants, photosynthesis, biochemical and physiological responses, and nutrient absorption at varying levels of chilling. Compared with chilling-sensitive FH18, the reduced impact of chilling stress on chilling-tolerant NH5 was associated with reduced ROS accumulation, higher ascorbate peroxidase activity and soluble sugar content, lower soluble protein content, and smaller reductions in nutrient content during stress. After removal of chilling stress, FH18 had significant accumulation of O2 •- and H2O2, which decreased photosynthesis, nutrient absorption, and transport. ROS-scavenging reduced damage from chilling stress, allowed remobilization of nutrients, improved chilling tolerance, and restored plant functioning after chilling stress removal. These findings provide a reference for targeted research on peanut seedling tolerance to chilling and lay the foundation for bioinformatics-based research on peanut chilling tolerance mechanisms.
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Bao J, Zhang X, Xiang S, Liu H, Cheng M, Yang Y, Huang X, Xiang W, Cui W, Lai HC, Huang S, Wang Y, Qian D, Yu H. Deep Learning-Based Facial and Skeletal Transformations for Surgical Planning. J Dent Res 2024:220345241253186. [PMID: 38808566 DOI: 10.1177/00220345241253186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
The increasing application of virtual surgical planning (VSP) in orthognathic surgery implies a critical need for accurate prediction of facial and skeletal shapes. The craniofacial relationship in patients with dentofacial deformities is still not understood, and transformations between facial and skeletal shapes remain a challenging task due to intricate anatomical structures and nonlinear relationships between the facial soft tissue and bones. In this study, a novel bidirectional 3-dimensional (3D) deep learning framework, named P2P-ConvGC, was developed and validated based on a large-scale data set for accurate subject-specific transformations between facial and skeletal shapes. Specifically, the 2-stage point-sampling strategy was used to generate multiple nonoverlapping point subsets to represent high-resolution facial and skeletal shapes. Facial and skeletal point subsets were separately input into the prediction system to predict the corresponding skeletal and facial point subsets via the skeletal prediction subnetwork and facial prediction subnetwork. For quantitative evaluation, the accuracy was calculated with shape errors and landmark errors between the predicted skeleton or face with corresponding ground truths. The shape error was calculated by comparing the predicted point sets with the ground truths, with P2P-ConvGC outperforming existing state-of-the-art algorithms including P2P-Net, P2P-ASNL, and P2P-Conv. The total landmark errors (Euclidean distances of craniomaxillofacial landmarks) of P2P-ConvGC in the upper skull, mandible, and facial soft tissues were 1.964 ± 0.904 mm, 2.398 ± 1.174 mm, and 2.226 ± 0.774 mm, respectively. Furthermore, the clinical feasibility of the bidirectional model was validated using a clinical cohort. The result demonstrated its prediction ability with average surface deviation errors of 0.895 ± 0.175 mm for facial prediction and 0.906 ± 0.082 mm for skeletal prediction. To conclude, our proposed model achieved good performance on the subject-specific prediction of facial and skeletal shapes and showed clinical application potential in postoperative facial prediction and VSP for orthognathic surgery.
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Diao H, Lu G, Zhang Y, Wang Z, Liu X, Ma Q, Yu H, Li Y. Risk factors for multidrug-resistant and extensively drug-resistant Acinetobacter baumannii infection of patients admitted in intensive care unit: a systematic review and meta-analysis. J Hosp Infect 2024; 149:77-87. [PMID: 38710306 DOI: 10.1016/j.jhin.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Acinetobacter baumannii infections pose challenges for clinical treatment and cause high mortality, particularly in intensive care units (ICUs). AIM To systematically summarize and analyse the risk factors for MDR/XDR A. baumannii-infected patients admitted to ICUs. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for eligible original studies published in English before October 2023. Meta-analysis was conducted where appropriate, with mean differences (MDs) and odds ratios (ORs) calculated for continuous and nominal scaled data. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). FINDINGS Ten studies reporting 1199 ICU patients (604 from general ICUs, 435 from neonatal ICUs, and 160 from paediatric ICUs) from eight countries were included in our analysis. Risk factors associated with MDR A. baumannii infection among patients admitted to general ICUs included high Acute Physiology And Clinical Health II (APACHE Ⅱ) score (mean difference (MD): 7.52; 95% confidence interval (CI): 3.24-11.80; P = 0.0006), invasive procedures (odds ratio (OR): 3.47; 95% CI: 1.70-7.10; P = 0.0006), longer ICU stay (MD: 3.40; 95% CI: 2.94-3.86; P < 0.00001), and use of antibiotics (OR: 2.69; 95% CI: 1.22-5.94; P = 0.01). In the sub-group analysis, longer neonatal ICU stay (MD: 16.88; 95% CI: 9.79-23.97; P < 0.00001) was associated with XDR A. baumannii infection. CONCLUSION Close attention should be paid to patients with longer ICU stays, undergoing invasive procedures, using antibiotics, and with high APACHE Ⅱ scores to reduce the risk of MDR and XDR A. baumannii infections.
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Acharya S, Adamová D, Aglieri Rinella G, Aglietta L, Agnello M, Agrawal N, Ahammed Z, Ahmad S, Ahn SU, Ahuja I, Akindinov A, Al-Turany M, Aleksandrov D, Alessandro B, Alfanda HM, Alfaro Molina R, Ali B, Alici A, Alizadehvandchali N, Alkin A, Alme J, Alocco G, Alt T, Altamura AR, Altsybeev I, Alvarado JR, Anaam MN, Andrei C, Andreou N, Andronic A, Andronov E, Anguelov V, Antinori F, Antonioli P, Apadula N, Aphecetche L, Appelshäuser H, Arata C, Arcelli S, Aresti M, Arnaldi R, Arneiro JGMCA, Arsene IC, Arslandok M, Augustinus A, Averbeck R, Azmi MD, Baba H, Badalà A, Bae J, Baek YW, Bai X, Bailhache R, Bailung Y, Bala R, Balbino A, Baldisseri A, Balis B, Banerjee D, Banoo Z, Barile F, Barioglio L, Barlou M, Barman B, Barnaföldi GG, Barnby LS, Barreau E, Barret V, Barreto L, Bartels C, Barth K, Bartsch E, Bastid N, Basu S, Batigne G, Battistini D, Batyunya B, Bauri D, Bazo Alba JL, Bearden IG, Beattie C, Becht P, Behera D, Belikov I, Bell Hechavarria ADC, Bellini F, Bellwied R, Belokurova S, Beltran LGE, Beltran YAV, Bencedi G, Beole S, Berdnikov Y, Berdnikova A, Bergmann L, Besoiu MG, Betev L, Bhaduri PP, Bhasin A, Bhat MA, Bhattacharjee B, Bianchi L, Bianchi N, Bielčík J, Bielčíková J, Bigot AP, Bilandzic A, Biro G, Biswas S, Bize N, Blair JT, Blau D, Blidaru MB, Bluhme N, Blume C, Boca G, Bock F, Bodova T, Boi S, Bok J, Boldizsár L, Bombara M, Bond PM, Bonomi G, Borel H, Borissov A, Borquez Carcamo AG, Bossi H, Botta E, Bouziani YEM, Bratrud L, Braun-Munzinger P, Bregant M, Broz M, Bruno GE, Buckland MD, Budnikov D, Buesching H, Bufalino S, Buhler P, Burmasov N, Buthelezi Z, Bylinkin A, Bysiak SA, Cabanillas Noris JC, Cai M, Caines H, Caliva A, Calvo Villar E, Camacho JMM, Camerini P, Canedo FDM, Cantway SL, Carabas M, Carballo AA, Carnesecchi F, Caron R, Carvalho LAD, Castillo Castellanos J, Catalano F, Cattaruzzi S, Ceballos Sanchez C, Cerri R, Chakaberia I, Chakraborty P, Chandra S, Chapeland S, Chartier M, Chattopadhyay S, Chattopadhyay S, Cheng T, Cheshkov C, Chibante Barroso V, Chinellato DD, Chizzali ES, Cho J, Cho S, Chochula P, Choudhury D, Christakoglou P, Christensen CH, Christiansen P, Chujo T, Ciacco M, Cicalo C, Ciupek MR, Clai G, Colamaria F, Colburn JS, Colella D, Colocci M, Concas M, Conesa Balbastre G, Conesa Del Valle Z, Contin G, Contreras JG, Coquet ML, Cortese P, Cosentino MR, Costa F, Costanza S, Cot C, Crkovská J, Crochet P, Cruz-Torres R, Cui P, Dainese A, Danisch MC, Danu A, Das P, Das P, Das S, Dash AR, Dash S, De Caro A, de Cataldo G, de Cuveland J, De Falco A, De Gruttola D, De Marco N, De Martin C, De Pasquale S, Deb R, Del Grande R, Dello Stritto L, Deng W, Dhankher P, Di Bari D, Di Mauro A, Diab B, Diaz RA, Dietel T, Ding Y, Ditzel J, Divià R, Dixit DU, Djuvsland Ø, Dmitrieva U, Dobrin A, Dönigus B, Dubinski JM, Dubla A, Dudi S, Dupieux