A sandglass ladder residual network(SLRN)is proposed for multi-label chest X-ray classification,thereby improving the accuracy of clinical diagnosis.SLRN consists of 3 key modules:(1)a sandglass convolutional module to simultaneously extract inter-channel and spatial information;(2)a ladder self attention block to achieve different window divisions through shift operations,expand the receptive field,and realize multi-scale feature extraction and fusion;(3)class specific residual attention in the multi-label classification stage to capture the correlation between different labels and the importance of features for accomplishing more accurate classification by adjusting the weights of different features.The proposed model is validated using the IU X-Ray dataset collected by Indiana University and the publicly available Chest X-Ray14 dataset collected by the National Institutes of Health in the United States;and the results demonstrate that SLRN which combines the advantages of convolutional neural network and vision transformer enables the capture of local features and global correlations in images,better handles long-distance dependencies,and assists doctors in clinical diagnosis.

A sandglass ladder residual network(SLRN)is proposed for multi-label chest X-ray classification,thereby improving the accuracy of clinical diagnosis.SLRN consists of 3 key modules:(1)a sandglass convolutional module to simultaneously extract inter-channel and spatial information;(2)a ladder self attention block to achieve different window divisions through shift operations,expand the receptive field,and realize multi-scale feature extraction and fusion;(3)class specific residual attention in the multi-label classification stage to capture the correlation between different labels and the importance of features for accomplishing more accurate classification by adjusting the weights of different features.The proposed model is validated using the IU X-Ray dataset collected by Indiana University and the publicly available Chest X-Ray14 dataset collected by the National Institutes of Health in the United States;and the results demonstrate that SLRN which combines the advantages of convolutional neural network and vision transformer enables the capture of local features and global correlations in images,better handles long-distance dependencies,and assists doctors in clinical diagnosis.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Objective:To identify the genetic variation in a mucopolysaccharidosis type Ⅱ(MPS Ⅱ)family, and conduct a functional study of iduronate-2-sulfatase(IDS): c.323A>C.Methods:A five-generation MPS Ⅱ family of 83 individuals including 4 patients from northern China was collected. Urine mucopolysaccharide and Alder-Reilly body were tested to assist the clinical diagnosis of MPS Ⅱ. IDS enzyme activity was detected on core family members. By the whole exome sequencing of a MPS Ⅱ patient in this family and bioinformatics analysis, the variant was screened and further identified by PCR-Sanger sequencing. Finally, to validate the function of the variant in vitro, the wild-type IDS overexpression plasmid(pCMV-hIDS-WT)and the IDS overexpression plasmid carrying the mutation site(pCMV-hIDS-c.323A>C)were transfected into COS-7 cells and the IDS activity was detected. Results:The proband(Ⅳ3)and Ⅳ4 were diagnosed as MPS Ⅱ by urine mucopolysaccharide, Alder-Reilly body, and IDS enzyme activity tests. Ⅳ3, Ⅳ4, Ⅲ19, and Ⅲ32 were determined to carry IDS: c.323A>C missense variant through the whole-exome sequencing, and diagnosed as MPS Ⅱ. Meanwhile, Ⅱ2, Ⅱ4, Ⅱ8, Ⅱ12, Ⅱ14, Ⅲ5, Ⅲ7, Ⅳ14 in the MPS Ⅱ family carried IDS: c.323A>C missense variant, and were excluded as MPS Ⅱ. The in vitro experiment in COS-7 cells showed that the missense mutation led to a significant decrease in IDS enzyme activity. Conclusion:The variant IDS: c.323A>C: p.Y108S significantly decreases the activity of IDS enzyme in vivo and in vitro, and it is identified as a pathogenic variant for MPS Ⅱ.

Hepatic ischemia-reperfusion injury (HIRI) is a very common complication of liver transplantation, liver resection, and shock. At present, many studies have been conducted on HIRI, but there is still a lack of drugs for radical treatment in clinical practice. Many factors, such as related cells, molecular mechanisms and signaling pathways, reactive oxygen species and oxidative stress response, nitric oxide, and mitochondria, mediate the development and progression of HIRI, which leads to the decline of patients' quality of life and even endangers their life safety. Based on the pathogenesis of HIRI and related articles, this article summarizes the research advances in the prevention and treatment of HIRI with traditional Chinese medicine components, so as to provide theoretical support for basic research and clinical research on HIRI.

Hepatic ischemia-reperfusion injury (HIRI) is a common clinical problem after hepatectomy and liver transplantation and is the main cause of liver dysfunction and liver failure after transplantation. In recent years, autophagy-mediated pathways have become a research hotspot in alleviating HIRI. Autophagy refers to the process in which a large number of substrates such as cytoplasm and damaged organelles are transported into lysosomes for digestion and degradation, so as to constantly renew, reshape, and reuse cells. This article summarizes the research advances in the mechanism of targeting autophagy to alleviate HIRI from the aspects of gene, protein, signaling pathway, inflammatory response, oxidative stress, and mitochondrial and endoplasmic reticulum stress, as well as existing problems and prospects in research, in order to provide theoretical support for the future research on alleviating HIRI by targeting autophagy.

