Safety considerations for withdrawal of nucleos(t)ide analogues in patients with chronic hepatitis B: First, do no harm

Nucleos(t)ide analogues (NA) are widely used to treat hepatitis B virus (HBV) infection, but they cannot eradicate the virus and treatment duration can be lifelong if the endpoint is set at seroclearance of the hepatitis B surface antigen (HBsAg). As an alternative strategy, finite NA therapy without the prerequisite of HBsAg seroclearance has been proposed to allow treatment cessation in patients with sustained undetectable HBV viremia for two to three years. However, reactivation of viral replication almost always follows NA withdrawal. Whereas HBV reactivation might facilitate HBsAg seroclearance in some, it could lead to serious acute flare-ups in a certain proportion of patients. Occurrence and consequences of NA withdrawal flares are complicated with various factors involving the virus, host, and treatment. Accurate risk prediction for severe flares following NA cessation is essential to ensure patient safety. The risks of life-threatening flares in patients who discontinued NA according to the stopping rules of current guidelines or local reimbursement policies have recently been quantitatively estimated in large-scale studies, which also provided empirical evidence to help identify vulnerable patients at risk of devastating outcomes. Moreover, risk predictors were further explored and validated to hopefully aid in patient selection and management. In this narrative review with a focus on patient safety, we summarize and discuss current literature on the incidence of severe flares following NA cessation, risk stratification for candidate selection, rules of posttreatment monitoring, and indications for treatment resumption. We also share our thoughts on the limitations of existing knowledge and suggestions for future research

Thermal-Aware Test Schedule and TAM Co-Optimization for Three-Dimensional IC

[[abstract]]Testing is regarded as one of the most difficult challenges for three-dimensional integrated circuits (3D ICs). In this paper, we want to optimize the cost of TAM (test access mechanism) and the test time for 3D IC. We used both greedy and simulated annealing algorithms to solve this optimization problem. We compare the results of two assumptions: soft-die mode and hard-die mode. The former assumes that the DfT of dies cannot be changed, while the latter assumes that the DfT of dies can be adjusted. The results show that thermal-aware cooptimization is essential to decide the optimal TAM and test schedule. Blindly adding TAM cannot reduce the total test cost due to temperature constraints. Another conclusion is that soft-die mode is more effective than hard-die mode to reduce the total test cost for 3D IC.[[notice]]補正完畢[[booktype]]電子

Decoupled Contrastive Learning

Contrastive learning (CL) is one of the most successful paradigms for self-supervised learning (SSL). In a principled way, it considers two augmented "views" of the same image as positive to be pulled closer, and all other images as negative to be pushed further apart. However, behind the impressive success of CL-based techniques, their formulation often relies on heavy-computation settings, including large sample batches, extensive training epochs, etc. We are thus motivated to tackle these issues and establish a simple, efficient, yet competitive baseline of contrastive learning. Specifically, we identify, from theoretical and empirical studies, a noticeable negative-positive-coupling (NPC) effect in the widely used InfoNCE loss, leading to unsuitable learning efficiency concerning the batch size. By removing the NPC effect, we propose decoupled contrastive learning (DCL) loss, which removes the positive term from the denominator and significantly improves the learning efficiency. DCL achieves competitive performance with less sensitivity to sub-optimal hyperparameters, requiring neither large batches in SimCLR, momentum encoding in MoCo, or large epochs. We demonstrate with various benchmarks while manifesting robustness as much less sensitive to suboptimal hyperparameters. Notably, SimCLR with DCL achieves 68.2% ImageNet-1K top-1 accuracy using batch size 256 within 200 epochs pre-training, outperforming its SimCLR baseline by 6.4%. Further, DCL can be combined with the SOTA contrastive learning method, NNCLR, to achieve 72.3% ImageNet-1K top-1 accuracy with 512 batch size in 400 epochs, which represents a new SOTA in contrastive learning. We believe DCL provides a valuable baseline for future contrastive SSL studies.Comment: Accepted by ECCV202

MedEval: A Multi-Level, Multi-Task, and Multi-Domain Medical Benchmark for Language Model Evaluation

Curated datasets for healthcare are often limited due to the need of human annotations from experts. In this paper, we present MedEval, a multi-level, multi-task, and multi-domain medical benchmark to facilitate the development of language models for healthcare. MedEval is comprehensive and consists of data from several healthcare systems and spans 35 human body regions from 8 examination modalities. With 22,779 collected sentences and 21,228 reports, we provide expert annotations at multiple levels, offering a granular potential usage of the data and supporting a wide range of tasks. Moreover, we systematically evaluated 10 generic and domain-specific language models under zero-shot and finetuning settings, from domain-adapted baselines in healthcare to general-purposed state-of-the-art large language models (e.g., ChatGPT). Our evaluations reveal varying effectiveness of the two categories of language models across different tasks, from which we notice the importance of instruction tuning for few-shot usage of large language models. Our investigation paves the way toward benchmarking language models for healthcare and provides valuable insights into the strengths and limitations of adopting large language models in medical domains, informing their practical applications and future advancements.Comment: Accepted to EMNLP 2023. Camera-ready version: updated IRB, added more evaluation results on LLMs such as GPT4, LLaMa2, and LLaMa2-cha

