Artificial intelligence promotes shared decision-making through recommending tests to febrile pediatric outpatients.

BACKGROUND: To promote the shared decision-making (SDM) between patients and doctors in pediatric outpatient departments, this study was designed to validate artificial intelligence (AI) -initiated medical tests for children with fever. METHODS: We designed an AI model, named Xiaoyi, to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic. We calculated the sensitivity, specificity, and F1 score to evaluate the efficacy of Xiaoyi's recommendations. The patients were divided into the rejection and acceptance groups. Then we analyzed the rejected examination items in order to obtain the corresponding reasons. RESULTS: We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics. The recommended examinations given by Xiaoyi for 10,636 (89.6%) patients were qualified. The average F1 score reached 0.94. A total of 58.4% of the patients accepted Xiaoyi's suggestions (acceptance group), and 41.6% refused (rejection group). Imaging examinations were rejected by most patients (46.7%). The tests being time-consuming were rejected by 2,133 patients (43.2%), including rejecting pathogen studies in 1,347 patients (68.5%) and image studies in 732 patients (31.8%). The difficulty of sampling was the main reason for rejecting routine tests (41.9%). CONCLUSION: Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients, and is worth promoting in facilitating SDM.

Improved LDTW Algorithm Based on the Alternating Matrix and the Evolutionary Chain Tree.

Dynamic time warping under limited warping path length (LDTW) is a state-of-the-art time series similarity evaluation method. However, it suffers from high space-time complexity, which makes some large-scale series evaluations impossible. In this paper, an alternating matrix with a concise structure is proposed to replace the complex three-dimensional matrix in LDTW and reduce the high complexity. Furthermore, an evolutionary chain tree is proposed to represent the warping paths and ensure an effective retrieval of the optimal one. Experiments using the benchmark platform offered by the University of California-Riverside show that our method uses 1.33% of the space, 82.7% of the time used by LDTW on average, which proves the efficiency of the proposed method.

Cord blood 25(OH)D3, cord blood total immunoglobulin E levels, and food allergies in infancy: A birth cohort study in Chongqing, China.

Background: Food allergy (FA) in infants has become a common disease worldwide. There are many controversies surrounding the relationships among levels of cord blood 25-hydroxy vitamin D3 [25(OH)D3], total immunoglobulin E (IgE), and FA. Methods: In this study, we recruited pregnant women in the third trimester undergoing obstetric examination in Chongqing City, Western China. Healthy full-term singleton births between May to August 2018 and November 2018 to January 2019 were included in the summer-birth and winter-birth cohorts, respectively. Questionnaires on vitamin D status in pregnancy and family allergies were used to investigate the pregnant women. The levels of <12 ng/mL, 12～20 ng/mL, and >20 ng/mL 25(OH)D3 in cord blood detected by liquid chromatography tandem mass spectrometry were considered deficient, insufficient, and sufficient, respectively. The electrochemiluminescence method was used to detect the total lgE levels in cord blood, classified into low-IgE (<0.35 IU/mL) and high-IgE (≥0.35 IU/mL) levels, respectively. Within postnatal 6 months, allergic symptoms in infants were investigated using questionnaire during the infants' monthly physical examinations. Suspected cases of FA underwent a history inquiry, skin prick test, food elimination test, and open-food challenge for diagnosis of FA. Multivariate logistic regression was used to analyze the risk factors of FA in infants. Results: In this study, we recruited 741 pairs of pregnant women and infants, including 343 infants in the summer-birth cohort and 398 infants in the winter-birth cohort. The incidence of FA within postnatal 6 months was 6.88%, showing significantly higher incidence of FA in the winter-birth cohorts than in the summer-birth cohorts (10.3% vs. 2.9%, χ2 = 15.682, P = 0.000). Among the 741 infants, 47.1%, 27.5%, and 13.8% of infants had deficient, insufficient, and sufficient 25(OH)D3, respectively, in the cord blood; 81.5% and 18.5% of infants had total low-IgE and total high-IgE levels, respectively, in the cord blood. No significant correlation was found between the 25(OH)D3 and IgE levels (r = -0.038, P = 0.300). Logistic regression analysis showed that winter birth [odds ratio (OR) 95% confidence interval (CI): 4.292 (2.003～8.359)] compared with infants in summer birth group, and sufficient (>20 ng/mL) 25(OH)D3 levels in cord blood [OR (95% CI): 2.355 (1.129～4.911) compared with infants in the deficient group (<12 ng/mL) and 3.782 (1.680～8.514) compared with infants in the insufficient group (12～20 ng/mL)] were independent risk factors for FA in infants within postnatal 6 months. Conclusions: Winter birth and sufficient 25(OH)D3 levels in infant cord blood were independent risk factors for FA in infants. 25(OH)D3 and total IgE levels in cord blood cannot be used as predictors of FA in early infancy.

Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China.

BACKGROUND: Asthma has been a global problem, especially in children. We aim to evaluate the contemporary prevalence and influencing factors of asthma among children aged 3-7 years in Shanghai, China. METHODS: A random sample of preschool children was included in this study. The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma. Multivariable logistic regression models were used to evaluate the associations between independent variables and childhood asthma. RESULTS: Of 6389 preschool children who were invited to take part in this study, 6163 (response rate: 96.5%) completed the questionnaire and were included in the analysis. The overall prevalence of asthma was 14.6% which increased more than six folds from 2.1% in 1990. Being male, younger age, preterm delivery, being born in spring or autumn, being delivered by elective cesarean section without indication, miscarriage, high socioeconomic status, having allergy history, and exposure to passive smoking, latex paint, and dust were potential risk factors for childhood asthma. Spending more time outdoors (> 30 min/day), having indoor plants, and cleaning rooms more frequently were potential protective factors. CONCLUSIONS: The prevalence of childhood asthma in Shanghai has increased dramatically during the past three decades. The findings about risk and protective factors of childhood asthma could be used to develop appropriate strategies to prevent and control childhood asthma in Shanghai and in other similar metropolitan cities.

Real-World Verification of Artificial Intelligence Algorithm-Assisted Auscultation of Breath Sounds in Children.

Objective: Lung auscultation plays an important role in the diagnosis of pulmonary diseases in children. The objective of this study was to evaluate the use of an artificial intelligence (AI) algorithm for the detection of breath sounds in a real clinical environment among children with pulmonary diseases. Method: The auscultations of breath sounds were collected in the respiratory department of Shanghai Children's Medical Center (SCMC) by using an electronic stethoscope. The discrimination results for all chest locations with respect to a gold standard (GS) established by 2 experienced pediatric pulmonologists from SCMC and 6 general pediatricians were recorded. The accuracy, sensitivity, specificity, precision, and F1-score of the AI algorithm and general pediatricians with respect to the GS were evaluated. Meanwhile, the performance of the AI algorithm for different patient ages and recording locations was evaluated. Result: A total of 112 hospitalized children with pulmonary diseases were recruited for the study from May to December 2019. A total of 672 breath sounds were collected, and 627 (93.3%) breath sounds, including 159 crackles (23.1%), 264 wheeze (38.4%), and 264 normal breath sounds (38.4%), were fully analyzed by the AI algorithm. The accuracy of the detection of adventitious breath sounds by the AI algorithm and general pediatricians with respect to the GS were 77.7% and 59.9% (p < 0.001), respectively. The sensitivity, specificity, and F1-score in the detection of crackles and wheeze from the AI algorithm were higher than those from the general pediatricians (crackles 81.1 vs. 47.8%, 94.1 vs. 77.1%, and 80.9 vs. 42.74%, respectively; wheeze 86.4 vs. 82.2%, 83.0 vs. 72.1%, and 80.9 vs. 72.5%, respectively; p < 0.001). Performance varied according to the age of the patient, with patients younger than 12 months yielding the highest accuracy (81.3%, p < 0.001) among the age groups. Conclusion: In a real clinical environment, children's breath sounds were collected and transmitted remotely by an electronic stethoscope; these breath sounds could be recognized by both pediatricians and an AI algorithm. The ability of the AI algorithm to analyze adventitious breath sounds was better than that of the general pediatricians.

Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology.