P, Durkac M, Dzalaiova N, Eder TM, Ehlers RJ, Eisenhut F, Ejima R, Elia D, Erazmus B, Ercolessi F, Espagnon B, Eulisse G, Evans D, Evdokimov S, Fabbietti L, Faggin M, Faivre J, Fan F, Fan W, Fantoni A, Fasel M, Feliciello A, Feofilov G, Fernández Téllez A, Ferrandi L, Ferrer MB, Ferrero A, Ferrero C, Ferretti A, Feuillard VJG, Filova V, Finogeev D, Fionda FM, Flatland E, Flor F, Flores AN, Foertsch S, Fokin I, Fokin S, Fragiacomo E, Frajna E, Fuchs U, Funicello N, Furget C, Furs A, Fusayasu T, Gaardhøje JJ, Gagliardi M, Gago AM, Gahlaut T, Galvan CD, Gangadharan DR, Ganoti P, Garabatos C, García Chávez T, Garcia-Solis E, Gargiulo C, Gasik P, Gautam A, Gay Ducati MB, Germain M, Ghimouz A, Ghosh C, Giacalone M, Gioachin G, Giubellino P, Giubilato P, Glaenzer AMC, Glässel P, Glimos E, Goh DJQ, Gonzalez V, Gordeev P, Gorgon M, Goswami K, Gotovac S, Grabski V, Graczykowski LK, Grecka E, Grelli A, Grigoras C, Grigoriev V, Grigoryan S, Grosa F, Grosse-Oetringhaus JF, Grosso R, Grund D, Grunwald NA, Guardiano GG, Guernane R, Guilbaud M, Gulbrandsen K, Gündem T, Gunji T, Guo W, Gupta A, Gupta R, Gupta R, Gwizdziel K, Gyulai L, Hadjidakis C, Haider FU, Haidlova S, Haldar M, Hamagaki H, Hamdi A, Han Y, Hanley BG, Hannigan R, Hansen J, Harris JW, Harton A, Hartung MV, Hassan H, Hatzifotiadou D, Hauer P, Havener LB, Hellbär E, Helstrup H, Hemmer M, Herman T, Herrera Corral G, Herrmann F, Herrmann S, Hetland KF, Heybeck B, Hillemanns H, Hippolyte B, Hoffmann FW, Hofman B, Hong GH, Horst M, Horzyk A, Hou Y, Hristov P, Huhn P, Huhta LM, Humanic TJ, Hutson A, Hutter D, Hwang MC, Ilkaev R, Ilyas H, Inaba M, Innocenti GM, Ippolitov M, Isakov A, Isidori T, Islam MS, Ivanov M, Ivanov M, Ivanov V, Iversen KE, Jablonski M, Jacak B, Jacazio N, Jacobs PM, Jadlovska S, Jadlovsky J, Jaelani S, Jahnke C, Jakubowska MJ, Janik MA, Janson T, Ji S, Jia S, Jimenez AAP, Jonas F, Jones DM, Jowett JM, Jung J, Jung M, Junique A, Jusko A, Kabus MJ, Kaewjai J, Kalinak P, Kalteyer AS, Kalweit A, Karatovic D, Karavichev O, Karavicheva T, Karczmarczyk P, Karpechev E, Kebschull U, Keidel R, Keijdener DLD, Keil M, Ketzer B, Khade SS, Khan AM, Khan S, Khanzadeev A, Kharlov Y, Khatun A, Khuntia A, Khuranova Z, Kileng B, Kim B, Kim C, Kim DJ, Kim EJ, Kim J, Kim J, Kim J, Kim M, Kim S, Kim T, Kimura K, Kirsch S, Kisel I, Kiselev S, Kisiel A, Kitowski JP, Klay JL, Klein J, Klein S, Klein-Bösing C, Kleiner M, Klemenz T, Kluge A, Kobdaj C, Kollegger T, Kondratyev A, Kondratyeva N, Konig J, Konigstorfer SA, Konopka PJ, Kornakov G, Korwieser M, Koryciak SD, Kotliarov A, Kovacic N, Kovalenko V, Kowalski M, Kozhuharov V, Králik I, Kravčáková A, Krcal L, Krivda M, Krizek F, Krizkova Gajdosova K, Kroesen M, Krüger M, Krupova DM, Kryshen E, Kučera V, Kuhn C, Kuijer PG, Kumaoka T, Kumar D, Kumar L, Kumar N, Kumar S, Kundu S, Kurashvili P, Kurepin A, Kurepin AB, Kuryakin A, Kushpil S, Kuskov V, Kutyla M, Kweon MJ, Kwon Y, La Pointe SL, La Rocca P, Lakrathok A, Lamanna M, Landou AR, Langoy R, Larionov P, Laudi E, Lautner L, Lavicka R, Lea R, Lee H, Legrand I, Legras G, Lehrbach J, Lelek TM, Lemmon RC, León Monzón I, Lesch MM, Lesser ED, Lévai P, Li X, Liang-Gilman BE, Lien J, Lietava R, Likmeta I, Lim B, Lim SH, Lindenstruth V, Lindner A, Lippmann C, Liu DH, Liu J, Liveraro GSS, Lofnes IM, Loizides C, Lokos S, Lömker J, Loncar P, Lopez X, López Torres E, Lu P, Lugo FV, Luhder JR, Lunardon M, Luparello G, Ma YG, Mager M, Maire A, Majerz EM, Makariev MV, Malaev M, Malfattore G, Malik NM, Malik QW, Malik SK, Malinina L, Mallick D, Mallick N, Mandaglio G, Mandal SK, Manko V, Manso F, Manzari V, Mao Y, Marcjan RW, Margagliotti GV, Margotti A, Marín A, Markert C, Martinengo P, Martínez MI, Martínez García G, Martins MPP, Masciocchi S, Masera M, Masoni A, Massacrier L, Massen O, Mastroserio A, Matonoha O, Mattiazzo S, Matyja A, Mayer C, Mazuecos AL, Mazzaschi F, Mazzilli M, Mdhluli JE, Melikyan Y, Menchaca-Rocha A, Mendez JEM, Meninno E, Menon AS, Meres M, Miake Y, Micheletti L, Mihaylov DL, Mikhaylov K, Miśkowiec D, Modak A, Mohanty B, Khan MM, Molander MA, Monira S, Mordasini C, Moreira De Godoy DA, Morozov I, Morsch A, Mrnjavac T, Muccifora V, Muhuri S, Mulligan JD, Mulliri A, Munhoz MG, Munzer RH, Murakami H, Murray S, Musa L, Musinsky J, Myrcha JW, Naik B, Nambrath AI, Nandi BK, Nania R, Nappi E, Nassirpour AF, Nath A, Nattrass C, Naydenov MN, Neagu A, Negru A, Nekrasova E, Nellen L, Nepeivoda R, Nese S, Neskovic G, Nicassio N, Nielsen BS, Nielsen EG, Nikolaev S, Nikulin S, Nikulin V, Noferini F, Noh S, Nomokonov P, Norman J, Novitzky N, Nowakowski P, Nyanin A, Nystrand J, Oh S, Ohlson A, Okorokov VA, Oleniacz J, Onnerstad A, Oppedisano C, Ortiz Velasquez A, Otwinowski J, Oya M, Oyama K, Pachmayer Y, Padhan S, Pagano D, Paić G, Paisano-Guzmán S, Palasciano A, Panebianco S, Park H, Park H, Park J, Parkkila JE, Patley Y, Paul B, Paulino MMDM, Pei H, Peitzmann T, Peng X, Pennisi M, Perciballi S, Peresunko D, Perez GM, Pestov Y, Petrov V, Petrovici M, Pezzi RP, Piano S, Pikna M, Pillot P, Pinazza O, Pinsky L, Pinto C, Pisano S, Płoskoń M, Planinic M, Pliquett F, Poghosyan MG, Polichtchouk B, Politano S, Poljak N, Pop A, Porteboeuf-Houssais S, Pozdniakov V, Pozos IY, Pradhan KK, Prasad SK, Prasad S, Preghenella R, Prino F, Pruneau CA, Pshenichnov I, Puccio M, Pucillo S, Pugelova Z, Qiu S, Quaglia L, Ragoni S, Rai A, Rakotozafindrabe A, Ramello L, Rami F, Rancien TA, Rasa M, Räsänen SS, Rath R, Rauch MP, Ravasenga I, Read KF, Reckziegel C, Redelbach AR, Redlich K, Reetz CA, Regules-Medel HD, Rehman A, Reidt F, Reme-Ness HA, Rescakova Z, Reygers K, Riabov A, Riabov V, Ricci R, Richter M, Riedel AA, Riegler W, Riffero AG, Ristea C, Rodriguez MV, Rodríguez Cahuantzi M, Rodríguez Ramírez SA, Røed K, Rogalev R, Rogochaya E, Rogoschinski TS, Rohr D, Röhrich D, Rojas PF, Rojas Torres S, Rokita PS, Romanenko G, Ronchetti F, Rosano A, Rosas ED, Roslon K, Rossi A, Roy A, Roy S, Rubini N, Ruggiano D, Rui R, Russek PG, Russo R, Rustamov A, Ryabinkin E, Ryabov Y, Rybicki A, Rytkonen H, Ryu J, Rzesa W, Saarimaki OAM, Sadhu S, Sadovsky S, Saetre J, Šafařík K, Saha P, Saha SK, Saha S, Sahoo B, Sahoo R, Sahoo S, Sahu D, Sahu PK, Saini J, Sajdakova K, Sakai S, Salvan MP, Sambyal S, Samitz D, Sanna I, Saramela TB, Sarkar D, Sarma P, Sarritzu V, Sarti VM, Sas MHP, Sawan S, Scapparone E, Schambach J, Scheid HS, Schiaua C, Schicker R, Schlepper F, Schmah A, Schmidt C, Schmidt HR, Schmidt MO, Schmidt M, Schmidt NV, Schmier AR, Schotter R, Schröter A, Schukraft J, Schweda K, Scioli G, Scomparin E, Seger JE, Sekiguchi Y, Sekihata D, Selina M, Selyuzhenkov I, Senyukov S, Seo JJ, Serebryakov D, Serkin L, Šerkšnytė L, Sevcenco A, Shaba TJ, Shabetai A, Shahoyan R, Shangaraev A, Sharma B, Sharma D, Sharma H, Sharma M, Sharma S, Sharma S, Sharma U, Shatat A, Sheibani O, Shigaki K, Shimomura M, Shin J, Shirinkin S, Shou Q, Sibiriak Y, Siddhanta S, Siemiarczuk T, Silva TF, Silvermyr D, Simantathammakul T, Simeonov R, Singh B, Singh B, Singh K, Singh R, Singh R, Singh R, Singh S, Singh VK, Singhal V, Sinha T, Sitar B, Sitta M, Skaali TB, Skorodumovs G, Slupecki M, Smirnov N, Snellings RJM, Solheim EH, Song J, Sonnabend C, Sonneveld JM, Soramel F, Soto-Hernandez AB, Spijkers R, Sputowska I, Staa J, Stachel J, Stan I, Steffanic PJ, Stiefelmaier SF, Stocco D, Storehaug I, Stratmann P, Strazzi S, Sturniolo A, Stylianidis CP, Suaide AAP, Suire C, Sukhanov M, Suljic M, Sultanov R, Sumberia V, Sumowidagdo S, Szarka I, Szymkowski M, Taghavi SF, Taillepied G, Takahashi J, Tambave GJ, Tang S, Tang Z, Tapia Takaki JD, Tapus N, Tarasovicova LA, Tarzila MG, Tassielli GF, Tauro A, Tavira García A, Tejeda Muñoz G, Telesca A, Terlizzi L, Terrevoli C, Thakur S, Thomas D, Tikhonov A, Tiltmann N, Timmins AR, Tkacik M, Tkacik T, Toia A, Tokumoto R, Tomohiro K, Topilskaya N, Toppi M, Tork T, Torres PV, Torres VV, Torres Ramos AG, Trifiró A, Triolo AS, Tripathy S, Tripathy T, Trogolo S, Trubnikov V, Trzaska WH, Trzcinski TP, Tumkin A, Turrisi R, Tveter TS, Ullaland K, Ulukutlu B, Uras A, Urioni M, Usai GL, Vala M, Valle N, van Doremalen LVR, van Leeuwen M, van Veen CA, van Weelden RJG, Vande Vyvre P, Varga D, Varga Z, Vasileiou M, Vasiliev A, Vázquez Doce O, Vazquez Rueda O, Vechernin V, Vercellin E, Vergara Limón S, Verma R, Vermunt L, Vértesi R, Verweij M, Vickovic L, Vilakazi Z, Villalobos Baillie O, Villani A, Vinogradov A, Virgili T, Virta MMO, Vislavicius V, Vodopyanov A, Volkel B, Völkl MA, Voloshin SA, Volpe G, von Haller B, Vorobyev I, Vozniuk N, Vrláková J, Wan J, Wang C, Wang D, Wang Y, Wang Y, Wegrzynek A, Weiglhofer FT, Wenzel SC, Wessels JP, Wiechula J, Wikne J, Wilk G, Wilkinson J, Willems GA, Windelband B, Winn M, Wright JR, Wu W, Wu Y, Xu R, Yadav A, Yadav AK, Yamaguchi Y, Yang S, Yano S, Yeats ER, Yin Z, Yoo IK, Yoon JH, Yu H, Yuan S, Yuncu A, Zaccolo V, Zampolli C, Zanone F, Zardoshti N, Zarochentsev A, Závada P, Zaviyalov N, Zhalov M, Zhang B, Zhang C, Zhang L, Zhang S, Zhang X, Zhang Y, Zhang Z, Zhao M, Zherebchevskii V, Zhi Y, Zhong C, Zhou D, Zhou Y, Zhu J, Zhu Y, Zugravel SC, Zurlo N. Emergence of Long-Range Angular Correlations in Low-Multiplicity Proton-Proton Collisions. PHYSICAL REVIEW LETTERS 2024; 132:172302. [PMID: 38728735 DOI: 10.1103/physrevlett.132.172302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 03/22/2024] [Indexed: 05/12/2024]
