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COVID-19 ICU and mechanical ventilation patient characteristics and outcomes—A systematic review and meta-analysis
Insight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning.
Electronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI 0.12-0.34] and 69% of cases needed IMV [95% CI 0.61-0.75]. ICU and IMV mortality were 28.3% [95% CI 0.25-0.32], 43% [95% CI 0.29-0.58] and ICU, IMV duration was 7.78 [95% CI 6.99-8.63] and 10.12 [95% CI 7.08-13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19 previously reported, we found the major correlates with ICU mortality were IMV [pOR 16.46, 95% CI 4.37-61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52-102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66-16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes.
This is a comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as suggesting the need for further research into optimal ventilation strategies for COVID-19 patients in the ICU setting. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.
Journal Article
تأثير الثقافة الشرقية على النهضة الأوربية في العصر الحديث
يبحث هذا الكتاب من عدة زوايا تاريخية وثقافية مختلفة مدعومة بالوثائق الغربية والشرقية الموثوقة انتقال مظاهر الشرقية ومنجزاتها العديدة إلى الغرب سواء كانت منجزات الثقافة الصينية أو العربية الإسلامية أو الهندية، كما يشرح الكتاب انتقال المنتجات الفنية وعلوم الطب القديم الصيني والعربي والكيمياء وغيرها من العلوم الشرقية المنبع ويتتبع آثارها في أوربا الحديثة. وينفرد هذا الكتاب بجمعه للثقافة الصينية والعربية معا في صف واحد تحت اسم الثقافة الشرقية وهي نظرية تسعى لإعادة النهضة الشرقية مرة أخرى وخطوة أولى نحو حلف شرقي.
BOOK
The Pathogenesis of Adenomyosis vis-à-vis Endometriosis
Adenomyosis is used to be called endometriosis interna, and deep endometriosis is now called adenomyosis externa. Thus, there is a question as to whether adenomyosis is simply endometriosis of the uterus, either from the perspective of pathogenesis or pathophysiology. In this manuscript, a comprehensive review was performed with a literature search using PubMed for all publications in English, related to adenomyosis and endometriosis, from inception to June 20, 2019. In addition, two prevailing theories, i.e., invagination—based on tissue injury and repair (TIAR) hypothesis—and metaplasia, on adenomyosis pathogenesis, are briefly overviewed and then critically scrutinized. Both theories have apparent limitations, i.e., difficulty in falsification, explaining existing data, and making useful predictions. Based on the current understanding of wound healing, a new hypothesis, called endometrial-myometrial interface disruption (EMID), is proposed to account for adenomyosis resulting from iatrogenic trauma to EMI. The EMID hypothesis not only highlights the more salient feature, i.e., hypoxia, at the wounding site, but also incorporates epithelial mesenchymal transition, recruitment of bone-marrow-derived stem cells, and enhanced survival and dissemination of endometrial cells dispersed and displaced due to iatrogenic procedures. More importantly, the EMID hypothesis predicts that the risk of adenomyosis can be reduced if certain perioperative interventions are performed. Consequently, from a pathogenic standpoint, adenomyosis is not simply endometriosis of the uterus, and, as such, may call for interventional procedures that are somewhat different from those for endometriosis to achieve the best results.
Journal Article
Ancient China and its Eurasian neighbors : artifacts, identity and death in the frontier, 3000-700 BCE
\"This volume examines the role of objects in the region north of early dynastic state centers, at the intersection of Ancient China and Eurasia, a large area that stretches from Xinjiang to the China Sea, from c.3000 BCE to the mid-eighth century BCE. This area was a frontier, an ambiguous space that lay at the margins of direct political control by the metropolitan states, where local and colonial ideas and practices were reconstructed transculturally. These identities were often merged and displayed in material culture. Types of objects, styles, and iconography were often hybrids or new to the region, as were the tomb assemblages in which they were deposited and found. Patrons commissioned objects that marked a symbolic vision of place and person and that could mobilize support, legitimize rule, and bind people together.\"--Back cover.
Book
Identification of a subset of immunosuppressive P2RX1-negative neutrophils in pancreatic cancer liver metastasis
The immunosuppressive microenvironment that is shaped by hepatic metastatic pancreatic ductal adenocarcinoma (PDAC) is essential for tumor cell evasion of immune destruction. Neutrophils are important components of the metastatic tumor microenvironment and exhibit heterogeneity. However, the specific phenotypes, functions and regulatory mechanisms of neutrophils in PDAC liver metastases remain unknown. Here, we show that a subset of P2RX1-negative neutrophils accumulate in clinical and murine PDAC liver metastases. RNA sequencing of murine PDAC liver metastasis-infiltrated neutrophils show that P2RX1-deficient neutrophils express increased levels of immunosuppressive molecules, including PD-L1, and have enhanced mitochondrial metabolism. Mechanistically, the transcription factor Nrf2 is upregulated in P2RX1-deficient neutrophils and associated with PD-L1 expression and metabolic reprogramming. An anti-PD-1 neutralizing antibody is sufficient to compromise the immunosuppressive effects of P2RX1-deficient neutrophils on OVA-activated OT1 CD8+ T cells. Therefore, our study uncovers a mechanism by which metastatic PDAC tumors evade antitumor immunity by accumulating a subset of immunosuppressive P2RX1-negative neutrophils.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive metastatic disease characterized by an immunosuppressive microenvironment. Here the authors show that a subset of P2RX1-negative neutrophils with immunosuppressive properties accumulate in PDAC metastatic liver tissues and promote tumor growth.