BACKGROUND: Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness. Virtual touch imaging quantification (VTIQ) based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children. AIM: To determine the standard value in healthy children, and to identify possible factors that might influence the VTIQ measurement. METHODS: With the ethical approval, 202 children between 1 month and 15 years old were included in this study. None of them had any liver or systematic diseases. All children had a normal ultrasound scan and normal body mass index (BMI) range. The subjects were divided into four age and BMI groups. The effects of gender, age, liver lobe, measurement depth, and BMI on liver elasticity were investigated. RESULTS: A significant correlation was found between age and shear wave velocity (SWV) value. At measurement depths of 1.5 cm and 2.0 cm in the left lobe, there were significant differences among the age groups. SWV values were significantly negatively correlated with the measurement depth. Gender, liver lobe, and BMI showed no significant effect on the SWV values. Age and BMI may influence the quality of the elastogram. CONCLUSION: VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children. The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.

Directional virtual backbone based data aggregation scheme for Wireless Visual Sensor Networks.

Data gathering is a fundamental task in Wireless Visual Sensor Networks (WVSNs). Features of directional antennas and the visual data make WVSNs more complex than the conventional Wireless Sensor Network (WSN). The virtual backbone is a technique, which is capable of constructing clusters. The version associating with the aggregation operation is also referred to as the virtual backbone tree. In most of the existing literature, the main focus is on the efficiency brought by the construction of clusters that the existing methods neglect local-balance problems in general. To fill up this gap, Directional Virtual Backbone based Data Aggregation Scheme (DVBDAS) for the WVSNs is proposed in this paper. In addition, a measurement called the energy consumption density is proposed for evaluating the adequacy of results in the cluster-based construction problems. Moreover, the directional virtual backbone construction scheme is proposed by considering the local-balanced factor. Furthermore, the associated network coding mechanism is utilized to construct DVBDAS. Finally, both the theoretical analysis of the proposed DVBDAS and the simulations are given for evaluating the performance. The experimental results prove that the proposed DVBDAS achieves higher performance in terms of both the energy preservation and the network lifetime extension than the existing methods.

Semi-automatic segmentation of femur based on harmonic barrier.

BACKGROUND AND OBJECTIVE: Segmentation of the femur from the hip joint in computed tomography (CT) is an important preliminary step in hip surgery planning and simulation. However, this is a time-consuming and challenging task due to the weak boundary, the varying topology of the hip joint, and the extremely narrow or blurred space between the femoral head and the acetabulum. To address these problems, this study proposed a semi-automatic segmentation framework based on harmonic fields for accurate segmentation. METHODS: The proposed method comprises three steps. First, with high-level information provided by the user, shape information provided by neighboring slices as well as the statistical information in the mask, a region selection method is proposed to effectively locate joint space for the harmonic field. Second, incorporated with an improved gradient, the harmonic field is used to adaptively extract a curve as the barrier that separates the femoral head from the acetabulum accurately. Third, a divide and conquer segmentation strategy based on the harmonic barrier is used to combine the femoral head part and body part as the final segmentation result. RESULTS: We have tested 40 hips with considerately narrow or disappeared joint spaces. The experimental results are evaluated based on Jaccard, Dice, directional cut discrepancy (DCD) and receiver operating characteristic (ROC), and we achieve the higher Jaccard of 84.02%, Dice of 85.96%, area under curve (AUC) of 89.3%, and the lower error with DCD of 0.52mm. The effective ratio of our method is 79.1% even for cases with severe malformation. The results show that our method performs best in terms of effectiveness and accuracy on the whole data set. CONCLUSIONS: The proposed method is efficient to segment femurs with narrow joint space. The accurate segmentation results can assist the physicians for osteoarthritis diagnosis in future.

Automatic Tooth Segmentation of Dental Mesh Based on Harmonic Fields.

An important preprocess in computer-aided orthodontics is to segment teeth from the dental models accurately, which should involve manual interactions as few as possible. But fully automatic partition of all teeth is not a trivial task, since teeth occur in different shapes and their arrangements vary substantially from one individual to another. The difficulty is exacerbated when severe teeth malocclusion and crowding problems occur, which is a common occurrence in clinical cases. Most published methods in this area either are inaccurate or require lots of manual interactions. Motivated by the state-of-the-art general mesh segmentation methods that adopted the theory of harmonic field to detect partition boundaries, this paper proposes a novel, dental-targeted segmentation framework for dental meshes. With a specially designed weighting scheme and a strategy of a priori knowledge to guide the assignment of harmonic constraints, this method can identify teeth partition boundaries effectively. Extensive experiments and quantitative analysis demonstrate that the proposed method is able to partition high-quality teeth automatically with robustness and efficiency.

Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis.

OBJECTIVES: Epidemiologic studies have shown that chronic short sleep may be associated with the development of hypertension; however, the results are controversial. This meta-analysis was conducted to determine whether the duration of sleep is associated with hypertension. METHODS: Reference databases (PubMed, EmBase, the Cochrane Library, Chinese Biological Medicine database) were searched for studies related to sleep duration and hypertension. Sleep duration categories (≤ 5 h, 6 h, 7 h, 8 h, ≥ 9 h) and prevalence or incidence of hypertension in each sleep category were extracted. A general analysis and subgroup analyses stratified by gender, age, study design, and different definitions of sleep duration were conducted to evaluate the relationship between sleep duration and hypertension. RESULTS: Thirteen articles out of a total of 1,628 articles involving 347,759 participants met the inclusion criteria. A U-shaped change in pooled odds ratios (ORs) for hypertension due to the change of sleep duration was observed. The unadjusted OR for hypertension of individuals who slept ≤ 5 h vs. 7 h was 1.61, 95% CI = 1.28-2.02; those who slept ≥ 9 h vs. 7 h was 1.29, 95% CI = 0.97-1.71. The pooled ORs were still significant after adjusted by age and gender. Women deprived of sleep (sleep time ≤ 5 h vs. 7 h, OR = 1.68, 95% CI = 1.39-2.03) had a higher risk of hypertension than men (OR = 1.30, 95% CI = 0.93-1.83). CONCLUSION: Excessively longer and shorter periods of sleep may both be risk factors for high blood pressure; these associations are stronger in women than men.

Interactive tooth partition of dental mesh base on tooth-target harmonic field.

The accurate tooth partition of dental mesh is a crucial step in computer-aided orthodontics. However, tooth boundary identification is not a trivial task for tooth partition, since different shapes and their arrangements vary substantially among common clinical cases. Though curvature field is traditionally used for identifying boundaries, it is normally not reliable enough. Other methods may improve the accuracy, but require intensive user interaction. Motivated by state-of-the-art general interactive mesh segmentation methods, this paper proposes a novel tooth-target partition framework that employs harmonic fields to partition teeth accurately and effectively. In addition, a refining strategy is introduced to successfully segment teeth from the complicated dental model with indistinctive tooth boundaries on its lingual side surface, addressing an issue that had not been solved properly before. To utilise high-level information provided by the user, smart and intuitive user interfaces are also proposed with minimum interaction. In fact, most published interactive methods specifically designed for tooth partition are lacking efficient user interfaces. Extensive experiments and quantitative analyses show that our tooth partition method outperforms the state-of-the-art approaches in terms of accuracy, robustness and efficiency.

Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies.

AIMS: Multiple studies have investigated the prognostic role of red blood cell distribution width (RDW) for patients with heart failure (HF), but the results have been inconsistent. The aim of the present study was to estimate the impact of RDW on the prognosis of HF by performing a systematic review and meta-analysis. METHODS AND RESULTS: The Embase, PubMed, and Web of Science databases were searched up to November 16, 2013 to identify eligible cohort studies. The quality of each study was assessed using the Newcastle-Ottawa Scale (NOS). The association between RDW, either on admission or at discharge, and HF outcomes (all-cause mortality [ACM], heart transplantation, cardiovascular mortality, and rehospitalization, etc.) were reviewed. The overall hazard ratio (HR) for the effect of RDW on ACM was pooled using a random-effects model, and the publication bias was evaluated using funnel plots and Eggers' tests. Seventeen studies, with a total of 18288 HF patients, were included for systematic review. All eligible studies indicated that RDW on admission and RDW at discharge, as well as its change during treatment, were of prognostic significance for HF patients. The HR for the effect of a 1% increase in baseline RDW on ACM was 1.10 (95% confidence interval: 1.07-1.13), based on pooling of nine studies that provided related data. However, publication bias was observed among these studies. CONCLUSIONS: HF patients with higher RDW may have poorer prognosis than those with lower RDW. Further studies are needed to explore the potential mechanisms underlying this association.

Antitumor and antiangiogenic activity of Schisandra chinensis polysaccharide in a renal cell carcinoma model.