Abstract
This Letter presents the measurement of near-side associated per-trigger yields, denoted ridge yields, from the analysis of angular correlations of charged hadrons in proton-proton collisions at sqrt[s]=13 TeV. Long-range ridge yields are extracted for pairs of charged particles with a pseudorapidity difference of 1.4<|Δη|<1.8 and a transverse momentum of 1
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Shao S, Liao H, Zhou S, Li Y, Yu H, Dai X, Zhu Q, Hua Y, Wang C, Zhou K. Isolated non-immune mediated second-degree atrioventricular block in fetus: natural history and predictive factors for spontaneous recovery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024. [PMID: 38642334 DOI: 10.1002/uog.27662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To uncover the clinical course of fetal isolated non-immune mediated second-degree AVB and determine the factors associated with the spontaneous recovery for fetal non-immune second-degree atrioventricular block (AVB). METHODS A total of 20 fetuses with isolated, non-immune mediated second-degree AVB were prospectively recruited between 2014 and 2022. These fetuses were divided into the spontaneous recovery group (n=12) and the non-spontaneous recovery group (n=8). Maternal and fetal basic characteristics, intrauterine and postnatal outcomes were compared between groups. RESULTS Twelve fetuses restored 1:1 atrioventricular conduction in utero and did not recur during the postnatal follow-up period. The residual eight fetuses maintained as second-degree AVB and six of them were aborted due to parental request in utero. Of the two live children with second-degree AVB, one of them progressed to complete AVB at the latest follow up at the age of 34 months, but without any symptoms, heart enlargement or dysfunction. The residual one progressed to complete AVB and was finally diagnosed with type 2 long-QT syndrome. Fetuses in the spontaneous recovery group presented with earlier gestational age at diagnosis (20.0[17.0-26.0] vs. 24.5[18.0-35.0] weeks, p=0.004) and higher atrial rate (147[130-160] vs 138.00[125.00-149.00] bpm, p=0.006) in comparison with the non-spontaneous recovery group. A cut-off value of 22.5 weeks of gestational age and 144 bpm of atrial rate at diagnosis could predict the failure of spontaneous recovery, with sensitivities of 87.5%, 75%, and specificities of 92.0%, 87.5%, respectively. CONCLUSIONS The outcome of fetal non-immune second-degree AVB was favorable. Earlier gestational age at diagnosis and higher atrial rate were related to spontaneous reversion for isolated non-immune-mediated second-degree AVB. However, prenatal gene test should be performed for those with persistent AVB to exclude the heritable disorders including LQTS. These findings may provide important references for clinical management and prenatal counseling. This article is protected by copyright. All rights reserved.
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Acharya S, Adamová D, Adler A, Aglieri Rinella G, Agnello M, Agrawal N, Ahammed Z, Ahmad S, Ahn SU, Ahuja I, Akindinov A, Al-Turany M, Aleksandrov D, Alessandro B, Alfanda HM, Alfaro Molina R, Ali B, Alici A, Alizadehvandchali N, Alkin A, Alme J, Alocco G, Alt T, Altamura AR, Altsybeev I, Alvarado JR, Anaam MN, Andrei C, Andronic A, Anguelov V, Antinori F, Antonioli P, Apadula N, Aphecetche L, Appelshäuser H, Arata C, Arcelli S, Aresti M, Arnaldi R, Arneiro JGMCA, Arsene IC, Arslandok M, Augustinus A, Averbeck R, Azmi MD, Baba H, Badalà A, Bae J, Baek YW, Bai X, Bailhache R, Bailung Y, Balbino A, Baldisseri A, Balis B, Banerjee D, Banoo Z, Barbera R, Barile F, Barioglio L, Barlou M, Barnaföldi GG, Barnby LS, Barret V, Barreto L, Bartels C, Barth K, Bartsch E, Bastid N, Basu S, Batigne G, Battistini D, Batyunya B, Bauri D, Bazo Alba JL, Bearden IG, Beattie C, Becht P, Behera D, Belikov I, Bell Hechavarria ADC, Bellini F, Bellwied R, Belokurova S, Bencedi G, Beole S, Bercuci A, Berdnikov Y, Berdnikova A, Bergmann L, Besoiu MG, Betev L, Bhaduri PP, Bhasin A, Bhat MA, Bhattacharjee B, Bianchi L, Bianchi N, Bielčík J, Bielčíková J, Biernat J, Bigot AP, Bilandzic A, Biro G, Biswas S, Bize N, Blair JT, Blau D, Blidaru MB, Bluhme N, Blume C, Boca G, Bock F, Bodova T, Bogdanov A, Boi S, Bok J, Boldizsár L, Bombara M, Bond PM, Bonomi G, Borel H, Borissov A, Borquez Carcamo AG, Bossi H, Botta E, Bouziani YEM, Bratrud L, Braun-Munzinger P, Bregant M, Broz M, Bruno GE, Buckland MD, Budnikov D, Buesching H, Bufalino S, Buhler P, Burmasov N, Buthelezi Z, Bylinkin A, Bysiak SA, Cai M, Caines H, Caliva A, Calvo Villar E, Camacho JMM, Camerini P, Canedo FDM, Cantway SL, Carabas M, Carballo AA, Carnesecchi F, Caron R, Carvalho LAD, Castillo Castellanos J, Catalano F, Ceballos Sanchez C, Chakaberia I, Chakraborty P, Chandra S, Chapeland S, Chartier M, Chattopadhyay S, Chattopadhyay S, Cheng T, Cheshkov C, Cheynis B, Chibante Barroso V, Chinellato DD, Chizzali ES, Cho J, Cho S, Chochula P, Christakoglou P, Christensen CH, Christiansen P, Chujo T, Ciacco M, Cicalo C, Cindolo F, Ciupek MR, Clai G, Colamaria F, Colburn JS, Colella D, Colocci M, Concas M, Conesa Balbastre G, Conesa Del Valle Z, Contin G, Contreras JG, Coquet ML, Cortese P, Cosentino MR, Costa F, Costanza S, Cot C, Crkovská J, Crochet P, Cruz-Torres R, Cui P, Dainese A, Danisch MC, Danu A, Das P, Das P, Das S, Dash AR, Dash S, De Caro A, de Cataldo G, de Cuveland J, De Falco A, De Gruttola D, De Marco N, De Martin C, De Pasquale S, Deb R, Deb S, Del Grande R, Dello Stritto L, Deng W, Dhankher P, Di Bari D, Di Mauro A, Diab B, Diaz RA, Dietel T, Ding Y, Divià R, Dixit DU, Djuvsland Ø, Dmitrieva U, Dobrin A, Dönigus B, Dubinski JM, Dubla A, Dudi S, Dupieux P, Durkac M, Dzalaiova N, Eder TM, Ehlers RJ, Eisenhut F, Ejima R, Elia D, Erazmus B, Ercolessi F, Erhardt F, Ersdal MR, Espagnon B, Eulisse G, Evans D, Evdokimov S, Fabbietti L, Faggin M, Faivre J, Fan F, Fan W, Fantoni A, Fasel M, Fecchio P, Feliciello A, Feofilov G, Fernández Téllez A, Ferrandi L, Ferrer MB, Ferrero A, Ferrero C, Ferretti A, Feuillard VJG, Filova V, Finogeev D, Fionda FM, Flor F, Flores AN, Foertsch S, Fokin I, Fokin S, Fragiacomo E, Frajna E, Fuchs U, Funicello N, Furget C, Furs A, Fusayasu T, Gaardhøje JJ, Gagliardi M, Gago AM, Gahlaut T, Galvan CD, Gangadharan DR, Ganoti P, Garabatos C, Garcia AT, García Chávez T, Garcia-Solis E, Gargiulo C, Garner K, Gasik P, Gautam A, Gay Ducati MB, Germain M, Ghimouz A, Ghosh C, Giacalone M, Giubellino P, Giubilato P, Glaenzer AMC, Glässel P, Glimos E, Goh DJQ, Gonzalez V, Gorgon M, Goswami K, Gotovac S, Grabski V, Graczykowski LK, Grecka E, Grelli A, Grigoras C, Grigoriev V, Grigoryan S, Grosa F, Grosse-Oetringhaus JF, Grosso R, Grund D, Guardiano GG, Guernane R, Guilbaud M, Gulbrandsen K, Gündem T, Gunji T, Guo W, Gupta A, Gupta R, Gupta R, Gwizdziel K, Gyulai L, Habib MK, Hadjidakis C, Haider FU, Hamagaki H, Hamdi A, Hamid M, Han Y, Hanley BG, Hannigan R, Hansen J, Haque MR, Harris JW, Harton A, Hassan H, Hatzifotiadou D, Hauer P, Havener LB, Heckel ST, Hellbär E, Helstrup H, Hemmer M, Herman T, Herrera Corral G, Herrmann F, Herrmann S, Hetland KF, Heybeck B, Hillemanns H, Hippolyte B, Hoffmann FW, Hofman B, Hohlweger B, Hong GH, Horst M, Horzyk A, Hou Y, Hristov P, Hughes C, Huhn P, Huhta LM, Humanic TJ, Hutson A, Hutter D, Ilkaev R, Ilyas H, Inaba M, Innocenti GM, Ippolitov M, Isakov A, Isidori T, Islam MS, Ivanov