Monoclonal Antibody for the Prevention of Respiratory Syncytial Virus in Infants and Children: A Systematic Review and Network Meta-analysis

IMPORTANCE: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection in children younger than 5 years; effective prevention strategies are urgently needed. OBJECTIVE: To compare the efficacy and safety of monoclonal antibodies for the prevention of RSV infection in infants and children. DATA SOURCES: In this systematic review and network meta-analysis, PubMed, Embase, CENTRAL, and ClinicalTrials.gov were searched from database inception to March 2022. STUDY SELECTION: Randomized clinical trials that enrolled infants at high risk of RSV infection to receive a monoclonal antibody or placebo were included. Keywords and extensive vocabulary related to monoclonal antibodies, RSV, and randomized clinical trials were searched. DATA EXTRACTION AND SYNTHESIS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used. Teams of 2 reviewers independently performed literature screening, data extraction, and risk of bias assessment. The Grading of Recommendations, Assessments, Developments, and Evaluation approach was used to rate the certainty of evidence. A random-effects model network meta-analysis was conducted using a consistency model under the frequentist framework. MAIN OUTCOMES AND MEASURES: The main outcomes were all-cause mortality, RSV-related hospitalization, RSV-related infection, drug-related adverse events, intensive care unit admission, supplemental oxygen use, and mechanical ventilation use. RESULTS: Fifteen randomized clinical trials involving 18 395 participants were eligible; 14 were synthesized, with 18 042 total participants (median age at study entry, 3.99 months [IQR, 3.25-6.58 months]; median proportion of males, 52.37% [IQR, 50.49%-53.85%]). Compared with placebo, with moderate- to high-certainty evidence, nirsevimab, palivizumab, and motavizumab were associated with significantly reduced RSV-related infections per 1000 participants (nirsevimab: -123 [95% CI, -138 to -100]; palivizumab: -108 [95% CI, -127 to -82]; motavizumab: -136 [95% CI, -146 to -125]) and RSV-related hospitalizations per 1000 participants (nirsevimab: -54 [95% CI, -64 to -38; palivizumab: -39 [95% CI, -48 to -28]; motavizumab: -48 [95% CI, -58 to -33]). With moderate-certainty evidence, both motavizumab and palivizumab were associated with significant reductions in intensive care unit admissions per 1000 participants (-8 [95% CI, -9 to -4] and -5 [95% CI, -7 to 0], respectively) and supplemental oxygen use per 1000 participants (-59 [95% CI, -63 to -54] and -55 [95% CI, -61 to -41], respectively), and nirsevimab was associated with significantly reduced supplemental oxygen use per 1000 participants (-59 [95% CI, -65 to -40]). No significant differences were found in all-cause mortality and drug-related adverse events. Suptavumab did not show any significant benefits for the outcomes of interest. CONCLUSIONS AND RELEVANCE: In this study, motavizumab, nirsevimab, and palivizumab were associated with substantial benefits in the prevention of RSV infection, without a significant increase in adverse events compared with placebo. However, more research is needed to confirm the present conclusions, especially for safety and cost-effectiveness

MRL-Seg: Overcoming Imbalance in Medical Image Segmentation With Multi-Step Reinforcement Learning

Medical image segmentation is a critical task for clinical diagnosis and research. However, dealing with highly imbalanced data remains a significant challenge in this domain, where the region of interest (ROI) may exhibit substantial variations across different slices. This presents a significant hurdle to medical image segmentation, as conventional segmentation methods may either overlook the minority class or overly emphasize the majority class, ultimately leading to a decrease in the overall generalization ability of the segmentation results. To overcome this, we propose a novel approach based on multi-step reinforcement learning, which integrates prior knowledge of medical images and pixel-wise segmentation difficulty into the reward function. Our method treats each pixel as an individual agent, utilizing diverse actions to evaluate its relevance for segmentation. To validate the effectiveness of our approach, we conduct experiments on four imbalanced medical datasets, and the results show that our approach surpasses other state-of-the-art methods in highly imbalanced scenarios. These findings hold substantial implications for clinical diagnosis and research

CT radiomics model combined with clinical and radiographic features for discriminating peripheral small cell lung cancer from peripheral lung adenocarcinoma

PurposeExploring a non-invasive method to accurately differentiate peripheral small cell lung cancer (PSCLC) and peripheral lung adenocarcinoma (PADC) could improve clinical decision-making and prognosis.MethodsThis retrospective study reviewed the clinicopathological and imaging data of lung cancer patients between October 2017 and March 2022. A total of 240 patients were enrolled in this study, including 80 cases diagnosed with PSCLC and 160 with PADC. All patients were randomized in a seven-to-three ratio into the training and validation datasets (170 vs. 70, respectively). The least absolute shrinkage and selection operator regression was employed to generate radiomics features and univariate analysis, followed by multivariate logistic regression to select significant clinical and radiographic factors to generate four models: clinical, radiomics, clinical-radiographic, and clinical-radiographic-radiomics (comprehensive). The Delong test was to compare areas under the receiver operating characteristic curves (AUCs) in the models.ResultsFive clinical-radiographic features and twenty-three selected radiomics features differed significantly in the identification of PSCLC and PADC. The clinical, radiomics, clinical-radiographic and comprehensive models demonstrated AUCs of 0.8960, 0.8356, 0.9396, and 0.9671 in the validation set, with the comprehensive model having better discernment than the clinical model (P=0.036), the radiomics model (P=0.006) and the clinical–radiographic model (P=0.049).ConclusionsThe proposed model combining clinical data, radiographic characteristics and radiomics features could accurately distinguish PSCLC from PADC, thus providing a potential non-invasive method to help clinicians improve treatment decisions

