The P24 antigen test, HIV RNA PCR test, HIV isolation/culture and fourth-generation HIV uniform Ag/Ab assay are being utilized in diagnosing acute HIV infection in different labs. Many factors limit the use of screeni...The P24 antigen test, HIV RNA PCR test, HIV isolation/culture and fourth-generation HIV uniform Ag/Ab assay are being utilized in diagnosing acute HIV infection in different labs. Many factors limit the use of screening for acute HIV in high-risk populations, in blood donors and during voluntary HIV testing, including, cost, technique, sensitivity and specificity. In this review we explore a new NAAT method which involves HIV RNA RT-PCR on pooled samples. This technique is able to screen for acute infections in a large testing volume and may be used as a screening method in high-risk populations and blood donors.展开更多
Often in longitudinal studies, some subjects complete their follow-up visits, but others miss their visits due to various reasons. For those who miss follow-up visits, some of them might learn that the event of intere...Often in longitudinal studies, some subjects complete their follow-up visits, but others miss their visits due to various reasons. For those who miss follow-up visits, some of them might learn that the event of interest has already happened when they come back. In this case, not only are their event times interval-censored, but also their time-dependent measurements are incomplete. This problem was motivated by a national longitudinal survey of youth data. Maximum likelihood estimation (MLE) method based on expectation-maximization (EM) algorithm is used for parameter estimation. Then missing information principle is applied to estimate the variance-covariance matrix of the MLEs. Simulation studies demonstrate that the proposed method works well in terms of bias, standard error, and power for samples of moderate size. The national longitudinal survey of youth 1997 (NLSY97) data is analyzed for illustration.展开更多
We examine Africa's vaccine manufacturing potential,spurred by the coronavirus disease 2019(COVID-19)pan-demic,while critically analyzing vaccine price inequities and procurement strategies during the pandemic,wit...We examine Africa's vaccine manufacturing potential,spurred by the coronavirus disease 2019(COVID-19)pan-demic,while critically analyzing vaccine price inequities and procurement strategies during the pandemic,with anticipation of future outbreaks.Although Africa consumes approximately 25%of the global vaccine supply,over 99%of these vaccines are produced outside the continent,primarily due to insufficient local investment.Vaccine procurement strategies have relied heavily on pooled procurement mechanisms and tiered-pricing mod-els,predominantly controlled by external organizations.Significant disparities in vaccine pricing have resulted in vaccine price inequities,with evidence suggesting price discrimination,where different prices are charged for the same vaccine across countries and regions.While vaccine prices are only one component of vaccination cam-paign costs,the inequitable pricing of vaccines poses serious challenges to fair access,especially in low-income countries.Given the inevitability of future pandemics and other outbreaks,the central question remains:Does Africa possess the capacity to strengthen its vaccine production infrastructure and reduce dependency on ex-ternal suppliers?Our review reveals that,with robust political commitment,enhanced investment in Research and Development,and leveraging the heterogeneous nature of the regional bloc,Africa has made strides toward establishing vaccine manufacturing hubs with the potential for substantial capacity expansion.Furthermore,we argue for a regional campaign based on the principles of the fair priority model as an ethical framework for vaccine procurement,which prioritizes need and ensures equitable distribution,thereby complementing existing pooled procurement arrangements in times of future pandemics.This paper concludes with two key recommen-dations based on lessons learned from the COvID-19 crisis and future preparedness.First,Africa must push for a transparent and equitable tiered-pricing structure to ensure affordability for all Second,intentional and sustained investment in R&D is critical to addressing systemic inequities in vaccine supply,not only for cOVID-19 but for future outbreaks and routine immunization programs.展开更多
Purpose: To assess the efficacy and safety of Olaparib, a PARP inhibitor on progression-free survival (PFS), objective response rate (ORR) and overall survival (OS) in patients with breast and ovarian cancer. Methods:...Purpose: To assess the efficacy and safety of Olaparib, a PARP inhibitor on progression-free survival (PFS), objective response rate (ORR) and overall survival (OS) in patients with breast and ovarian cancer. Methods: Research data from clinical trials through PubMed, Science Citation Index, Elsevier Science Direct and Cochrane Library of all published studies exploring the PFS, ORR or OS of Olaparib for maintenance monotherapy on survival in breast and ovarian cancer were analysed. Pooled estimates of the ORR, weighted medians of PFS and OS from all Olaparib were calculated. Assessment of quality and level of evidence was assigned by Cochrane guidelines and guidelines of Oxford Centre for Evidence-Based Medicine. Results: Data of 893 patients (731 olaparib;162 control) from 6 trials, 2 randomised controlled trials and 4 non-randomised trials, were included. The overall median weighted PFS and OS in patients treated with Olaparib were 5.9 and 19.1 months, respectively. The pooled ORR was 25%. Olaparib showed a greater effect on PFS in patients with both wild-type BRCA and BRCA mutant gene. The most common toxicity were nausea and vomiting. Conclusions: Olaparib as maintenance monotherapy for breast and ovarian cancer is associated with promising outcomes including increased response rate and improved PFS. Its potential in clinical application is needed for further investigation in phase III trials.展开更多