M, Ivanov M, Ivanov V, Iversen KE, Jablonski M, Jacak B, Jacazio N, Jacobs PM, Jadlovska S, Jadlovsky J, Jaelani S, Jahnke C, Jakubowska MJ, Janik MA, Janson T, Jercic M, Ji S, Jia S, Jimenez AAP, Jonas F, Jones DM, Jowett JM, Jung J, Jung M, Junique A, Jusko A, Kabus MJ, Kaewjai J, Kalinak P, Kalteyer AS, Kalweit A, Kaplin V, Karasu Uysal A, Karatovic D, Karavichev O, Karavicheva T, Karczmarczyk P, Karpechev E, Kebschull U, Keidel R, Keijdener DLD, Keil M, Ketzer B, Khade SS, Khan AM, Khan S, Khanzadeev A, Kharlov Y, Khatun A, Khuntia A, Kidson MB, Kileng B, Kim B, Kim C, Kim DJ, Kim EJ, Kim J, Kim JS, Kim J, Kim J, Kim M, Kim S, Kim T, Kimura K, Kirsch S, Kisel I, Kiselev S, Kisiel A, Kitowski JP, Klay JL, Klein J, Klein S, Klein-Bösing C, Kleiner M, Klemenz T, Kluge A, Knospe AG, Kobdaj C, Kollegger T, Kondratyev A, Kondratyeva N, Kondratyuk E, Konig J, Konigstorfer SA, Konopka PJ, Kornakov G, Korwieser M, Koryciak SD, Kotliarov A, Kovalenko V, Kowalski M, Kozhuharov V, Králik I, Kravčáková A, Krcal L, Krivda M, Krizek F, Krizkova Gajdosova K, Kroesen M, Krüger M, Krupova DM, Kryshen E, Kučera V, Kuhn C, Kuijer PG, Kumaoka T, Kumar D, Kumar L, Kumar N, Kumar S, Kundu S, Kurashvili P, Kurepin A, Kurepin AB, Kuryakin A, Kushpil S, Kweon MJ, Kwon Y, La Pointe SL, La Rocca P, Lakrathok A, Lamanna M, Landou AR, Langoy R, Larionov P, Laudi E, Lautner L, Lavicka R, Lea R, Lee H, Legrand I, Legras G, Lehrbach J, Lelek TM, Lemmon RC, León Monzón I, Lesch MM, Lesser ED, Lévai P, Li X, Li XL, Lien J, Lietava R, Likmeta I, Lim B, Lim SH, Lindenstruth V, Lindner A, Lippmann C, Liu A, Liu DH, Liu J, Liveraro GSS, Lofnes IM, Loizides C, Lokos S, Lomker J, Loncar P, Lopez JA, Lopez X, López Torres E, Lu P, Luhder JR, Lunardon M, Luparello G, Ma YG, Mager M, Maire A, Majerz EM, Makariev MV, Malaev M, Malfattore G, Malik NM, Malik QW, Malik SK, Malinina L, Mallick D, Mallick N, Mandaglio G, Mandal SK, Manko V, Manso F, Manzari V, Mao Y, Marcjan RW, Margagliotti GV, Margotti A, Marín A, Markert C, Martinengo P, Martínez MI, Martínez García G, Martins MPP, Masciocchi S, Masera M, Masoni A, Massacrier L, Mastroserio A, Matonoha O, Mattiazzo S, Matuoka PFT, Matyja A, Mayer C, Mazuecos AL, Mazzaschi F, Mazzilli M, Mdhluli JE, Mechler AF, Melikyan Y, Menchaca-Rocha A, Meninno E, Menon AS, Meres M, Mhlanga S, Miake Y, Micheletti L, Migliorin LC, Mihaylov DL, Mikhaylov K, Mishra AN, Miśkowiec D, Modak A, Mohanty AP, Mohanty B, Mohisin Khan M, Molander MA, Monira S, Moravcova Z, Mordasini C, Moreira De Godoy DA, Morozov I, Morsch A, Mrnjavac T, Muccifora V, Muhuri S, Mulligan JD, Mulliri A, Munhoz MG, Munzer RH, Murakami H, Murray S, Musa L, Musinsky J, Myrcha JW, Naik B, Nambrath AI, Nandi BK, Nania R, Nappi E, Nassirpour AF, Nath A, Nattrass C, Naydenov MN, Neagu A, Negru A, Nellen L, Nepeivoda R, Nese S, Neskovic G, Nielsen BS, Nielsen EG, Nikolaev S, Nikulin S, Nikulin V, Noferini F, Noh S, Nomokonov P, Norman J, Novitzky N, Nowakowski P, Nyanin A, Nystrand J, Ogino M, Oh S, Ohlson A, Okorokov VA, Oleniacz J, Oliveira Da Silva AC, Oliver MH, Onnerstad A, Oppedisano C, Ortiz Velasquez A, Otwinowski J, Oya M, Oyama K, Pachmayer Y, Padhan S, Pagano D, Paić G, Paisano-Guzmán S, Palasciano A, Panebianco S, Park H, Park H, Park J, Parkkila JE, Patley Y, Patra RN, Paul B, Pei H, Peitzmann T, Peng X, Pennisi M, Peresunko D, Perez GM, Pestov Y, Petrov V, Petrovici M, Pezzi RP, Piano S, Pikna M, Pillot P, Pinazza O, Pinsky L, Pinto C, Pisano S, Płoskoń M, Planinic M, Pliquett F, Poghosyan MG, Polichtchouk B, Politano S, Poljak N, Pop A, Porteboeuf-Houssais S, Pozdniakov V, Pozos IY, Pradhan KK, Prasad SK, Prasad S, Preghenella R, Prino F, Pruneau CA, Pshenichnov I, Puccio M, Pucillo S, Pugelova Z, Qiu S, Quaglia L, Quishpe RE, Ragoni S, Rakotozafindrabe A, Ramello L, Rami F, Rancien TA, Rasa M, Räsänen SS, Rath R, Rauch MP, Ravasenga I, Read KF, Reckziegel C, Redelbach AR, Redlich K, Reetz CA, Regules-Medel HD, Rehman A, Reidt F, Reme-Ness HA, Rescakova Z, Reygers K, Riabov A, Riabov V, Ricci R, Richter M, Riedel AA, Riegler W, Ristea C, Rodriguez MV, Rodríguez Cahuantzi M, Rodríguez Ramírez SA, Røed K, Rogalev R, Rogochaya E, Rogoschinski TS, Rohr D, Röhrich D, Rojas PF, Rojas Torres S, Rokita PS, Romanenko G, Ronchetti F, Rosano A, Rosas ED, Roslon K, Rossi A, Roy A, Roy S, Rubini N, Ruggiano D, Rui R, Russek PG, Russo R, Rustamov A, Ryabinkin E, Ryabov Y, Rybicki A, Rytkonen H, Ryu J, Rzesa W, Saarimaki OAM, Sadek R, Sadhu S, Sadovsky S, Saetre J, Šafařík K, Saha P, Saha SK, Saha S, Sahoo B, Sahoo B, Sahoo R, Sahoo S, Sahu D, Sahu PK, Saini J, Sajdakova K, Sakai S, Salvan MP, Sambyal S, Sanna I, Saramela TB, Sarkar D, Sarkar N, Sarma P, Sarritzu V, Sarti VM, Sas MHP, Schambach J, Scheid HS, Schiaua C, Schicker R, Schmah A, Schmidt C, Schmidt HR, Schmidt MO, Schmidt M, Schmidt NV, Schmier AR, Schotter R, Schröter A, Schukraft J, Schweda K, Scioli G, Scomparin E, Seger JE, Sekiguchi Y, Sekihata D, Selina M, Selyuzhenkov I, Senyukov S, Seo JJ, Serebryakov D, Šerkšnytė L, Sevcenco A, Shaba TJ, Shabetai A, Shahoyan R, Shangaraev A, Sharma A, Sharma B, Sharma D, Sharma H, Sharma M, Sharma S, Sharma S, Sharma U, Shatat A, Sheibani O, Shigaki K, Shimomura M, Shin J, Shirinkin S, Shou Q, Sibiriak Y, Siddhanta S, Siemiarczuk T, Silva TF, Silvermyr D, Simantathammakul T, Simeonov R, Singh B, Singh B, Singh K, Singh R, Singh R, Singh R, Singh S, Singh VK, Singhal V, Sinha T, Sitar B, Sitta M, Skaali TB, Skorodumovs G, Slupecki M, Smirnov N, Snellings RJM, Solheim EH, Song J, Songmoolnak A, Sonnabend C, Soramel F, Soto-Hernandez AB, Spijkers R, Sputowska I, Staa J, Stachel J, Stan I, Steffanic PJ, Stiefelmaier SF, Stocco D, Storehaug I, Stratmann P, Strazzi S, Stylianidis CP, Suaide AAP, Suire C, Sukhanov M, Suljic M, Sultanov R, Sumberia V, Sumowidagdo S, Swain S, Szarka I, Szymkowski M, Taghavi SF, Taillepied G, Takahashi J, Tambave GJ, Tang S, Tang Z, Tapia Takaki JD, Tapus N, Tarasovicova LA, Tarzila MG, Tassielli GF, Tauro A, Tejeda Muñoz G, Telesca A, Terlizzi L, Terrevoli C, Thakur S, Thomas D, Tikhonov A, Timmins AR, Tkacik M, Tkacik T, Toia A, Tokumoto R, Tomohiro K, Topilskaya N, Toppi M, Tork T, Torres VV, Torres Ramos AG, Trifiró A, Triolo AS, Tripathy S, Tripathy T, Trogolo S, Trubnikov V, Trzaska WH, Trzcinski TP, Tumkin A, Turrisi R, Tveter TS, Ullaland K, Ulukutlu B, Uras A, Urioni M, Usai GL, Vala M, Valle N, van Doremalen LVR, van Leeuwen M, van Veen CA, van Weelden RJG, Vande Vyvre P, Varga D, Varga Z, Vasileiou M, Vasiliev A, Vázquez Doce O, Vazquez Rueda O, Vechernin V, Vercellin E, Vergara Limón S, Verma R, Vermunt L, Vértesi R, Verweij M, Vickovic L, Vilakazi Z, Villalobos Baillie O, Villani A, Vino G, Vinogradov A, Virgili T, Virta MMO, Vislavicius V, Vodopyanov A, Volkel B, Völkl MA, Voloshin K, Voloshin SA, Volpe G, von Haller B, Vorobyev I, Vozniuk N, Vrláková J, Wan J, Wang C, Wang D, Wang Y, Wang Y, Wegrzynek A, Weiglhofer FT, Wenzel SC, Wessels JP, Wiechula J, Wikne J, Wilk G, Wilkinson J, Willems GA, Windelband B, Winn M, Wright JR, Wu W, Wu Y, Xu R, Yadav A, Yadav AK, Yalcin S, Yamaguchi Y, Yang S, Yano S, Yin Z, Yoo IK, Yoon JH, Yu H, Yuan S, Yuncu A, Zaccolo V, Zampolli C, Zanone F, Zardoshti N, Zarochentsev A, Závada P, Zaviyalov N, Zhalov M, Zhang B, Zhang C, Zhang L, Zhang S, Zhang X, Zhang Y, Zhang Z, Zhao M, Zherebchevskii V, Zhi Y, Zhou D, Zhou Y, Zhu J, Zhu Y, Zugravel SC, Zurlo N. First Measurement of the |t| Dependence of Incoherent J/ψ Photonuclear Production. PHYSICAL REVIEW LETTERS 2024; 132:162302. [PMID: 38701458 DOI: 10.1103/physrevlett.132.162302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/22/2023] [Accepted: 01/23/2024] [Indexed: 05/05/2024]
Abstract
The first measurement of the cross section for incoherent photonuclear production of J/ψ vector mesons as a function of the Mandelstam |t| variable is presented. The measurement was carried out with the ALICE detector at midrapidity, |y|<0.8, using ultraperipheral collisions of Pb nuclei at a center-of-mass energy per nucleon pair of sqrt[s_{NN}]=5.02 TeV. This rapidity interval corresponds to a Bjorken-x range (0.3-1.4)×10^{-3}. Cross sections are given in five |t| intervals in the range 0.04<|t|<1 GeV^{2} and compared to the predictions by different models. Models that ignore quantum fluctuations of the gluon density in the colliding hadron predict a |t| dependence of the cross section much steeper than in data. The inclusion of such fluctuations in the same models provides a better description of the data.