Two new species of Diphya Nicolet, 1849 (Araneae, Tetragnathidae) from Southwest China

Two new species of tetragnathid spiders from Guizhou and Sichuang provinces of China are described: Diphya guiyang J. Zhang & H. Yu, sp. nov. (♂♀) and Diphya weimiani J. Zhang & H. Yu, sp. nov. (♀). Detailed descriptions, diagnoses, and photographs are provided for these two species, as well as a key and a distribution map for Chinese Diphya species. DNA barcodes (a partial fragment of the mitochondrial cytochrome oxidase subunit I gene, COI) of both new species were obtained for species delimitation, matching of different sexes, and future use in molecular studies

Resilience, organizational support, and innovative behavior on nurses’ work engagement: a moderated mediation analysis

ObjectivesTo investigate the status of nurses’ work engagement and the relationship among resilience, organizational support, and innovative behaviors.MethodsIn this cross-sectional study, we investigated 496 nurses in Hunan, China, from July 2022 to December 2022. A descriptive statistical approach, Pearson’s correlation analysis and Hayes’ PROCESS Macro Models 4 and 14 were used to analyze the available data.ResultsThe level of work engagement among nurses was found to be moderate. Resilience positively predicted work engagement among nurses. Organizational support played a partially mediating role in the association between resilience and work engagement. Furthermore, innovative behavior played a moderating role in the association between adaptive resilience and work engagement.ConclusionBased on the results, greater attention needs to be paid to nurses’ work engagement. A high level of resilience, organizational support, and innovative behavior may increase work engagement among nurses. Nursing leaders can take measures to increase work engagement among nurses by improving nurses’ resilience and organizational support, and cultivating innovative behavior

Forty-two years of scientific research on eight legs-celebrating the 60th birthday of Dr Yuri M. Marusik

The biography of Dr Yuri Mikhailovich Marusik is presented, and his scientific life illuminated on the occasion of his 60th birthday. Yuri is a renowned specialist of spiders. He has described 718 new species, 57 new genera, and two new subfamilies of order Araneae. Twenty-five species and one genus have been dedicated to him. Facts and impressions are given as well as a bibliography of his 545 publications

Design and manufacture of high-performance microbatteries: lithium and beyond

The accelerated development of miniaturized and customized electronics has stimulated the demand for high-energy microbatteries (MBs) as on-chip power sources for autonomous state operations. However, commercial MBs with thin-film configurations exhibit insufficient energy and power density due to their limited active materials and sluggish ion diffusion kinetics. In order to simultaneously enhance electrochemical performance and maintain low-cost production, efforts have been devoted to constructing three-dimensional battery architectures. This review summarizes the state-of-the-art progress in designing and fabricating microelectrodes for microbattery assembly, including the top-down etching and bottom-up printing techniques, with a particular focus on elucidating the correlations between electrode structures, battery performance, and cost-effectiveness. More importantly, advancements in post-lithium batteries based on sodium, zinc and aluminum are also surveyed to offer alternative options with potentially higher energy densities and/or lower battery manufacturing costs. The applications of advanced MBs in on-chip microsystems and wearable electronics are also highlighted. Finally, conclusions and perspectives for the future development of MBs are proposed

Forty-two years of scientific research on eight legs—celebrating the 60th birthday of Dr Yuri M. Marusik

The biography of Dr Yuri Mikhailovich Marusik is presented, and his scientific life illuminated on the occasion of his 60th birthday. Yuri is a renowned specialist of spiders. He has described 718 new species, 57 new genera, and two new subfamilies of order Araneae. Twenty-five species and one genus have been dedicated to him. Facts and impressions are given as well as a bibliography of his 545 publications

Forty-two years of scientific research on eight legs—celebrating the 60th birthday of Dr Yuri M. Marusik

The biography of Dr Yuri Mikhailovich Marusik is presented, and his scientific life illuminated on the occasion of his 60th birthday. Yuri is a renowned specialist of spiders. He has described 718 new species, 57 new genera, and two new subfamilies of order Araneae. Twenty-five species and one genus have been dedicated to him. Facts and impressions are given as well as a bibliography of his 545 publications

Diabetes distress as mediators of loneliness and health promotion behaviour: a cross-sectional study

Objectives The purpose of this study was to explore whether diabetes distress mediated the relationship between loneliness and health promotion in older adults with diabetes.Design A cross-sectional study.Setting The study was conducted at three tertiary hospitals in Changsha, Hunan Province, China.Participants The sample included 140 patients with diabetes (65 years and older, mean age 72.6 years, SD=4.6).Methods We employed path models to analyse data on diabetes distress, loneliness and health promotion behaviours. We collected diabetes distress, loneliness and health promotion behaviour with self-reported questionnaires including the Diabetes Distress Scale, the University of California at Los Angeles (UCLA) Loneliness Scale and the Elderly Health Promotion Scale from January 2022 to October 2022. Mediation analysis was performed by SPSS V.26.0’s PROCESS macro.Result The findings of this study indicated diabetes distress acted as a mediator between loneliness and health promotion behaviour. According to bootstrapping results, the total effect of loneliness on health promotion behaviour was significantly negative (β=−0.312, p=0.006). Loneliness significantly and negatively correlated with diabetes distress (β=−0.043, p<0.001), while diabetes distress significantly and negatively correlated with health promotion behaviours (β=−2.724, p=0.008). Both the indirect effect and the direct effect of loneliness on health promotion behaviour were significant.Conclusion Our study illustrated that loneliness was negatively associated with health promotion behaviours, and diabetes distress acted as a mediator in this relationship. It is suggested that healthcare providers should prioritise the identification and management of diabetes distress in older patients with diabetes who experience loneliness to improve health promotion behaviours and optimise disease management outcomes