Background: Childhood tuberculosis accounts for about 10% of estimated TB cases in the world. Despite advances in diagnostics, childhood TB remains a challenge. We evaluated pooling method and testing with GeneXpert M...Background: Childhood tuberculosis accounts for about 10% of estimated TB cases in the world. Despite advances in diagnostics, childhood TB remains a challenge. We evaluated pooling method and testing with GeneXpert MTB/RIF in southern Ethiopia. Methods: This is a cross-sectional study in presumptive TB children st, 2nd and pooled samples. Results: Of 340 presumptive TB cases enrolled, 96 and 244 children submitted gastric aspirate and sputum samples respectively. Of 1020 samples collected (282 gastric aspirate and 738 sputum samples), 38 (3.7%) were positive by Xpert (10 (3.5%) from gastric aspirate and 28 (3.8%) from sputum sample). Similarly, 8 (1.2%) of sputum samples were positive by ZN but none from gastric aspirate. Of 244 children who submitted sputum samples, 3 (1.2%) were bacteriologically positive compared to 12 (4.9%) by Xpert. Of 96 children who submitted gastric aspirate samples, none were positive by ZN while 5 (5.2%) were positive by Xpert. Of bacteriologically confirmed TB cases 0.9% was by ZN and 4.7% by Xpert, an increase of 3.8%. Pooled testing increased positivity by 0.3% for ZN and 1.5% by Xpert compared to the 1st sample. Conclusions: Xpert MTB/RIF testing increases yield compared to ZN testing for gastric aspirate samples. The same-day approach and pooling samples improves efficient use of cartridge, reduce the number of visits for seeking diagnosis and save resources.展开更多
Four enzyme immunoassay (EIA) test kits, 1 Canadian product and 3 Chinese products,were used in the comparative study. Each pool consisted of 5 sera, and the 5 single sera were tested as controls. The tests were carri...Four enzyme immunoassay (EIA) test kits, 1 Canadian product and 3 Chinese products,were used in the comparative study. Each pool consisted of 5 sera, and the 5 single sera were tested as controls. The tests were carried out according to the instructions, keeping the same dilution of each serum in single and pool samples. It was found that with the Canadian kit,the positive and negative results of opled sera had no difference from that of the controls (P>0. 10). In the case of Chinese Yali and Kehua kits, the positive results of pooled sera showed no difference from the controls (P >0. 10), but the optical density (OD) of negative opls were increased (P < 0. 01 ), though quite distant from the cut-off values. In the case of Changzheng kit, the OD of opitive opls were significantly lower than those of the controls (P < 0. 05 ), and weak positive samples missed the detection. However this problem could be overcome by blocking the microwells beforehand. Our experiment demonstrate that not all EIA test kits are suitable for screening opls for antithey to hepatitis C virus, and that it is important to assess the sensitivity of the EIA kit to be used for this purpose.展开更多
In studies reporting rugby league injuries,match injuries varied depending upon participation level.To review and update pooled data estimates for rugby league injury epidemiology and add information for participation...In studies reporting rugby league injuries,match injuries varied depending upon participation level.To review and update pooled data estimates for rugby league injury epidemiology and add information for participation levels in match and training environments.A systematic review and pooled analysis for published studies reporting rugby league match and training injuries.Searches were performed in the PubMed,CINHAL,ScienceDirect,Scopus,SPORTDiscus,SpringerLink,and Wiley Online databases.Studies were considered if they reported on rugby league match or training injuries between Jan 1990 to June 2021.Two authors(DK,TC)extracted the study characteristics,numerical data and assessed the article quality,by adhering to the protocol for systematic review of observational studies(MOOSE)and the STrengthening and Reporting of OBservational studies in Epidemiology(STROBE)statement.The 46 studies included a combined exposure of 419,037 h and 18,783 injuries incorporating 158,003 match-hr and 15,706 match injuries(99.4[95%CI:97.9–101.0]per 1000 match-hr)and 264,033 training-hr and 3077 training injuries(11.8[95%CI:11.4–12.2]per 1000 training-hr).Of included studies,47.9%utilised a medical attention/treatment injury definition.There was a five-fold difference in injuries for the semi-professional participation level(431.6 per 1000 match-hr)compared with professional(RR:4.92;p<0.001)and elite(RR:3.77;p<0.001)participation levels.The hooker recorded the highest pooled injury incidence(93.1 per 1000 match-hr).Compared to the 2014 analysis there was a 10-fold increase for headneck region(RR:10.7;p<0.001)injury incidence,and more injuries for the ball carrier(RR:1.1;p?0.008)and tackler(RR:1.2;p?0.001).There was a three-fold decrease in injury incidence in the first half(RR:2.9;p<0.001)and a two-fold decrease in the second half(RR:2.3;p<0.001)of matches.While rugby league match and training injury incidence had decreased since 2014,the increase in head injuries,and greater injury rate at the semi-professional level,mean further injury prevention interventions are needed.展开更多
Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed...Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed the utility and cost-saving of pooled Xpert MTB/RIF testing strategy for the diagnosis of TB in Mwanza, Tanzania. Methods: Sputum samples from Presumptive TB patients were submitted to TB laboratory for routine diagnosis of TB using Xpert MTB/RIF. The TB results from the individual sputum samples were used as the reference standard and were concealed to the investigating laboratory technicians. The remainder of samples were collected serially and were pooled (5 samples per pool) for testing. The agreement of the results between individual sample testing against pooled sample testing and cost-savings was assessed. Results: A total of 250 sputum samples from presumptive TB patients were analyzed and 50 pools were made with each pool containing 5 samples. Of the 50 sputum pools made, Mycobacterium tuberculosis (MTB) was detected in 17 (34.0%) pools. Results from the individual sputum samples MTB/RIF testing were retrieved for all 250 samples and there were 28 (11.2%) samples in which MTB was detected whereas 222 (88.8%) samples had no MTB detected. Following re-analysis of positive pools, all 28 (100%) individual positive MTB samples were detected within the 17 positive pools, with 1 to 3 individual MTB positive samples per pool. The individual sputum samples were correctly identified by pooled sputum on Xpert MTB/RIF testing, with the sensitivity of 100% and specificity of 100%. Using pooling of sputum samples strategy, we saved 46.0% (115/250) of the cartridges. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0% and has the potential to increase the affordability of Xpert MTB/RIF testing in countries with limited resources, such as Tanzania.展开更多
Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This ...Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.展开更多
Clinical studies on trastuzumab deruxtecan for human epidermal growth factor receptor 2-positive brain metastases Several previous clinical studies have suggested significant intracranial activity of trastuzumab derux...Clinical studies on trastuzumab deruxtecan for human epidermal growth factor receptor 2-positive brain metastases Several previous clinical studies have suggested significant intracranial activity of trastuzumab deruxtecan(T-DXd)in brain metastases(BMs)of human epidermal growth factor receptor 2(HER2)-positive(HER2-positive)metastatic breast cancer(mBC).Pooled analyses from DESTINY-Breast(DB)01,02,and 03 showed that T-DXd outperformed controls in terms of intracranial overall response rate(ORR)and median progression-free survival(mPFS).展开更多
Background Bladder leiomyoma is an uncommon type of bladder neoplasms. Most publications are reports of isolated cases. The influence of tumor size on patients＇ early symptoms was seldom analyzed. We aim to investiga...Background Bladder leiomyoma is an uncommon type of bladder neoplasms. Most publications are reports of isolated cases. The influence of tumor size on patients＇ early symptoms was seldom analyzed. We aim to investigate the clinical characteristics of bladder leiomyoma and the influence of tumor size on patients＇ symptoms in Chinese population. Methods We reviewed the medical records of eight patients diagnosed with bladder leiomyoma at our department, collected 53 cases from Chinese National Knowledge Infrastructure （CNKI）, Wangfang data base, and Chinese Biological Medicine Disk, and performed a pooled analysis. The clinical characteristics of the patients were analyzed and then classified into symptomatic and asymptomatic groups. The association between tumor size and the occurrence of symptoms was evaluated. Furthermore, Logistic regression model was constructed to discriminate variables. Results Women comprised the majority of the patients （49/61, 80.3%）. The mean age and tumor size were （42.3＋14.0） years and （45.0＋25.7） mm, respectively. Among all the symptoms, irritative symptoms occurred most frequently （37.7%, 23/61）, followed by obstructive urinary symptoms （31.1%, 19/61）, hematuria （24.6%, 15/61 ）, and abdominal bulge or pain （14.8%, 9/61）. In our study, patients who were 45 years old or younger tended to be asymptomatic compared with elder ones （14/36 vs. 3/25, P=-0.021）. The histological, as well as anatomical, location of tumor, did not show significant differences between symptomatic and asymptomatic patients （P=-0.306 and 0.700）. Tumors larger than 30 mm in the greatest diameter would cause clinical symptoms such as obstructive urinary symptoms （P=0.048） and irritative symptoms （P=0.037）. Logistic regression confirmed the association between tumor size and the occurrence of symptoms, which was related with age. Conclusions Bladder leiomyoma occurs mainly in women and most frequently with irritative symptoms. The occurrence of symptoms is related to tumor size rather than the location： In this setting, patients with endovesical tumors smaller than 30 mm in the greatest diameter tended to be asymptomatic, which were usually treated with transurethrai resection of bladder tumor.展开更多
Artificial aeration system for aquaculture ponds becomes essential to meet the oxygen requirement posed by the aquatic species.The performance of an aerator is generally mea-sured in terms of standard aeration efficie...Artificial aeration system for aquaculture ponds becomes essential to meet the oxygen requirement posed by the aquatic species.The performance of an aerator is generally mea-sured in terms of standard aeration efficiency(SAE),which is significantly affected by the different geometric and dynamic parameters of the aerator.Therefore,to enhance the aer-ation performance of an aerator,these parameters need to be optimized.In the present study,a perforated pooled circular stepped cascade(PPCSC)aerator was developed,and the geometric and dynamic parameters of the developed aerator were optimized using the hybrid ANN-PSO technique for maximizing its aeration efficiency.The geometric parameters include consecutive step width ratio(W_(i-1)/W_(i))and the perforation diameter to the bottom-most radius ratio(d/R_(b)),whereas the dynamic parameter includes the water flow rate(Q).A 3–6-1 ANN model coupled with particle swarm optimization(PSO)approach was used to obtain the optimum values of geometric and dynamic parameters correspond-ing to the maximum SAE.The optimal values of the consecutive step width ratio(W_(i-1)/W_(i)),the perforation diameter to the bottom-most radius ratio(d/R_(b)),and the water flow rate(Q)for maximizing the SAE were found to be 1.15,0.0027 and 0.0167 m^(3)/s,respectively.The cross-validation results showed a deviation of 3.07%between the predicted and experimen-tal SAE values,thus confirming the adequacy of the proposed hybrid ANN-PSO technique.展开更多