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Chen K, Yu H, Zhu LM, Liu Q, Wang B. [Spatial-temporal distribution characteristics of etiologically positive pulmonary tuberculosis in Jiangsu Province from 2011 to 2021]. ZHONGHUA LIU XING BING XUE ZA ZHI = ZHONGHUA LIUXINGBINGXUE ZAZHI 2024; 45:513-519. [PMID: 38678346 DOI: 10.3760/cma.j.cn112338-20230915-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Objective: To analyze the spatial-temporal distribution of etiologically positive pulmonary tuberculosis (PTB) at the county (city, district) unit in Jiangsu Province from 2011 to 2021 to provide evidence for the implementation and adjustment of prevention and control strategies of PTB in Jiangsu Province. Methods: The registration data of etiologically positive PTB patients in Jiangsu Province from 2011 to 2021 were collected from the Tuberculosis Management Information System in the China Information System of Disease Control and Prevention. Data on the permanent population were from the statistical yearbook of each county (city, district) in Jiangsu Province. Geoda 1.18.0 software was used to analyze the global and local spatial autocorrelation and explore the spatial clustering. SaTScan 10.1 software was used to analyze the spatial-temporal clusters, and ArcGIS 10.7 software was used to visualize the spatial-temporal clusters. Results: A total of 128 240 etiological positive PTB cases were registered in Jiangsu Province from 2011 to 2021, with an average annual registration rate of 13.99/100 000. The registration rate showed an overall upward trend (trend χ2=63.49, P<0.001) after 2017, and the etiologically positive rate showed an overall upward trend (trend χ2=3 710.86, P<0.001). The annual Moran's I values ranged from 0.107 to 0.343, which showed a spatial clustering distribution. The results of local spatial autocorrelation analysis showed that there were "high-high" clustering areas in Jiangsu Province each year, showing a dynamic distribution, and most of the areas were distributed in the central and southern regions of Jiangsu Province, with the largest number (7) in 2015 and the smallest number (1) in 2011. A total of 4 spatial-temporal clustering areas were explored by spatial-temporal scanning analysis (all P<0.001), among which the first-level clustering area covered 3 counties (cities, districts), namely Changshu, Taicang, and Xiangcheng District of Suzhou, and the clustering time was from 2011 to 2015. The secondary clustering areas covered 24 counties (cities, districts), mainly covering Jiangsu's central and northern regions, such as Huai'an, Suqian, and Yancheng. The third-level clustering areas covered 26 counties (cities, districts); the fourth-level clustering area was the Gaochun District of Nanjing, with the clustering period from 2017 to 2021. Conclusions: From 2011 to 2021, the etiologically positive PTB registration rate at the county (city, district) level in Jiangsu Province had obvious spatial-temporal clustering characteristics. The clustering areas included the northern areas with relatively backward economies and the southern areas with better economic development. Multiple measures should be taken to prevent and control PTB according to the specific situation in different regions.
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Wei XL, Du WC, Wang R, Zhou JY, Yu H, Lu Y, Wang LC, Huang CY. [Epidemic characteristics and trend analysis of major injuries deaths among children and adolescents in Jiangsu Province from 2012 to 2021]. ZHONGHUA LIU XING BING XUE ZA ZHI = ZHONGHUA LIUXINGBINGXUE ZAZHI 2024; 45:536-541. [PMID: 38678349 DOI: 10.3760/cma.j.cn112338-20230912-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Objective: To understand the situation and epidemic characteristics of injury deaths among children aged 5 to 24 years in Jiangsu Province from 2012 to 2021 and the trend of annual changes. Methods: The main injury mortality data of children and adolescents was collected, and the crude and standardized mortality rates of road traffic accidents, drowning, suicide, and accidental falls among children and adolescents over a decade and the annual average percentage of change (AAPC) were calculated. The main injury mortality characteristics and trends of children and adolescents of different age groups and genders were analyzed. Results: The total number of injury deaths among 5 to 24 adolescents in Jiangsu Province was 16 052, with a standardized mortality rate of 9.58/100 000. There was no significant trend in the overall standardized mortality rate of injuries (AAPC=-3.450%, P=0.055). The standardized mortality rate of road traffic injuries among children and adolescents showed a decreasing trend over the past decade, with statistical significance (AAPC=-9.406%, P<0.001). The standardized suicide mortality rate showed an upward trend over the past decade, with statistical significance (AAPC=9.000%, P=0.001). The overall injury mortality rate showed an upward trend with age. Suicide rates in males and females were on the rise and both have statistical significance (AAPC=9.420% and AAPC=9.607%, both P<0.05). The standardized mortality rates of female traffic accidents, drowning, and male traffic accidents showed a decreasing trend and were statistically significant (AAPC for female traffic accidents=-7.364%, AAPC for female drowning=-5.352%, and AAPC for male traffic accidents=-10.242%, all P<0.05). The standardized mortality rate of urban and rural traffic accidents showed a decreasing trend and was statistically significant(AAPC=-7.899% and AAPC=-9.421%, both P<0.001). The standardized suicide mortality rate showed an upward trend and statistical significance (AAPC=11.009% and AAPC=7.528%, both P<0.05). Conclusions: The overall injury situation of children and adolescents in Jiangsu Province improved in the past decade from 2012 to 2021, but the suicide mortality rate was on the rise. It is necessary to focus on the mental health issues of this age group and to strengthen the prevention and control of suicide among children and adolescents, in Jiangsu.
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Yang MS, Fan XK, Su J, Wan XL, Yu H, Lu Y, Hua YJ, Jin JR, Pei P, Yu CQ, Sun DJY, Lyu J, Tao R, Zhou JY. [A prospective study on association between sleep duration and the risk of chronic obstructive pulmonary disease in adults in Suzhou]. ZHONGHUA LIU XING BING XUE ZA ZHI = ZHONGHUA LIUXINGBINGXUE ZAZHI 2024; 45:331-338. [PMID: 38514308 DOI: 10.3760/cma.j.cn112338-20230918-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Objective: To investigate the prospective association of sleep duration with the development of chronic obstructive pulmonary disease (COPD) in adults in Suzhou. Methods: The study used the data of 53 269 participants aged 30-79 years recruited in the baseline survey from 2004 to 2008 and the follow-up until December 31, 2017 of China Kadoorie Biobank (CKB) conducted in Wuzhong District, Suzhou. After excluding participants with airflow limitation, self-reported chronic bronchitis/emphysema/coronary heart disease history at the baseline survey and abnormal or incomplete data, a total of 45 336 participants were included in the final analysis. The association between daily sleep duration and the risk for developing COPD was analyzed by using a Cox proportional hazard regression model, and the hazard ratio (HR) values and their 95%CI were calculated. The analysis was stratified by age, gender and lifestyle factors, and cross-analysis was conducted according to smoking status and daily sleep duration. Results: The median follow-up time was 11.12 years, with a total of 515 COPD diagnoses in the follow-up. After adjusting for potential confounders, multifactorial Cox proportional hazard regression analysis showed that daily sleep duration ≥10 hours was associated with higher risk for developing COPD (HR=1.42, 95%CI: 1.03-1.97). The cross analysis showed that excessive daily sleep duration increased the risk for COPD in smokers (HR=2.49, 95%CI: 1.35-4.59, interaction P<0.001). Conclusion: Longer daily sleep duration (≥10 hours) might increase the risk for COPD in adults in Suzhou, especially in smokers.
