A transformer-based representation-learning model with unified processing of multimodal input for clinical diagnostics.

During the diagnostic process, clinicians leverage multimodal information, such as the chief complaint, medical images and laboratory test results. Deep-learning models for aiding diagnosis have yet to meet this requirement of leveraging multimodal information. Here we report a transformer-based representation-learning model as a clinical diagnostic aid that processes multimodal input in a unified manner. Rather than learning modality-specific features, the model leverages embedding layers to convert images and unstructured and structured text into visual tokens and text tokens, and uses bidirectional blocks with intramodal and intermodal attention to learn holistic representations of radiographs, the unstructured chief complaint and clinical history, and structured clinical information such as laboratory test results and patient demographic information. The unified model outperformed an image-only model and non-unified multimodal diagnosis models in the identification of pulmonary disease (by 12% and 9%, respectively) and in the prediction of adverse clinical outcomes in patients with COVID-19 (by 29% and 7%, respectively). Unified multimodal transformer-based models may help streamline the triaging of patients and facilitate the clinical decision-making process.

Steric Effects in the Deposition Mode and Drug-Delivering Efficiency of Nanocapsule-Based Multilayer Films.

Using surface-initiated atom transfer radical polymerization (ATRP), block polymers with a series of quaternization degrees were coated on the surface of silica nanocapsules (SNCs) by the "grafting-from" technique. Molnupiravir, an antiviral medicine urgently approved for the treatment of SARS-CoV-2, was encapsulated in polymer-coated SNCs and further incorporated into well-defined films with polystyrene sulfonate (PSS) homopolymers by layer-by-layer (LBL) self-assembly via electrostatic interactions. We investigated the impact of the quaternization degree of the polymers and steric hindrance of functional groups on the growth mode, swelling/deswelling transition, and drug-delivering efficiency of the obtained LBL films. The SNCs were derived from coronas of parent block polymers of matched molecular weights-poly(N-isopropylacrylamide)-block-poly(N,N-dimethylaminoethyl methacrylate) (PNIPAM-b-PDMAEMA)-by quaternization with methyl sulfate. As revealed by the data results, SNCs with coronas with higher quaternization degrees resulted in a larger layering distance of the film structure because of weaker ionic pairing (due to the presence of a bulky methyl spacer) between SNCs and PSS. Interestingly, when comparing the drug release profile of the encapsulated drugs from SNC-based films, the release rate was slower in the case of capsule coronas with higher quaternization degrees because of the larger diffusion distance of the encapsulated drugs and stronger hydrophobic-hydrophobic interactions between SNCs and drug molecules.

Correlation between vaccine coverage and the COVID-19 pandemic throughout the world: Based on real-world data.

The aim of the study was to examine the correlation between COVID-19 vaccine coverage rates and outcomes of the COVID-19 epidemic in the case of COVID-19 variants based on real-world data. The data came from Our World in Data, which is building the international COVID-19 vaccination data set and is an open-source data set for everyone to use. The vaccination data set uses the most recent official numbers from governments and health ministries worldwide. We assessed the correlation between COVID-19 vaccine coverage rates and outcomes of the COVID-19 epidemic with existing variants by performing temporal analysis and spatial analysis. Overall, new cases per million population, the reproduction rate of COVID-19, new deaths from all causes per million population, excess mortality attributed to COVID-19 pandemic, and hospital patients or intensive care unit (ICU) patients per million population were not decreased with the time course. However, at the same time point, new cases per million population, the reproduction rate of COVID-19, new deaths per million population, and hospital patients or ICU patients per million population gradually decreased as the rate of vaccination coverage increased. High coverage percentages of COVID-19 vaccination were negatively correlated with the reproduction rate of COVID-19 (correlation coefficient -0.116) and ICU patients per million of the local population (correlation coefficient -0.055). Currently, there is no effective treatment for the COVID-19 pandemic, and prevention of the COVID-19 pandemic mainly depends on vaccines, especially when the rate of COVID-19 vaccine coverage is over 60%. The benefits of preventing severe disease and preventing transmission of infection are likely to be obvious.

Clinical characteristics of COVID-19 in family clusters: a systematic review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world and reports of children during early epidemic period showed features of family clusters. The aim of this study is to assess clinical profiles of COVID-19 in family clusters with children. METHODS: We performed a systematic literature review of English database (PubMed, Web of Science) and Chinese database (" www.cnki.net ", " www.cqvip.com " and " www.Wanfangdata.com.cn ") to identify papers on family clusters of COVID-19 with children and their family members. RESULTS: Eighteen studies involving 34 children and 98 adults from 28 families were included. Fever, cough and ground-grass opacity change of chest computed tomography (CT) were the dominant features, whereas proportion of asymptomatic infections for children was higher than adults with statistical significance (32.4% and 13.3%, respectively, P < 0.05). Median time of longer incubation period (10 days) and shorter duration of pharyngeal swab nucleic acid test positive period (11 days) were seen in children than adults (7 and 17 days, respectively) with statistical significance (P < 0.05). There were statistically significant differences in lymphopenia, increased C-reactive protein and abnormal chest CT between children and adult patients (P < 0.05). Twenty-seven families reported adults as first case of COVID-19 in family clusters. CONCLUSIONS: The same virus strain can cause milder disease in children compared with their caregivers. Children of COVID-19 were infected by adults in family during the early epidemic period. Asymptomatic patients can transmit the virus.

Epidemiologic and clinical characteristics of 10 children with coronavirus disease 2019 in Changsha, China.

BACKGROUND: The outbreak of a new coronavirus, first reported in Wuhan, China, is spreading around the world. Information on the characteristics of children with Coronavirus Disease 2019 (COVID-19) is limited. METHODS: In this retrospective study, we recruited 10 children infected with SARS-COV-2 from January 27 to March 10, 2020, in Changsha, China. We report the epidemiological, clinical, laboratory, and high-resolution CT findings for these children. Qualitative descriptive analysis was used to describe the key results. RESULTS: Ten children were included. Three were male and seven were female. Three were from Wuhan, Hubei Province, and seven were from Changsha. All had a history of close contact with adults with COVID-19 before the onset of disease. Clinical manifestations included fever in four cases, respiratory symptoms in three cases, febrile convulsions in one case, vomiting in one case, abdominal pain in one case, and asymptomatic infection in two cases. All the children tested positive for nucleic acid in throat swabs at admission. Stool swabs of three cases were positive for nucleic acid after several days of fever. In nine children, blood routine results were normal, whereas in one case the white blood cell count was elevated. In four cases, CT findings of the lungs showed light ground-glass opacities, one case showed changes similar to bronchopneumonia, and the remaining cases were normal. All were treated with symptomatic support without complications. CONCLUSION: Our findings indicate that intrafamily transmission may be the main form of transmission of COVID-19 in children, and persistent intestinal excretion of virus is another characteristic among children. The results of stool swab tests should be considered for discharge and release from isolation.