Objective To discuss clinical application,value and effect of tracheal stent in surgical operation for tracheostenosis caused by thyroid tumor.Methods Clinical data of 6 patients with tracheal stenosis and dyspnea caused by thyroid tumor invasiveness or tracheal compression from Oct.2015 to Sep.2016 were retrospectively analyzed.Of the 6 patients,1 case had nodular goiter and 5 cases had differentiated thyroid carcinoma(DTC).Results All patients had dyspnea caused by thyroid tumor invasiveness or tracheal compression.Dyspnea relieved dramatically after tracheal stent was implantated under local anesthesia.Thyroidectomy was given later,with intraoperative tracheal intubation as well as anesthesia,and the surgery finally succeeded.One case with benign multinodular goiter received complete resection and 5 cases with DTC invading the trachea received complete resection of thyroid and neck lymph node dissection,followed by end-to-end anastomosis of invaded trachea sleeve resection.All patients got stage Ⅰ healing in surgical wound.Five cases received radioactive 131I treatment as well as TSH suppression therapy after DTC surgery.All patients were alive and disease-free after a follow-up of 4 to 15 months.Conclusions For patients with tracheostenosis caused by thyroid tumor invasiveness or tracheal compression,operation under cardiopulmonary bypass is necessary if tracheal intubation is difficult.For hospitals without cardiopulmonary bypass,tracheal stent implantation can effectively relieve dyspnea symptom and reduce risk of tracheal intubation under anesthesia,which provides possibility for surgical treatment.

Objective To investigate changes in the more of fatigue and sleep of shipboard personnel during prolonged deployment at sea and effects of prolonged deployment on fatigue and sleep.Methods at day 20 during deployment and at homeport,questionnaire surveys were conducted on the ship crew by using fatigue self-assessment scale (FSAS) and Pittsburg sleep quality index (PSQI).Results Correlative analysis was made on the fatigue and sleep status of the crew during prolonged deployment at sea.Results showed that fatigue scores of the individuals were positively correlated with the recognition of fatigue,and actual sleep time was negatively correlated with total sleep scores.During prolonged deployment,the sensation of fatigue gradually increased from morning to noon,but then gradually decreased from noon to evening.Generally,the sensation of fatigue at different time points of a day did not fluctuate too much.Fatigue scores at 9:30 in the morning,12∶30 at noon and at 15:30 in the afternoon during prolonged deployment were respectively(3.79 ± 0.31,4.23 ± 0.28 and 4.03 ± 0.46),which were remarkably higher than those detected before deployment (2.38 ± 0.42,2.21 ± 0.25 and 1.98 ± 0.36) respectively(P ＜ 0.01).With the average scores of individual sensation of fatigue as the demarcation line (9.99),they could be divided into the high-score group and lowscore group.Those who held that environment exerted great impact on fatigue had higher fatigue self-assessment scores,and they had less sleep time with relatively poor sleep quality.Statistical significance could be seen,when comparisons were made between the 2 groups(P ＜ 0.05).With the average scores of(3.60)as an index of sleep quality assessment,those individuals who had better sleep quality experienced less fatigue,and their fatigue recognition scores were also relatively lower and also had longer sleep time.Statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions Sleep and fatigue status of the shipboard naval personnel were correlated with fatigue recognition,and the sensation of fatigue during deployment was directly correlated with the work-rest schedules.Those who had better sleep quality would experience less fatigue.

Objective To investigate changes in the more of fatigue and sleep of shipboard personnel during prolonged deployment at sea and effects of prolonged deployment on fatigue and sleep.Methods at day 20 during deployment and at homeport,questionnaire surveys were conducted on the ship crew by using fatigue self-assessment scale (FSAS) and Pittsburg sleep quality index (PSQI).Results Correlative analysis was made on the fatigue and sleep status of the crew during prolonged deployment at sea.Results showed that fatigue scores of the individuals were positively correlated with the recognition of fatigue,and actual sleep time was negatively correlated with total sleep scores.During prolonged deployment,the sensation of fatigue gradually increased from morning to noon,but then gradually decreased from noon to evening.Generally,the sensation of fatigue at different time points of a day did not fluctuate too much.Fatigue scores at 9:30 in the morning,12∶30 at noon and at 15:30 in the afternoon during prolonged deployment were respectively(3.79 ± 0.31,4.23 ± 0.28 and 4.03 ± 0.46),which were remarkably higher than those detected before deployment (2.38 ± 0.42,2.21 ± 0.25 and 1.98 ± 0.36) respectively(P ＜ 0.01).With the average scores of individual sensation of fatigue as the demarcation line (9.99),they could be divided into the high-score group and lowscore group.Those who held that environment exerted great impact on fatigue had higher fatigue self-assessment scores,and they had less sleep time with relatively poor sleep quality.Statistical significance could be seen,when comparisons were made between the 2 groups(P ＜ 0.05).With the average scores of(3.60)as an index of sleep quality assessment,those individuals who had better sleep quality experienced less fatigue,and their fatigue recognition scores were also relatively lower and also had longer sleep time.Statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions Sleep and fatigue status of the shipboard naval personnel were correlated with fatigue recognition,and the sensation of fatigue during deployment was directly correlated with the work-rest schedules.Those who had better sleep quality would experience less fatigue.