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Hu M, Shen Y, Yu H, Song Y, Zheng T, Hong D, Gong L. Prognostic value of cardiac magnetic resonance imaging feature tracking technology in patients with light chain amyloidosis. Clin Radiol 2024; 79:e239-e246. [PMID: 37953095 DOI: 10.1016/j.crad.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/27/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023]
Abstract
AIM To undertake a meta-analysis of the prognostic value of cardiac magnetic resonance imaging feature tracking (CMR-FT) in patients with light-chain cardiac amyloidosis (LCA). MATERIALS AND METHODS A systematic search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. All analyses were conducted using RevMan 5.3 software. RESULTS Eight studies were included with 663 patients. For the left ventricle, the results showed that CMR-FT was statistically significant in predicting death, with less impaired global circumferential (GCS), radial (GRS) and longitudinal (GLS) strain in survivors of LCA (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.25; 0.95, 0.93-0.96; 1.12, 1.05-1.20, all p<0.001). For ejection fraction (EF) and mass index, surviving patients had higher EFs and mass index (OR 0.96, 95% CI 0.96-0.97; 1.01, 1.01-1.02). For the right ventricle, the results showed that CMR-FT was statistically significant in predicting death, with less impaired GLS and GRS in survivors of LCA (OR 1.11, 95% CI 1.08-1.15; 0.93, 0.90-0.96, all p<0.001). Surviving patients had higher EFs (OR 0.97, 95% CI 0.96-0.98, p<0.001). Upon removing the studies one by one, there was no significant change in the results of the study. Both analyses showed no apparent publication deviation on funnel plots. CONCLUSION Parameters derived from CMR-FT technology are promising new predictors for LCA, and are easily available and reliable. Patients with poor myocardial deformability are at highest risk of death.
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Fu Z, Jin Y, Lin Z, Jiang Y, DU S, Liu J, Zhang G, Liu Y, Yu H. Clinical characteristics of patients with migraine accompanied by tremor. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2024; 49:68-74. [PMID: 38615168 PMCID: PMC11017025 DOI: 10.11817/j.issn.1672-7347.2024.230252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Migraine and tremor share some genetic mutation sites, and clinical studies have also confirmed their correlation. This study aims to explore the clinical and electrophysiological characteristics of migraine patients with concomitant tremor, and to analyze the relevant influential factors of tremor occurrence. METHODS We retrospectively analyzed the clinical data of 217 migraine patients who visited the Third Affiliated Hospital of Qiqihar Medical University from June 2022 to October 2023. The Clinical Rating Scale for Tremor (CRST), Numerical Rating Scale (NRS), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were respectively used to assess the tremor symptoms, degree of headache, anxiety, and depression of patients. All patients underwent routine head MR scanning and electromyography examination, and were divided into a migraine with tremor group and a migraine without tremor group based on the electromyogram examination. RESULTS The migraine with tremor group and the migraine without tremor group were included 52 patients (23.96%) and 165 patients (76.04%), respectively. Compared with the migraine without tremor group, the migraine with tremor group had a longer course and duration of headache, higher frequency of headache attacks, higher NRS score, GAD-7 score, and PHQ-9 score, and fewer weekly physical exercises. The differences were statistically significant (all P<0.05). There were no statistically significant differences in the presence or absence of prodromal headache and white matter hyperintensities (WMHs) between the 2 groups (both P>0.05). The evaluation results of the CRST showed that out of 217 migraine patients, 39 patients (17.97%) were accompanied by tremors. The electromyographic results showed that all 52 migraine patients with tremors had upper limb tremors, including 28 migraine patients with postural tremors and 24 migraine patients with static tremors. Compared with the migraine patients with static tremors, the migraine patients with postural tremors had lower average frequency, peak frequency, and headache onset frequency (all P<0.05). Multiple linear regression analysis showed that frequency of physical exercise, duration of illness, frequency of headache attacks, NRS score, GAD-7 score, and PHQ-9 score were risk factors for migraine patients with concomitant tremors (all P<0.05). CONCLUSIONS Patients with migraine mainly experience upper limb postural tremors. Reduced physical exercise, long course of disease, long duration of headache, frequent headache attacks, severe headache, anxiety, and depression are risk factors for migraine patients with concomitant tremors.
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Jia LH, Lin HL, Zheng SW, Lin XJ, Zhang D, Yu H. [Mitigating metal artifacts from cobalt-chromium alloy crowns in cone-beam CT images through deep learning techniques]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2024; 59:71-79. [PMID: 38228542 DOI: 10.3760/cma.j.cn112144-20231030-00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Objective: To develop and evaluate metal artifact removal systems (MARS) based on deep learning to assess their effectiveness in removing artifacts caused by different thicknesses of metals in cone-beam CT (CBCT) images. Methods: A full-mouth standard model (60 mm×75 mm×110 mm) was three-dimensional (3D) printed using photosensitive resin. The model included a removable and replaceable target tooth position where cobalt-chromium alloy crowns with varying thicknesses were inserted to generate matched CBCT images. The artifacts resulting from cobalt-chromium alloys with different thicknesses were evaluated using the structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR). CNN-MARS and U-net-MARS were developed using a convolutional neural network and U-net architecture, respectively. The effectiveness of both MARSs were assessed through visualization and by measuring SSIM and PSNR values. The SSIM and PSNR values were statistically analyzed using one-way analysis of variance (α=0.05). Results: Significant differences were observed in the range of artifacts produced by different thicknesses of cobalt-chromium alloys (all P<0.05), with 1 mm resulting in the least artifacts. The SSIM values for specimens with thicknesses of 1.0, 1.5, and 2.0 mm were 0.916±0.019, 0.873±0.010, and 0.833±0.010, respectively (F=447.89, P<0.001). The corresponding PSNR values were 20.834±1.176, 17.002±0.427, and 14.673±0.429, respectively (F=796.51, P<0.001). After applying CNN-MARS and U-net-MARS to artifact removal, the SSIM and PSNR values significantly increased for images with the same thickness of metal (both P<0.05). When using the CNN-MARS for artifact removal, the SSIM values for 1.0, 1.5 and 2.0 mm were 0.938±0.023, 0.930±0.029, and 0.928±0.020 (F=2.22, P=0.112), while the PSNR values were 30.938±1.495, 30.578±2.154 and 30.553±2.355 (F=0.54, P=0.585). When using the U-net-MARS for artifact removal, the SSIM values for 1.0, 1.5 and 2.0 mm were 0.930±0.024, 0.932±0.017 and 0.930±0.012 (F=0.24, P=0.788), and the PSNR values were 30.291±0.934, 30.351±1.002 and 30.271±1.143 (F=0.07, P=0.929). No significant differences were found in SSIM and PSNR values after artifact removal using CNN-MARS and U-net-MARS for different thicknesses of cobalt-chromium alloys (all P>0.05). Visualization demonstrated a high degree of similarity between the images before and after artifact removal using both MARS. However, CNN-MARS displayed clearer metal edges and preserved more tissue details when compared with U-net-MARS. Conclusions: Both the CNN-MARS and U-net-MARS models developed in this study effectively remove the metal artifacts and enhance the image quality. CNN-MARS exhibited an advantage in restoring tissue structure information around the artifacts compared to U-net-MARS.
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Zheng C, Zeng R, Wu G, Hu Y, Yu H. Beyond Vision: A View from Eye to Alzheimer's Disease and Dementia. J Prev Alzheimers Dis 2024; 11:469-483. [PMID: 38374754 DOI: 10.14283/jpad.2023.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
With the aging of the global population, the health care burden of Alzheimer's disease (AD) and dementia is considered to increase dramatically in the coming decades. Given the insufficiency of effective interventions for AD and dementia, clinical research on identifying potentially modifiable risk factors and early diagnostic biomarkers becomes a public health priority. Currently, extracerebral manifestations with a large proportion of ocular involvement are usually recognized to precede the symptoms of AD and dementia. Growing epidemiologic evidence also suggests that eye disorders, such as cataracts, age-related macular degeneration, glaucoma, diabetic retinopathy, and so on, are closely associated with and even have a higher incidence of AD and dementia. The eye, as an extension of the central nervous system, therefore has the potential to provide a feasible approach to detecting structural and functional abnormalities of the brain. Numerous new imaging modalities are developed and give novel insights into the detection of several neurodegenerative, vascular, neuropathological, and other ocular abnormalities of AD and dementia in scientific research and clinical application. This review provides an overview of the epidemiologic associations between eye disorders and AD or dementia and summarizes the recent advances in ocular examinations and techniques employed for the detection of AD and dementia. With more brain-and-eye interconnections being identified, the eye is becoming a noninvasive and easily accessible window for the early diagnosis and prevention of AD and dementia.