Intense chemical weathering in tropical regions produces soils characterized by silicon(Si)depletion and iron and aluminum oxide accumulation,leading to soil degradation.Consequently,Si cycling is of paramount importa...Intense chemical weathering in tropical regions produces soils characterized by silicon(Si)depletion and iron and aluminum oxide accumulation,leading to soil degradation.Consequently,Si cycling is of paramount importance in tropical regions.This review summarizes the key processes of the terrestrial Si biogeochemical cycle in tropical areas and underscores its biogeochemical significance in ecosystems.Runoff outputs constitute the dominant mechanism of Si depletion in tropical soils.However,the combined effects of dissolved Si(DSi)retention by highly weathered soil and Si uptake by vegetation attenuate desilication rates in these ecosystems.Tropical soils exhibit limited quantities of weatherable minerals,resulting in soil solution with low concentrations of DSi.Consequently,the primary sources of available Si are atmospheric dust inputs from distant sources and biogenic silica originating from plants.Irrigation,application of Si fertilizers,crop harvesting,and corresponding Si exports significantly impact soil Si cycling within agroecosystems.Therefore,soil Si cycling in tropical regions is different from that in other climatic zones.However,there are still many knowledge gaps within contemporary research.We propose to delve into several perspectives,including the exploration of the processes,fluxes,rates,related factors,and mechanisms associated with Si cycling in tropical regions.Comprehensive research from these perspectives would significantly enhance the understanding of pedogenesis and soil evolution and provide valuable insights for guiding the sustainable management of tropical soils.展开更多
Using high-resolution observations,mesoscale simulations,and idealized experiments,this study investigates the mechanisms governing an episode of orographic convection initiation(CI)during the North China Heavy Rainfa...Using high-resolution observations,mesoscale simulations,and idealized experiments,this study investigates the mechanisms governing an episode of orographic convection initiation(CI)during the North China Heavy Rainfall Experiment.On 4 August 2024,repeated CI occurred over the eastern slopes of the Taihang Mountains in the late afternoon,subsequently enhancing an upstream downhill convective storm.Wind profiler radar data and dense automatic weather stations reveal that CI was supported by strengthening southeasterly upslope winds.These winds primarily resulted from the migration of the mountain-plain solenoid and the mountainward-propagating outflow from a convective cold pool over the plain,with sensitivity experiments showing the latter contributed roughly 22%of the wind strength.The upslope flows gradually transported unstable air from the plain to the slope,fostering CI.Mesoscale simulations further highlight the key role of orographic waves near the mountain ridge,which generated strong downslope winds.The near-surface convergence between downslope and upslope flows,combined with wave-induced divergence aloft,produced deep ascent over the slope.Removing mountain ridges weakened wave strength and reduced downslope wind speeds by~8 m s^(-1).Without orographic heating in the idealized simulation(i.e.,no mountain-plain solenoid),only strong wave descent occurred below 2km,inhibiting CI.These findings underscore the critical interplay among plain convection,orographic waves,and the mountain-plain solenoid,offering new insight into the processes controlling orographic CI in North China.展开更多
This paper introduces a fuzzy C-means-based pooling layer for convolutional neural networks that explicitly models local uncertainty and ambiguity.Conventional pooling operations,such as max and average,apply rigid ag...This paper introduces a fuzzy C-means-based pooling layer for convolutional neural networks that explicitly models local uncertainty and ambiguity.Conventional pooling operations,such as max and average,apply rigid aggregation and often discard fine-grained boundary information.In contrast,our method computes soft membershipswithin each receptive field and aggregates cluster-wise responses throughmembership-weighted pooling,thereby preserving informative structure while reducing dimensionality.Being differentiable,the proposed layer operates as standard two-dimensional pooling.We evaluate our approach across various CNN backbones and open datasets,including CIFAR-10/100,STL-10,LFW,and ImageNette,and further probe small training set restrictions on MNIST and Fashion-MNIST.In these settings,the proposed pooling consistently improves accuracy and weighted F1 over conventional baselines,with particularly strong gains when training data are scarce.Even with less than 1%of the training set,ourmethodmaintains reliable performance,indicating improved sample efficiency and robustness to noisy or ambiguous local patterns.Overall,integrating soft memberships into the pooling operator provides a practical and generalizable inductive bias that enhances robustness and generalization in modern CNN pipelines.展开更多
文摘The P24 antigen test, HIV RNA PCR test, HIV isolation/culture and fourth-generation HIV uniform Ag/Ab assay are being utilized in diagnosing acute HIV infection in different labs. Many factors limit the use of screening for acute HIV in high-risk populations, in blood donors and during voluntary HIV testing, including, cost, technique, sensitivity and specificity. In this review we explore a new NAAT method which involves HIV RNA RT-PCR on pooled samples. This technique is able to screen for acute infections in a large testing volume and may be used as a screening method in high-risk populations and blood donors.
