Assisting Clinical Decisions for Scarcely Available Treatment via Disentangled Latent Representation

Extracorporeal membrane oxygenation (ECMO) is an essential life-supporting modality for COVID-19 patients who are refractory to conventional therapies. However, the proper treatment decision has been the subject of significant debate and it remains controversial about who benefits from this scarcely available and technically complex treatment option. To support clinical decisions, it is a critical need to predict the treatment need and the potential treatment and no-treatment responses. Targeting this clinical challenge, we propose Treatment Variational AutoEncoder (TVAE), a novel approach for individualized treatment analysis. TVAE is specifically designed to address the modeling challenges like ECMO with strong treatment selection bias and scarce treatment cases. TVAE conceptualizes the treatment decision as a multi-scale problem. We model a patient's potential treatment assignment and the factual and counterfactual outcomes as part of their intrinsic characteristics that can be represented by a deep latent variable model. The factual and counterfactual prediction errors are alleviated via a reconstruction regularization scheme together with semi-supervision, and the selection bias and the scarcity of treatment cases are mitigated by the disentangled and distribution-matched latent space and the label-balancing generative strategy. We evaluate TVAE on two real-world COVID-19 datasets: an international dataset collected from 1651 hospitals across 63 countries, and a institutional dataset collected from 15 hospitals. The results show that TVAE outperforms state-of-the-art treatment effect models in predicting both the propensity scores and factual outcomes on heterogeneous COVID-19 datasets. Additional experiments also show TVAE outperforms the best existing models in individual treatment effect estimation on the synthesized IHDP benchmark dataset

Application of Zebrafish Models in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic, recurrent, and remitting inflammatory disease with unclear etiology. As a clinically frequent disease, it can affect individuals throughout their lives, with multiple complications. Unfortunately, traditional murine models are not efficient for the further study of IBD. Thus, effective and convenient animal models are needed. Zebrafish have been used as model organisms to investigate IBD because of their suggested highly genetic similarity to humans and their superiority as laboratory models. The zebrafish model has been used to study the composition of intestinal microbiota, novel genes, and therapeutic approaches. The pathogenesis of IBD is still unclear and many risk factors remain unidentified. In this review, we compare traditional murine models and zebrafish models in terms of advantages, pathogenesis, and drug discovery screening for IBD. We also review the progress and deficiencies of the zebrafish model for scientific applications

Auranofin Releasing Antibacterial and Antibiofilm Polyurethane Intravascular Catheter Coatings

Intravascular catheter related bloodstream infections (CRBSIs) are a leading cause of hospital-acquired infections worldwide, resulting not only in the burden of cost and morbidity for patients but also in the over-consumption of medical resources for hospitals and health care organizations. In this study, a novel auranofin releasing antibacterial and antibiofilm polyurethane (PU) catheter coating was developed and investigated for future use in preventing CRBSIs. Auranofin is an antirheumatic drug with recently identified antimicrobial properties. The drug carrier, PU, acts as a barrier surrounding the antibacterial agent, auranofin, to extend the drug release profile and improve its long-term antibacterial and antibiofilm efficacy and potentially the length of catheter implantation within a patient. The PU+auranofin coatings developed here were found to be highly stretchable (exhibiting ~500% percent elongation), which is important for the compliance of the material on a flexible catheter. PU+auranofin coated catheters were able to inhibit the growth of methicillin-resistant Staphylococcus aureus (MRSA) for 8 to 26 days depending on the specific drug concentration utilized during the dip coating process. The PU+auranofin coated catheters were also able to completely inhibit MRSA biofilm formation in vitro, an effect that was not observed with auranofin or PU alone. Lastly, these coatings were found to be hemocompatible with human erythrocytes and maintain liver cell viability

Image-guided interstitial brachytherapy for recurrent cervical cancer after radiotherapy: A single institution experience