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Jia LH, Lin HL, Zheng SW, Lin XJ, Zhang D, Yu H. [Mitigating metal artifacts in cone-beam CT images through deep learning techniques]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2023; 59:71-79. [PMID: 38172064 DOI: 10.3760/cma.j.cn112144-20231030-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Objective: To develop and evaluate metal artifact removal systems (MARSs) based on deep learning to assess their effectiveness in removing artifacts caused by different thicknesses of metals in cone-beam CT (CBCT) images. Methods: A full-mouth standard model (60 mm×75 mm×110 mm) was three-dimensional (3D) printed using photosensitive resin. The model included a removable and replaceable target tooth position where cobalt-chromium alloy crowns with varying thicknesses were inserted to generate matched CBCT images. The artifacts resulting from cobalt-chromium alloys with different thicknesses were evaluated using the structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR). CNN-MARS and U-net-MARS were developed using a convolutional neural network and U-net architecture, respectively. The effectiveness of both MARSs were assessed through visualization and by measuring SSIM and PSNR values. The SSIM and PSNR values were statistically analyzed using one-way analysis of variance (α=0.05). Results: Significant differences were observed in the range of artifacts produced by different thicknesses of cobalt-chromium alloys (all P<0.05), with 1 mm resulting in the least artifacts. The SSIM values for specimens with thicknesses of 1.0 mm, 1.5 mm, and 2.0 mm were 0.916±0.019, 0.873±0.010, and 0.833±0.010, respectively (F=447.89, P<0.001). The corresponding PSNR values were 20.834±1.176, 17.002±0.427, and 14.673±0.429, respectively (F=796.51, P<0.001). After applying CNN-MARS and U-net-MARS to artifact removal, the SSIM and PSNR values significantly increased for images with the same thickness of metal (both P<0.05). When using the CNN-MARS for artifact removal, the SSIM values for 1.0, 1.5 and 2.0 mm were 0.938±0.023, 0.930±0.029, and 0.928±0.020 (F=2.22, P=0.112), while the PSNR values were 30.938±1.495, 30.578±2.154 and 30.553±2.355 (F=0.54, P=0.585). When using the U-net-MARS for artifact removal, the SSIM values for 1.0, 1.5 and 2.0 mm were 0.930±0.024, 0.932±0.017 and 0.930±0.012 (F=0.24, P=0.788), and the PSNR values were 30.291±0.934, 30.351±1.002 and 30.271±1.143 (F=0.07, P=0.929). No significant differences were found in SSIM and PSNR values after artifact removal using CNN-MARS and U-net-MARS for different thicknesses of cobalt-chromium alloys (all P>0.05). Visualization demonstrated a high degree of similarity between the images before and after artifact removal using both MARSs. However, CNN-MARS displayed clearer metal edges and preserved more tissue details when compared with U-net-MARS. Conclusions: Both the CNN-MARS and U-net-MARS models developed in this study effectively remove the metal artifacts and enhance the image quality. CNN-MARS exhibited an advantage in restoring tissue structure information around the artifacts compared to U-net-MARS.
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Su C, Lu ZC, Yu H. [10-Methacryloyloxydecyl dihydrogen phosphate in resin-to-zirconia bonding durability: a systematic review and meta-analysis]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2023; 58:1281-1290. [PMID: 38061871 DOI: 10.3760/cma.j.cn112144-20230915-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To systematically assess the durability of the 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) pretreated resin-to-zirconia bonding and conducted a meta-analysis to provide clinical guidance on zirconia bonding strategies. Methods: A comprehensive search was conducted on PubMed, Scopus, Web of Science, CNKI, and Wanfang database to identify relevant studies on the resin-to-zirconia bonding after surface pretreatment with 10-MDP. Strict inclusion and exclusion criteria were applied to select appropriate literature and extract essential information and data. The included studies were categorized based on aging methods (water storage, thermocycling, or both), 10-MDP application methods (within primer, adhesive, resin cement, or both), and additional surface treatments (alumina sandblasting, tribochemical silica coating, acid etching, laser etching, and plasma treatment) and were analyzed by Review Manager 5.4. The evaluation indicator was the bonding strength of zirconia after surface pretreatment with 10-MDP. Results: A total of 72 studies were included in the systematic review, with 68 studies eligible for the meta-analysis. The bonding strength of zirconia decreased significantly after aging [P<0.001; mean difference (MD): 5.58; 95%CI: 5.11-6.05]. No significant differences in bonding strength of zirconia were observed after aging when employing various application methods of 10-MDP (all P>0.05). The bonding strength of zirconia was significantly enhanced after aging when 10-MDP was applied in conjunction with additional surface treatments, as compared to the application of 10-MDP alone (P<0.001; MD: 10.17; 95%CI: 8.20-12.14). Conclusions: The bonding strength of zirconia pretreated with 10-MDP exhibited a reduction after undergoing water storage or thermocycling. The application of 10-MDP with additional surface treatments enhanced the bonding strength of zirconia after aging, while the application methods of 10-MDP did not exert an influence.
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Li W, Xie X, Liu J, Yu H, Li SM. Prenylation of dimeric cyclo-L-Trp-L-Trp by the promiscuous cyclo-L-Trp-L-Ala prenyltransferase EchPT1. Appl Microbiol Biotechnol 2023; 107:6887-6895. [PMID: 37713115 PMCID: PMC10589136 DOI: 10.1007/s00253-023-12773-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
Prenyltransferases (PTs) from the dimethylallyl tryptophan synthase (DMATS) superfamily are known as efficient biocatalysts and mainly catalyze regioselective Friedel-Crafts alkylation of tryptophan and tryptophan-containing cyclodipeptides (CDPs). They can also use other unnatural aromatic compounds as substrates and play therefore a pivotal role in increasing structural diversity and biological activities of a broad range of natural and unnatural products. In recent years, several prenylated dimeric CDPs have been identified with wide range of bioactivities. In this study, we demonstrate the production of prenylated dimeric CDPs by chemoenzymatic synthesis with a known promiscuous enzyme EchPT1, which uses cyclo-L-Trp-L-Ala as natural substrate for reverse C2-prenylation. High product yields were achieved with EchPT1 for C3-N1' and C3-C3' linked dimers of cyclo-L-Trp-L-Trp. Isolation and structural elucidation confirmed the product structures to be reversely C19/C19'-mono- and diprenylated cyclo-L-Trp-L-Trp dimers. Our study provides an additional example for increasing structural diversity by prenylation of complex substrates with known biosynthetic enzymes. KEY POINTS: • Chemoenzymatic synthesis of prenylated cyclo-L-Trp-L-Trp dimers • Same prenylation pattern and position for cyclodipeptides and their dimers. • Indole prenyltransferases such as EchPT1 can be widely used as biocatalysts.
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Yu H, Zhang X, Acevedo-Rocha CG, Li A, Reetz MT. Protein engineering using mutability landscapes: Controlling site-selectivity of P450-catalyzed steroid hydroxylation. Methods Enzymol 2023; 693:191-229. [PMID: 37977731 DOI: 10.1016/bs.mie.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Directed evolution and rational design have been used widely in engineering enzymes for their application in synthetic organic chemistry and biotechnology. With stereoselectivity playing a crucial role in catalysis for the synthesis of valuable chemical and pharmaceutical compounds, rational design has not achieved such wide success in this specific area compared to directed evolution. Nevertheless, one bottleneck of directed evolution is the laborious screening efforts and the observed trade-offs in catalytic profiles. This has motivated researchers to develop more efficient protein engineering methods. As a prime approach, mutability landscaping avoids such trade-offs by providing more information of sequence-function relationships. Here, we describe an application of this efficient protein engineering method to improve the regio-/stereoselectivity and activity of P450BM3 for steroid hydroxylation, while keeping the mutagenesis libraries small so that they will require only minimal screening.
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Liu K, Chen YJ, Su J, Fan XK, Yu H, Qin Y, Yang J, Zhu Z, Guan HY, Shen C, Pan EC, Lu Y, Zhou JY, Wu M. [Association of category of dietary intake and physical activity with the risk of mortality in patients with type 2 diabetes mellitus: a prospective cohort study]. ZHONGHUA LIU XING BING XUE ZA ZHI = ZHONGHUA LIUXINGBINGXUE ZAZHI 2023; 44:1591-1598. [PMID: 37875446 DOI: 10.3760/cma.j.cn112338-20230328-00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective: To investigate the association between dietary intake and physical activity category and their combined effects on all-cause and cause-specific mortality risk in patients with type 2 diabetes mellitus (T2DM). Methods: Between December 2013 and December 2021, a prospective cohort study was conducted on 19 863 T2DM patients in Changshu City, Qingjiangpu District (formerly Qinghe District), and Huai'an District, included in the national basic health service management. Information on deaths and underlying causes of death was obtained from the Jiangsu Provincial CDC and Prevention Death Surveillance System. Cox proportional hazards models were used to estimate the intensity of associations between dietary intake, physical activity, and their combined effects with all-cause and cause-specific mortality in patients with T2DM. Results: As of December 31, 2021, the research subjects had been followed up for 150 283 person-years, with a median follow-up time of 8.15 years. During the follow-up period, 3 293 people died, including 1 124 deaths from cardiovascular disease (CVD) and 875 deaths from cancer. Cox regression analysis showed that compared with the population of 0-1 recommended food group, those having more than five recommended food groups had a 19% lower risk of all-cause mortality [hazard ratio (HR)=0.81, 95%CI: 0.70-0.94] and a 33% lower risk of all-cause mortality (HR=0.67, 95%CI: 0.52-0.87). Compared with the T2DM population in the physical activity Q1 group, the risk of all-cause mortality, CVD mortality, and cancer mortality among the physical activity Q4 group reduced by 50% (HR=0.50, 95%CI: 0.45-0.56), 50% (HR=0.50, 95%CI: 0.41-0.61), and 27% (HR=0.73, 95%CI: 0.60-0.88), respectively. The combined effect showed that compared with the population in the intake of food categories 0-2 and low physical activity groups, the risk of all-cause, CVD mortality, and cancer mortality in the intake of food categories 4-9 and high physical activity groups reduced by 55% (HR=0.45, 95%CI: 0.38-0.53), 56% (HR=0.44, 95%CI: 0.32-0.59), and 40% (HR=0.60, 95%CI: 0.44-0.82), respectively. Conclusion: Type of dietary intake, physical activity, and their combined effects are associated with a reduced mortality risk in patients with T2DM.