文摘Often in longitudinal studies, some subjects complete their follow-up visits, but others miss their visits due to various reasons. For those who miss follow-up visits, some of them might learn that the event of interest has already happened when they come back. In this case, not only are their event times interval-censored, but also their time-dependent measurements are incomplete. This problem was motivated by a national longitudinal survey of youth data. Maximum likelihood estimation (MLE) method based on expectation-maximization (EM) algorithm is used for parameter estimation. Then missing information principle is applied to estimate the variance-covariance matrix of the MLEs. Simulation studies demonstrate that the proposed method works well in terms of bias, standard error, and power for samples of moderate size. The national longitudinal survey of youth 1997 (NLSY97) data is analyzed for illustration.
文摘We examine Africa's vaccine manufacturing potential,spurred by the coronavirus disease 2019(COVID-19)pan-demic,while critically analyzing vaccine price inequities and procurement strategies during the pandemic,with anticipation of future outbreaks.Although Africa consumes approximately 25%of the global vaccine supply,over 99%of these vaccines are produced outside the continent,primarily due to insufficient local investment.Vaccine procurement strategies have relied heavily on pooled procurement mechanisms and tiered-pricing mod-els,predominantly controlled by external organizations.Significant disparities in vaccine pricing have resulted in vaccine price inequities,with evidence suggesting price discrimination,where different prices are charged for the same vaccine across countries and regions.While vaccine prices are only one component of vaccination cam-paign costs,the inequitable pricing of vaccines poses serious challenges to fair access,especially in low-income countries.Given the inevitability of future pandemics and other outbreaks,the central question remains:Does Africa possess the capacity to strengthen its vaccine production infrastructure and reduce dependency on ex-ternal suppliers?Our review reveals that,with robust political commitment,enhanced investment in Research and Development,and leveraging the heterogeneous nature of the regional bloc,Africa has made strides toward establishing vaccine manufacturing hubs with the potential for substantial capacity expansion.Furthermore,we argue for a regional campaign based on the principles of the fair priority model as an ethical framework for vaccine procurement,which prioritizes need and ensures equitable distribution,thereby complementing existing pooled procurement arrangements in times of future pandemics.This paper concludes with two key recommen-dations based on lessons learned from the COvID-19 crisis and future preparedness.First,Africa must push for a transparent and equitable tiered-pricing structure to ensure affordability for all Second,intentional and sustained investment in R&D is critical to addressing systemic inequities in vaccine supply,not only for cOVID-19 but for future outbreaks and routine immunization programs.
文摘Purpose: To assess the efficacy and safety of Olaparib, a PARP inhibitor on progression-free survival (PFS), objective response rate (ORR) and overall survival (OS) in patients with breast and ovarian cancer. Methods: Research data from clinical trials through PubMed, Science Citation Index, Elsevier Science Direct and Cochrane Library of all published studies exploring the PFS, ORR or OS of Olaparib for maintenance monotherapy on survival in breast and ovarian cancer were analysed. Pooled estimates of the ORR, weighted medians of PFS and OS from all Olaparib were calculated. Assessment of quality and level of evidence was assigned by Cochrane guidelines and guidelines of Oxford Centre for Evidence-Based Medicine. Results: Data of 893 patients (731 olaparib;162 control) from 6 trials, 2 randomised controlled trials and 4 non-randomised trials, were included. The overall median weighted PFS and OS in patients treated with Olaparib were 5.9 and 19.1 months, respectively. The pooled ORR was 25%. Olaparib showed a greater effect on PFS in patients with both wild-type BRCA and BRCA mutant gene. The most common toxicity were nausea and vomiting. Conclusions: Olaparib as maintenance monotherapy for breast and ovarian cancer is associated with promising outcomes including increased response rate and improved PFS. Its potential in clinical application is needed for further investigation in phase III trials.