Change in insulin resistance according to virological response during antiviral treatment for hepatitis C virus infection

SummaryBackgroundHepatitis C virus (HCV) infection can lead to increased insulin resistance, but the dynamics of insulin resistance in HCV-infected patients receiving pegylated interferon plus ribavirin remain elusive.MethodsThis prospective study enrolled HCV-infected patients who received pegylated interferon plus ribavirin. Patients were classified according to the attainment of sustained virological response (SVR). Insulin resistance was measured using homeostatic model assessment-insulin resistance (HOMA-IR). The change in HOMA-IR at baseline, the end of treatment, and 24 weeks after the end of treatment was compared in patients who achieved SVR and those who did not.ResultsA total of 65 patients participated in this study, of which 46 (71%) achieved SVR. Overall, The HOMA-IR changed significantly during antiviral therapy, with the median values [interquartile range (IQR)] of 3.7 (1.6–10.0) prior to the treatment, 1.5 (0.8–2.9) at the end, and 1.6 (0.9–3.1) at 24 weeks after completion of therapy. However, only patients who achieved SVR had significant off-therapy reduction of HOMA-IR, with median values of 1.3 (IQR, 0.7–2.6) at 24 weeks off therapy and 3.6 (IQR, 1.5–9.9) at baseline (p < 0.0001). In those without SVR, the HOMA-IR measured 24 weeks after treatment completion (median, 2.2; IQR, 1.9–4.7) did not differ from baseline values (median, 3.9; IQR, 2.2–10.0; p = 0.5).ConclusionDual therapy with pegylated interferon plus ribavirin ameliorated IR in HCV-infected patients, but the off-therapy improvement of IR was limited to those who attained SVR

Improved Performance for Dye-Sensitized Solar Cells Using a Compact TiO 2

This work determines the effect of compact TiO2 layers that are deposited onto fluorine-doped tin oxide (FTO), to improve the performance of dye-sensitized solar cells (DSSC). A series of compact TiO2 layers are prepared using radio frequency (rf) reactive magnetron sputtering. The films are characterized using X-ray diffraction (XRD), atomic force microscopy (AFM), scanning electron microscopy (SEM), and UV-Vis spectroscopy. The results show that when the Ar/O2/N2 flow rates are 36 : 18 : 9, the photo-induced decomposition of methylene blue and photo-induced hydrophilicity are enhanced. After annealing at 450°C in an atmosphere ambient for 30 min, the compact TiO2 layers exhibit higher optical transmittance. The XRD patterns for the TiO2 films for FTO/glass show a good crystalline structure and anatase (101) diffraction peaks, which demonstrate a higher crystallinity than the ITO/glass films. As a result of this increase in the short circuit photocurrent density, the open-circuit photovoltage, and the fill factor, the DSSC with the FTO/glass and Pt counter electrode demonstrates a solar conversion efficiency of 7.65%

Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation

AbstractAimRefractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution.MethodThis is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n=40) or CPR plus extracorporeal CPR (E-CPR, n=20) were compared.ResultsThe overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90±49.6min vs 34.3±17.7min, p=0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p=0.0009), and good neurological function at discharge (40.0% vs 7.5%, p=0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p=0.1512) at discharge and (50% vs 20%, p=0. 0998) at 1 year after discharge.ConclusionsThe management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR

Paeoniae alba Radix Promotes Peripheral Nerve Regeneration

The present study provides in vitro and in vivo evaluation of Paeoniae alba Radix (PR) on peripheral nerve regeneration. In the in vitro study, we found the PR caused a marked enhancement of the nerve growth factor-mediated neurite outgrowth from PC12 cells as well as their expression of growth associated protein 43 and synapsin I. In the in vivo study, silicone rubber chambers filled with the PR water extract were used to bridge a 10-mm sciatic nerve defect in rats. At the conclusion of 8 weeks, regenerated nerves in the PR groups, especially at 1.25 mg ml−1 had a higher rate of successful regeneration across the wide gap, relatively larger mean values of total nerve area, myelinated axon count and blood vessel number, and a significantly larger nerve conductive velocity compared to the control group (P  <  .05). These results suggest that the PR extract can be a potential nerve growth-promoting factor, being salutary in aiding the growth of injured peripheral nerve