The aim of this study was to determine the antitumor and antiangiogenic effects of the Schisandra chinensis polysaccharides (SCP) in selected renal cell carcinoma (RCC) cells and evaluate its potential mechanism of action. In vitro, endothelial growth factor (VEGF) secretion by Caki-1 was blockaded in response to SCP treatment for 48h. In vivo, a significant tumor growth inhibition effect was observed after SCP administration for 4 weeks. Moreover, SCP treatment decreased the level of VEGF, CD31 and CD34 in RCC tumor tissues. Further analysis of the tumor inhibition mechanism indicated that the number of apoptotic tumor cells increased significantly; the expression of Bax and p53 increased; and the expression of Bcl-2 decreased dramatically in transplanted tumor tissues following SCP administration. These results indicated that the potential mechanisms involved by which SCP exerted its antitumor and antiangiogenic activity might be associated with the up-regulation of Bax and p53, downregulation of Bcl-2, as well as the reduction of VEGF, CD31 and CD34 in xenografted tumors. These findings demonstrated that the SCP is a potential antitumor agent for RCC treatment.

SCP, a polysaccharide from Schisandra chinensis, induces apoptosis in human renal cell carcinoma Caki-1 cells through mitochondrial-dependent pathway via inhibition of ERK activation.

This study is the first to investigate the anticancer effect of Schisandra chinensis polysaccharide (SCP) in renal cell carcinoma (RCC) cells. The results revealed that SCP treatment showed high cytotoxic potency in Caki-1 cells by inducing apoptosis, which is associated with the disruption of mitochondrial membrane potential (MMP), release of cytochrome c into the cytosol, increase of Bax/Bcl-2 ratio, activation of caspase-3/9, and cleavage of poly(ADP-ribose) polymerase (PARP). Furthermore, pan-caspase inhibitor (z-VAD-fmk) significantly blocked SCP-induced apoptosis and PARP cleavage in Caki-1 cells. As well, we also observed that SCP inhibited the phosphorylation of ERK1/2, whereas it had no significant inhibition effect on the phospho-p38 and phospho-JNK activity. All the above parameters provided scientific evidence that SCP induced mitochondrial-mediated apoptosis in Caki-1 cells through the inactivation of ERK pathways, which may shed further light on its potential application as a cancer chemopreventive agent against RCC.

mda-7/IL-24, novel anticancer cytokine: focus on bystander antitumor, radiosensitization and antiangiogenic properties and overview of the phase I clinical experience (Review).

Subtraction hybridization applied to a 'differentiation therapy' model of cancer employing human melanoma cells resulted in the cloning of melanoma differentiation associated gene-7/interleukin-24 (mda-7/IL-24). Initial studies confirm an inverse correlation between mda-7 expression and melanoma development and progression. Forced expression of mda-7 by means of a plasmid or via a replication incompetent adenovirus (Ad.mda-7) promotes growth suppression and induces apoptosis in a broad array of human cancers. In contrast, mda-7 does not induce growth suppressive or toxic effects in normal cells. Based on structure (containing an IL-10 signature motif), secretion by cells (including subsets of T-cells) and location on chromosome 1q (in an area containing IL-10-family genes), mda-7 has now been renamed mda-7/IL-24. Studies by several laboratories have uncovered many of mda-7/IL-24's unique properties, including cancer-specific apoptosis-induction, cell cycle regulation, an ability to inhibit angiogenesis, potent 'bystander antitumor activity' and a capacity to enhance the sensitivity of tumor cells to radiation, chemotherapy and monoclonal antibody therapy. Moreover, based on its profound cancer tropism, substantiated by in vivo human xenograft studies in nude mice, mda-7/IL-24 (administered as Ad.mda-7) was evaluated in a phase I clinical trial in patients with melanomas and solid cancers. These studies document that mda-7/IL-24 is well tolerated and demonstrates evidence of significant clinical activity. In these contexts, mda-7/IL-24 represents a unique cytokine gene with potential for therapy of human cancers. The present review focuses on three unique properties of mda-7/IL-24, namely its potent 'bystander antitumor activity', ability to sensitize tumor cells to radiation, and its antiangiogenesis properties. Additionally, an overview of the phase I clinical trial is provided. These studies affirm that mda-7/IL-24 has promise for the management of diverse cancers.