文摘Background: Childhood tuberculosis accounts for about 10% of estimated TB cases in the world. Despite advances in diagnostics, childhood TB remains a challenge. We evaluated pooling method and testing with GeneXpert MTB/RIF in southern Ethiopia. Methods: This is a cross-sectional study in presumptive TB children st, 2nd and pooled samples. Results: Of 340 presumptive TB cases enrolled, 96 and 244 children submitted gastric aspirate and sputum samples respectively. Of 1020 samples collected (282 gastric aspirate and 738 sputum samples), 38 (3.7%) were positive by Xpert (10 (3.5%) from gastric aspirate and 28 (3.8%) from sputum sample). Similarly, 8 (1.2%) of sputum samples were positive by ZN but none from gastric aspirate. Of 244 children who submitted sputum samples, 3 (1.2%) were bacteriologically positive compared to 12 (4.9%) by Xpert. Of 96 children who submitted gastric aspirate samples, none were positive by ZN while 5 (5.2%) were positive by Xpert. Of bacteriologically confirmed TB cases 0.9% was by ZN and 4.7% by Xpert, an increase of 3.8%. Pooled testing increased positivity by 0.3% for ZN and 1.5% by Xpert compared to the 1st sample. Conclusions: Xpert MTB/RIF testing increases yield compared to ZN testing for gastric aspirate samples. The same-day approach and pooling samples improves efficient use of cartridge, reduce the number of visits for seeking diagnosis and save resources.
文摘Four enzyme immunoassay (EIA) test kits, 1 Canadian product and 3 Chinese products,were used in the comparative study. Each pool consisted of 5 sera, and the 5 single sera were tested as controls. The tests were carried out according to the instructions, keeping the same dilution of each serum in single and pool samples. It was found that with the Canadian kit,the positive and negative results of opled sera had no difference from that of the controls (P>0. 10). In the case of Chinese Yali and Kehua kits, the positive results of pooled sera showed no difference from the controls (P >0. 10), but the optical density (OD) of negative opls were increased (P < 0. 01 ), though quite distant from the cut-off values. In the case of Changzheng kit, the OD of opitive opls were significantly lower than those of the controls (P < 0. 05 ), and weak positive samples missed the detection. However this problem could be overcome by blocking the microwells beforehand. Our experiment demonstrate that not all EIA test kits are suitable for screening opls for antithey to hepatitis C virus, and that it is important to assess the sensitivity of the EIA kit to be used for this purpose.
文摘In studies reporting rugby league injuries,match injuries varied depending upon participation level.To review and update pooled data estimates for rugby league injury epidemiology and add information for participation levels in match and training environments.A systematic review and pooled analysis for published studies reporting rugby league match and training injuries.Searches were performed in the PubMed,CINHAL,ScienceDirect,Scopus,SPORTDiscus,SpringerLink,and Wiley Online databases.Studies were considered if they reported on rugby league match or training injuries between Jan 1990 to June 2021.Two authors(DK,TC)extracted the study characteristics,numerical data and assessed the article quality,by adhering to the protocol for systematic review of observational studies(MOOSE)and the STrengthening and Reporting of OBservational studies in Epidemiology(STROBE)statement.The 46 studies included a combined exposure of 419,037 h and 18,783 injuries incorporating 158,003 match-hr and 15,706 match injuries(99.4[95%CI:97.9–101.0]per 1000 match-hr)and 264,033 training-hr and 3077 training injuries(11.8[95%CI:11.4–12.2]per 1000 training-hr).Of included studies,47.9%utilised a medical attention/treatment injury definition.There was a five-fold difference in injuries for the semi-professional participation level(431.6 per 1000 match-hr)compared with professional(RR:4.92;p<0.001)and elite(RR:3.77;p<0.001)participation levels.The hooker recorded the highest pooled injury incidence(93.1 per 1000 match-hr).Compared to the 2014 analysis there was a 10-fold increase for headneck region(RR:10.7;p<0.001)injury incidence,and more injuries for the ball carrier(RR:1.1;p?0.008)and tackler(RR:1.2;p?0.001).There was a three-fold decrease in injury incidence in the first half(RR:2.9;p<0.001)and a two-fold decrease in the second half(RR:2.3;p<0.001)of matches.While rugby league match and training injury incidence had decreased since 2014,the increase in head injuries,and greater injury rate at the semi-professional level,mean further injury prevention interventions are needed.