Journal Article
Malicious software identification based on deep learning algorithms and API feature extraction
With the popularization of mobile Internet, the Android operating system has become the main target of malware attacks because of its openness. Traditional malware detection methods face challenges in handling complex feature representations, especially in utilizing the semantic information and call order of application programming interface call sequences. Therefore, this study develops a deep learning method to identify malicious software by analyzing the application programming interface calls and constructing heterogeneous graphs of Android applications. The results showed that the proposed method achieved accuracies of 92.80% and 94.24% on the Drebin and AndroZoo datasets, demonstrating excellent robustness and generalization ability. The ablation experiment showed that the accuracy of the complete model was 94.71%, verifying the key role of each part of the method. In comparison with existing methods, the proposed method led with an average accuracy of 94.27%, while maintaining detection time within 5–10 s, demonstrating high efficiency and practicality. This study contributes to the in-depth exploration of semantic information and behavioral patterns of application programming interface call sequences. The efficient malware identification method developed can cope with the constantly evolving malware threats.
Journal Article
Transformer Fault Diagnosis Based on DLH-GWO-SVM
In the field of transformer fault diagnosis, there are many diagnostic methods. These diagnostic methods are either not high accuracy or are used too long. In this paper, a dimension learning-based hunting (DLH) search strategy optimization grey wolf algorithm support vector machine (DLH-GWO-SVM) model was proposed. In the process of initializing the grey wolf population, logistic chaotic mapping was used to improve the quality of the initial wolf position. In the Wolf screening process, the DLH search strategy was adopted to solve the problem that GWO was prone to fall into the local optimal solution, and the improved Grey wolf algorithm (IGWO) was formed. Finally, the transformer fault types were classified by support vector machine (SVM), and IGWO was used to optimize the penalty factor and kernel parameter (g) of the SVM. Through the experimental analysis, the accuracy of transformer fault diagnosis can reach 95.83% after the application of the DLH-GWO-SVM model.
Journal Article
Platelets and Regulatory T Cells May Induce a Type 2 Immunity That Is Conducive to the Progression and Fibrogenesis of Endometriosis
Endometriosis is a hormonal disease, as well as a chronic inflammatory disease. While various immune cells are documented to be involved in endometriosis, there is a wanton lack of a bigger picture on how these cells are coordinated to work concertedly. Since endometriotic lesions experience cyclical bleeding, they are fundamentally wounds that undergo repeated tissue injury and repair (ReTIAR). In this study, we attempted to characterize the role of platelets and regulatory T cells (Tregs) in modulating the lesional immune microenvironment and its subsequent effects on lesional progression and fibrogenesis. Through two mouse experiments, we show that, by disrupting predominantly a type 2 immune response in lesional microenvironment, both platelets and Tregs depletion decelerated lesional progression and fibrogenesis, likely through the suppression of the TGF-β1/Smad3 and PDGFR-β/PI3K/Akt signaling pathways. In particular, platelet depletion resulted in significantly reduced lesional expression of thymic stromal lymphopoietin (TSLP), leading to reduced aggregation of macrophages and alternatively activated (M2) macrophages, and of Tregs, T helper 2 (Th2) and Th17 cells but increased aggregation of Th1 cells, in lesions, which, in turn, yields retarded fibrogenesis. Similarly, Tregs depletion resulted in suppression of platelet aggregation, and reduced aggregation of M2 macrophages, Th2 and Th17 cells but increased aggregation of Th1 cells, in lesions. Thus, both platelet and Tregs depletion decelerated lesional progression and fibrogenesis by disrupting predominantly a type 2 immunity in lesional microenvironment. Taken together, this suggests that both platelets and Tregs may induce a type 2 immunity in lesional microenvironment that is conducive to lesional progression and fibrogenesis.
Journal Article
Hydrocarbons mediate seed dispersal
Vespicochory, seed dispersal by hornets, is an uncommon seed dispersal pattern in angiosperms. To date, this phenomenon has been recorded in only four families. Because of its rarity, the causes and consequences of vespicochory remain unclear. Hence, this seed dispersal syndrome is often regarded as anecdotal.
Through field investigations, chemical analyses, electrophysiological tests, identification of chemosensory proteins from the antennae of hornets, and behavioral assays, we investigated whether olfactory and/or visual cues of the diaspores of Stemona tuberosa mediate the behavior of the social hornets and maintain their mutualism.
This study demonstrated that the elaiosome of S. tuberosa emits hydrocarbons, which are attractive to hornets. However, these compounds, which induce responses in the antennae of naive hornets, are ubiquitous substances on insect cuticle surfaces. Innate preference and experienced foraging behavior of hornets can increase their seed dispersal efficiency.
This is the first example in which hydrocarbons have been identified as a diaspore odour involved in the attraction of hornets. Given that the ubiquity of hornets, and the communication function of hydrocarbons in insects, we predict that this rare seed dispersal mechanism may be an overlooked mechanism of insect–plant mutualism.
Journal Article