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Wang H, Yu H, Zhou YY, Cong WM, Dong H. [Combined hepatocellular-cholangiocarcinoma containing both large and small duct type cholangiocarcinoma: report of a case]. ZHONGHUA BING LI XUE ZA ZHI = CHINESE JOURNAL OF PATHOLOGY 2023; 52:1047-1049. [PMID: 37805401 DOI: 10.3760/cma.j.cn112151-20230110-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
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Yu J, Jiang L, Zhao L, Wang X, Yang X, Yang D, Zhuo M, Chen H, Zhao YD, Zhou F, Li Q, Zhu Z, Chu L, Ma Z, Wang Q, Qu Y, Huang W, Zhang M, Gu T, Liu S, Yang Y, Yang J, Yu H, Yu R, Zhao J, Shi A. High Dose Hyperfractionated Thoracic Radiotherapy vs. Standard Dose for Limited Stage Small-Cell Lung Cancer: A Multicenter, Open-Label Randomized, Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S1. [PMID: 37784261 DOI: 10.1016/j.ijrobp.2023.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Limited stage small-cell lung cancer (LS-SCLC) is associated with poor prognosis. We aimed to assess the efficacy and safety of high-dose, hyperfractionated thoracic radiotherapy of 54 Gy in 30 fractions compared with standard dose (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC. MATERIALS/METHODS The study was an open-label, randomized, phase 3 trial, done at 16 public hospitals in China. Key inclusion criteria were patients aged 18-70 years, with previously histologically or cytologically confirmed LS-SCLC, previously untreated or received 1-2 courses of intravenous cisplatin (75 mg/m²of body-surface area, on day 1 or divided into two days of each cycle) or carboplatin (area under the curve of 5 mg/mL per min, day 1 of each cycle)and intravenous etoposide (100 mg/m²of body-surface area, on days 1-3 of each cycle), and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions or the simultaneous integrated boost VMAT (SIB-VMAT) of 54 Gy in 30 fractions to the primary lung tumor and lymph node metastases starting 0-42 days after the first chemotherapy course. Both groups of patients received thoracic radiotherapy twice per day and 10 fractions per week. Prophylactic cranial radiation (PCI, 25 Gy in 10 fractions) was implemented to patients with responsive disease. The primary endpoint was overall survival. Safety was analyzed in the as-treated population. RESULTS Between June 30, 2017, and April 6, 2021, 224 eligible patients were enrolled and randomly assigned to 54 Gy (n = 108) or 45 Gy (n = 116). Median follow-up for the primary analysis was 45 months (IQR 41-48). Median overall survival was significantly improved in the 54 Gy group (62.4 months) compared with the 45 Gy group (43.1 months; p = 0.001). Median progression-free survival was significantly improved in the 54 Gy group (30.5 months) compared with the 45 Gy group (16.7 months; p = 0.044). The most common grade 3-4 adverse events were neutropenia (30 [28%] of 108 patients in the 54 Gy group vs 27 [23%] of 116 patients in the 45 Gy group), neutropenic infections (6 [6%] vs 2 [2%]), thrombocytopenia (13 [12%] vs 12 [10%]), anemia (6 [6%] vs 4 [3%]), and esophagitis (1 [1%] vs 3 [3%]). Treatment-related serious adverse events occurred in 9 [8%] patients in the 54 Gy group and 16 [14%] patients in the 45 Gy group. There were one treatment-related deaths in 54 Gy group (myocardial infarction). CONCLUSION Compared with standard thoracic radiotherapy dose of 45 Gy, the high dose of 54 Gy improved overall survival and progression-free survival without increasing toxicities in patients with LS-SCLC, supporting twice-daily hyperfractionated thoracic radiotherapy of 54 Gy with concurrent chemotherapy is an alternative treatment option for LS-SCLC. This study is complete and registered with ClinicalTrials.gov, NCT03214003.
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Chen F, Zhou P, Lee KW, Liu Q, Helali AE, Jin JY, Lee AWM, Yu H, Kong FM. Interpretable Deep Learning Identified the Significance of 1 Gy Volume on Lymphopenia after Radiotherapy in Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e168. [PMID: 37784771 DOI: 10.1016/j.ijrobp.2023.06.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Lymphopenia is common after radiotherapy (RT) and is known for its significance on poor survival outcomes in patients with breast cancer. Previous work has demonstrated the significance of point dosimetric factors like the volume receiving 5 Gy. Considering the full dosimetric data together, this study aimed to develop and validate predictive models for lymphopenia after RT in breast cancer. MATERIALS/METHODS Patients with breast cancer treated with radiation therapy in adjuvant setting and with complete dosimetric data were eligible. Combining dose-volume histogram (DVH) dosimetric and clinical factors, dense neural network (DNN) models were developed to predict both the reduction in lymphocyte counts and the graded lymphopenia in breast cancer patients after adjuvant RT. A Shapley additive explanation was applied to explain each feature's directional contributions. The generalization of DNN models was validated in both internal and independent external validation cohorts. P<0.05 was considered to be significant. RESULTS A total of 928 consecutive patients with invasive breast cancer were eligible for this study. Treatment volumes of nearly all irradiation dose levels of DVH were significant predictors for lymphopenia after RT, including volumes at very low-dose 1 Gy (V1) of all structures considered including the lung, heart and body. DNN models using full DVH dosimetric and clinical factors were built and a simplified model was further established and validated in both internal and external validation cohorts. This simplified DNN AI model, combining full DVH dosimetric parameters of all OARs and five key clinical factors including baseline lymphocyte counts, tumor stage, RT technique, RT fields and RT fractionation, showed a predictive accuracy of 77% and above. CONCLUSION This study demonstrated and externally validated the significance of an AI model of combining clinical and full dosimetric data, especially the volume of low dose at as low as 1 Gy of all critical structures on lymphopenia after RT in patients with breast cancer. The significance of V1 deserves special attention, as modern arc RT technology often has relatively high value of this parameter. Further study warranted for breast cancer RT plan optimization.
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Zhou Z, Wang Y, Zhao F, Yao G, Yu H, Yu H, Bu L, Lu Z, Yan S. Radiation Induced Lung Injury in Rats after Pre-Oxygenation Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e279-e280. [PMID: 37785046 DOI: 10.1016/j.ijrobp.2023.06.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Deep inspiratory breath holding (DIBH) has been widely used during the radiotherapy of thoracic tumors. The main disadvantage of voluntary DIBH is the short duration of each breath hold. The hypocapnia induced by hyperoxia (oxygen concentration > 50%) pre-oxygenation (PreO2) combined with mechanical hyperventilation has been reported to prolong the duration of single breath hold, but its safety remains controversial, especially the sensitivity of lung tissue to radiation damage under hyperoxia exposure has not been elucidated. In this study, we aim to investigate the changes of radiation induced lung injury in rats after PreO2 radiation. MATERIALS/METHODS We evaluated the lung tissue of rats at different time points (48h, 2w, 4w, 8w, 12w) after thoracic radiation (15Gy single fraction to the right lung), and sequenced the transcriptome of lung tissue at 48 hours after irradiation. Rat cohorts (n = 7/group): 1. Control (Con); 2. Radiation group (RT); 3. Pre-oxygenation (oxygen concentration > 90%) for 8 hours before thoracic radiation (PreO2). RESULTS The inflammatory exudation emerged in the pulmonary interstitium at 48 hours, and reached the most serious alveolitis after four weeks of irradiation (the comparison of alveolitis scores in RT4w vs Con4w and PreO2(4w) vs Con4w, P<0.001) on hematoxylin-eosin staining. While the alveolitis scores in RT group and PreO2 group were not statistically different at each time point. Masson staining showed that the pulmonary fibrosis in the RT group and the PreO2 group reached an obvious pathological change at 12 weeks after irradiation, but the difference between the two groups was not significant. Transcriptome sequencing showed that the number of differential genes in PreO2 vs Con was 559 (302 up-regulated genes and 257 down-regulated genes). The GO enrichment analysis indicated that chromosome segregation was the most significant functional item with P value in the comparative analysis, and the KEGG enrichment analysis suggested that cell division was the most significant enrichment pathway of these differential genes. While there was a small quantity of differential genes in PreO2 vs RT group (3 up-regulated genes and 12 down-regulated genes). Pentose and glucuronate conversions were the most significant enrichment pathway of these differential genes. CONCLUSION This study demonstrated that PreO2 radiotherapy did not increase the severity of radiation induced lung injury in rats compared to conventional radiotherapy. Further study should be conducted to confirm these results and to investigate the regulatory mechanism of pneumonia caused by PreO2 radiotherapy.
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Zhang Y, Ye X, Ge J, Guo D, Zheng D, Yu H, Chen Y, Yao G, Lu Z, Yuille A, Lu L, Jin D, Yan S. Deep Learning-Based Multi-Modality Segmentation of Primary Gross Tumor Volume in CT and MRI for Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e498. [PMID: 37785566 DOI: 10.1016/j.ijrobp.2023.06.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The delineation of primary gross tumor volume (GTV) of nasopharyngeal carcinoma (NPC) is an essential step for radiotherapy planning. In clinical practice, radiation oncologists manually delineate the GTV in planning CT with the help of diagnostic MRI. This is because NPC tumors are closely adjacent to many important anatomic structures, and CT and MRI provide complementary strength to accurately determine the tumor extension boundary. Manual delineation is time-consuming with the potential registration errors between MRI and CT decreasing the delineation accuracy. In this study, we propose a fully automated GTV segmentation method based on CT and MRI by first aligning MRI to CT, and then, segmenting the GTV using a multi-modality deep learning model. MATERIALS/METHODS We collected 104 nasopharyngeal carcinoma patients with both planning CT and diagnostic MRI scans (T1 & T2 phases). An experienced radiation oncologists manually delineated the GTV, which was further examined by another senior radiation oncologist. Then, a coarse to fine cross-modality registration from MRI to CT was conducted as follows: (1) A rigid transformation was performed on MRI to roughly align MRI to CT with similar anatomic position. (2) Then, the region of interest (RoI) on both CT and rigid-transformed MRI were cropped. (3) A leading cross-modality deformable registration algorithm, named DEEDS, was applied on the cropped MRI and CT RoIs to find an accurate local alignment. Next, using CT and registered MRI as the combined input, a multi-modality deep segmentation network based on nnUNet was trained to generate the GTV prediction. 20% patients were randomly selected as the unseen testing set to quantitatively evaluate the performance. RESULTS The quantitative NPC GTV segmentation performance is summarized in Table 1. The deep segmentation model using CT alone achieved reasonable high performance with 76.6% Dice score and 1.34mm average surface distance (ASD). When both CT and registered MRI were used, the segmentation model further improved the performance by 0.9% Dice score increase and 11% relative ASD error reduction, demonstrating the complementary strength of CT and MRI in determining NPC GTV. Notably, the achieved 77.5% Dice score and 1.19mm ASD by the multimodality model is among the top performing results reported in recent automatic NPC GTV segmentation using either CT or MRI modality. CONCLUSION We developed a fully automated multi-modal deep-learning model for NPC GTV segmentation. The developed model can segment the NPC GTV in high accuracy. With further optimization and validation, this automated model has potential to standardize the NPC GTV segmentation and significantly decrease the workload of radiation oncologists in clinical practice.
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