文摘Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed the utility and cost-saving of pooled Xpert MTB/RIF testing strategy for the diagnosis of TB in Mwanza, Tanzania. Methods: Sputum samples from Presumptive TB patients were submitted to TB laboratory for routine diagnosis of TB using Xpert MTB/RIF. The TB results from the individual sputum samples were used as the reference standard and were concealed to the investigating laboratory technicians. The remainder of samples were collected serially and were pooled (5 samples per pool) for testing. The agreement of the results between individual sample testing against pooled sample testing and cost-savings was assessed. Results: A total of 250 sputum samples from presumptive TB patients were analyzed and 50 pools were made with each pool containing 5 samples. Of the 50 sputum pools made, Mycobacterium tuberculosis (MTB) was detected in 17 (34.0%) pools. Results from the individual sputum samples MTB/RIF testing were retrieved for all 250 samples and there were 28 (11.2%) samples in which MTB was detected whereas 222 (88.8%) samples had no MTB detected. Following re-analysis of positive pools, all 28 (100%) individual positive MTB samples were detected within the 17 positive pools, with 1 to 3 individual MTB positive samples per pool. The individual sputum samples were correctly identified by pooled sputum on Xpert MTB/RIF testing, with the sensitivity of 100% and specificity of 100%. Using pooling of sputum samples strategy, we saved 46.0% (115/250) of the cartridges. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0% and has the potential to increase the affordability of Xpert MTB/RIF testing in countries with limited resources, such as Tanzania.
基金Beijing Hospitals Authority’s Ascent Plan(DFL20220702)National Natural Science Foundation of China(82101398).
文摘Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.
基金supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2023-JKCS-23)the Special Research Fund for Central Universities,Peking Union Medical College(No.2022-I2M-C&T-A-014).
文摘Clinical studies on trastuzumab deruxtecan for human epidermal growth factor receptor 2-positive brain metastases Several previous clinical studies have suggested significant intracranial activity of trastuzumab deruxtecan(T-DXd)in brain metastases(BMs)of human epidermal growth factor receptor 2(HER2)-positive(HER2-positive)metastatic breast cancer(mBC).Pooled analyses from DESTINY-Breast(DB)01,02,and 03 showed that T-DXd outperformed controls in terms of intracranial overall response rate(ORR)and median progression-free survival(mPFS).
文摘Background Bladder leiomyoma is an uncommon type of bladder neoplasms. Most publications are reports of isolated cases. The influence of tumor size on patients＇ early symptoms was seldom analyzed. We aim to investigate the clinical characteristics of bladder leiomyoma and the influence of tumor size on patients＇ symptoms in Chinese population. Methods We reviewed the medical records of eight patients diagnosed with bladder leiomyoma at our department, collected 53 cases from Chinese National Knowledge Infrastructure （CNKI）, Wangfang data base, and Chinese Biological Medicine Disk, and performed a pooled analysis. The clinical characteristics of the patients were analyzed and then classified into symptomatic and asymptomatic groups. The association between tumor size and the occurrence of symptoms was evaluated. Furthermore, Logistic regression model was constructed to discriminate variables. Results Women comprised the majority of the patients （49/61, 80.3%）. The mean age and tumor size were （42.3＋14.0） years and （45.0＋25.7） mm, respectively. Among all the symptoms, irritative symptoms occurred most frequently （37.7%, 23/61）, followed by obstructive urinary symptoms （31.1%, 19/61）, hematuria （24.6%, 15/61 ）, and abdominal bulge or pain （14.8%, 9/61）. In our study, patients who were 45 years old or younger tended to be asymptomatic compared with elder ones （14/36 vs. 3/25, P=-0.021）. The histological, as well as anatomical, location of tumor, did not show significant differences between symptomatic and asymptomatic patients （P=-0.306 and 0.700）. Tumors larger than 30 mm in the greatest diameter would cause clinical symptoms such as obstructive urinary symptoms （P=0.048） and irritative symptoms （P=0.037）. Logistic regression confirmed the association between tumor size and the occurrence of symptoms, which was related with age. Conclusions Bladder leiomyoma occurs mainly in women and most frequently with irritative symptoms. The occurrence of symptoms is related to tumor size rather than the location： In this setting, patients with endovesical tumors smaller than 30 mm in the greatest diameter tended to be asymptomatic, which were usually treated with transurethrai resection of bladder tumor.
文摘Artificial aeration system for aquaculture ponds becomes essential to meet the oxygen requirement posed by the aquatic species.The performance of an aerator is generally mea-sured in terms of standard aeration efficiency(SAE),which is significantly affected by the different geometric and dynamic parameters of the aerator.Therefore,to enhance the aer-ation performance of an aerator,these parameters need to be optimized.In the present study,a perforated pooled circular stepped cascade(PPCSC)aerator was developed,and the geometric and dynamic parameters of the developed aerator were optimized using the hybrid ANN-PSO technique for maximizing its aeration efficiency.The geometric parameters include consecutive step width ratio(W_(i-1)/W_(i))and the perforation diameter to the bottom-most radius ratio(d/R_(b)),whereas the dynamic parameter includes the water flow rate(Q).A 3–6-1 ANN model coupled with particle swarm optimization(PSO)approach was used to obtain the optimum values of geometric and dynamic parameters correspond-ing to the maximum SAE.The optimal values of the consecutive step width ratio(W_(i-1)/W_(i)),the perforation diameter to the bottom-most radius ratio(d/R_(b)),and the water flow rate(Q)for maximizing the SAE were found to be 1.15,0.0027 and 0.0167 m^(3)/s,respectively.The cross-validation results showed a deviation of 3.07%between the predicted and experimen-tal SAE values,thus confirming the adequacy of the proposed hybrid ANN-PSO technique.