PurposeThe aim of this study is to evaluate the efficacy and toxicity of image-guided high-dose rate (HDR) interstitial brachytherapy (ISBT) for the reirradiation of cervical cancer within a previously irradiated area.Methods and materialsTwenty-three consecutive patients with cervical cancer were reirradiated with curative intent using brachytherapy (BT) with or without external beam irradiation. The median biologically equivalent dose in 2-Gy fractions (EQD2) for reirradiation was 64.0 Gy (range: 31.3–95.1 Gy), and the median cumulative EQD2 (for primary treatment and reirradiation) was 152.4 Gy (range: 97.8–200.9 Gy). The average clinical target volume was 82.9 cm3 (range: 26.9–208.3 cm3), and the median treatment-free interval (TFI) was 13 months (range: 3–93 months).ResultsThe median follow-up time was 19 months (range: 2–59 months). The complete response rate after reirradiation was 56.5%. The 1-, 2- 3-, and 4-year post-relapse survival (PRS) rates were 65.2%, 43.5%, 33.8%, and 27.1%, respectively. The median reirradiation EQD2 D2cc of rectum and bladder was 39.5 Gy (range = 14.6–96.2 Gy) and 52.1 Gy (range = 29.1–114.2 Gy). The median cumulative EQD2 D2cc of rectum and bladder was 115.0 Gy (range = 84.4–189.3 Gy) and 130.5 Gy (range = 95.5–173.5 Gy). During follow-up, nine (39.1%) patients had experienced grade 3 or 4 late toxicities. Grade ≥3 rectal toxicity occurred in three patients (13.0%). Grade ≥3 urinary toxicity occurred in five patients (21.7%). One patient (4.3%) had both grade ≥3 urinary and rectal toxicity. Tumor volume, TFI, tumor invasion organ number, and local control were significant prognostic factors adversely affecting OS.ConclusionsFor recurrent cervical cancer after radiotherapy, reirradiation of HDR-ISBT is feasible, even if the local tumor invasion is large, with a good chance of survival and acceptable side effects

Effects of forage type on the rumen microbiota, growth performance, carcass traits, and meat quality in fattening goats

Forages fed to goats influence ruminal microbiota, and further contribute to affect growth performance, meat quality and its nutritional composition. Our objective for current study was to investigate the effects of different forages on growth performance, carcass traits, meat nutritional composition, rumen microflora, and the relationships between key bacteria and amino acids and fatty acids in the longissimus dorsi and semimembranosus muscles of goats. Boer crossbred goats were separately fed commercial concentrate diet supplemented with Hemarthria altissima (HA), Pennisetum sinese (PS), or forage maize (FG), and then slaughtered 90 days after the beginning of the experiment. Growth performances did not vary but carcass traits of dressing percentage, semi-eviscerated slaughter percentage, and eviscerated slaughter percentage displayed significant difference with the treatment studied. Meats from goats fed forage maize, especially semimembranosus muscles are rich in essential amino acids, as well as an increase in the amount of beneficial fatty acids. Our 16S rRNA gene sequencing results showed that the Firmicutes, Bacteroidetes, and Proteobacteria were the most dominant phyla in all groups but different in relative abundance. Further, the taxonomic analysis and linear discriminant analysis effect size (LEfSe) identified the specific taxa that were differentially represented among three forage treatments. The spearman’s correlation analysis showed that rumen microbiota was significantly associated with the goat meat nutritional composition, and more significant positive correlations were identified in semimembranosus muscles when compared with longissimus dorsi muscles. More specifically, the lipid metabolism-related bacteria Rikenellaceae_RC9_gut_group showed positively correlated with meat amino acid profile, while genera Oscillospiraceae_UCG-005 were positively correlated with fatty acid composition. These bacteria genera might have the potential to improve nutritional value and meat quality. Collectively, our results showed that different forages alter the carcass traits, meat nutritional composition, and rumen microflora in fattening goats, and forage maize induced an improvement in its nutritional value

Design, Heat Transfer, and Visualization of the Milli-Reactor by CFD and ANN

This paper proposes a milli-reactor design method incorporating reactor runaway criteria. Based on Computational Fluid Dynamic (CFD) simulation, neural networks are applied to obtain the optimal reactor structure according to the target reaction requirements. Varma’s theory, the critical Nusselt number for stable operation of the flow reactor, is derived. Inserts of the multi-blade structure are designed and investigated to enhance mixing and heat transfer performance. The flow field and heat transfer capacities are obtained by CFD calculations in the range of Re 50–1800. The internal components increase the heat transfer performance up to 21 times, and the pressure drop up to 16 times. The inclined angle of the blade is recommended to be 45°, which can effectively improve heat transfer without generating excessive pressure drop. By partial least squares regression (PLS) analysis, Re and the number of blades are the most critical factors affecting heat transfer, and the five blades and smaller tilt angles are recommended. The CFD calculation results are in good agreement with the Particle Image Velocimetry (PIV) experimental results