基金financially supported by the National Natural Science Foundation of China(Nos.42277312 and 41877010)。
文摘Intense chemical weathering in tropical regions produces soils characterized by silicon(Si)depletion and iron and aluminum oxide accumulation,leading to soil degradation.Consequently,Si cycling is of paramount importance in tropical regions.This review summarizes the key processes of the terrestrial Si biogeochemical cycle in tropical areas and underscores its biogeochemical significance in ecosystems.Runoff outputs constitute the dominant mechanism of Si depletion in tropical soils.However,the combined effects of dissolved Si(DSi)retention by highly weathered soil and Si uptake by vegetation attenuate desilication rates in these ecosystems.Tropical soils exhibit limited quantities of weatherable minerals,resulting in soil solution with low concentrations of DSi.Consequently,the primary sources of available Si are atmospheric dust inputs from distant sources and biogenic silica originating from plants.Irrigation,application of Si fertilizers,crop harvesting,and corresponding Si exports significantly impact soil Si cycling within agroecosystems.Therefore,soil Si cycling in tropical regions is different from that in other climatic zones.However,there are still many knowledge gaps within contemporary research.We propose to delve into several perspectives,including the exploration of the processes,fluxes,rates,related factors,and mechanisms associated with Si cycling in tropical regions.Comprehensive research from these perspectives would significantly enhance the understanding of pedogenesis and soil evolution and provide valuable insights for guiding the sustainable management of tropical soils.
基金supported by the National Key Research and Development Program of China(Grant No.2024YFC3013003)the National Natural Science Foundation of China(Grant Nos.424B2033 and 42475002)+3 种基金projects supported by the Southern Marine Science and Engineering Guangdong Laboratory(Zhuhai)(Grant Nos.SML2024SP035,SML2024SP012,311024001)the Guangdong Project of Basic and Applied Basic Research(Grant Nos.2024A1515510005 and2025A1515011974)the Key Innovation Team of the China Meteorological Administration(Grant No.CMA2023ZD08)the State Key Laboratory of Severe Weather Meteorological Science and Technology(Grant No.2025QZA10)。
文摘Using high-resolution observations,mesoscale simulations,and idealized experiments,this study investigates the mechanisms governing an episode of orographic convection initiation(CI)during the North China Heavy Rainfall Experiment.On 4 August 2024,repeated CI occurred over the eastern slopes of the Taihang Mountains in the late afternoon,subsequently enhancing an upstream downhill convective storm.Wind profiler radar data and dense automatic weather stations reveal that CI was supported by strengthening southeasterly upslope winds.These winds primarily resulted from the migration of the mountain-plain solenoid and the mountainward-propagating outflow from a convective cold pool over the plain,with sensitivity experiments showing the latter contributed roughly 22%of the wind strength.The upslope flows gradually transported unstable air from the plain to the slope,fostering CI.Mesoscale simulations further highlight the key role of orographic waves near the mountain ridge,which generated strong downslope winds.The near-surface convergence between downslope and upslope flows,combined with wave-induced divergence aloft,produced deep ascent over the slope.Removing mountain ridges weakened wave strength and reduced downslope wind speeds by~8 m s^(-1).Without orographic heating in the idealized simulation(i.e.,no mountain-plain solenoid),only strong wave descent occurred below 2km,inhibiting CI.These findings underscore the critical interplay among plain convection,orographic waves,and the mountain-plain solenoid,offering new insight into the processes controlling orographic CI in North China.
文摘This paper introduces a fuzzy C-means-based pooling layer for convolutional neural networks that explicitly models local uncertainty and ambiguity.Conventional pooling operations,such as max and average,apply rigid aggregation and often discard fine-grained boundary information.In contrast,our method computes soft membershipswithin each receptive field and aggregates cluster-wise responses throughmembership-weighted pooling,thereby preserving informative structure while reducing dimensionality.Being differentiable,the proposed layer operates as standard two-dimensional pooling.We evaluate our approach across various CNN backbones and open datasets,including CIFAR-10/100,STL-10,LFW,and ImageNette,and further probe small training set restrictions on MNIST and Fashion-MNIST.In these settings,the proposed pooling consistently improves accuracy and weighted F1 over conventional baselines,with particularly strong gains when training data are scarce.Even with less than 1%of the training set,ourmethodmaintains reliable performance,indicating improved sample efficiency and robustness to noisy or ambiguous local patterns.Overall,integrating soft memberships into the pooling operator provides a practical and generalizable inductive bias that enhances robustness and generalization in modern CNN pipelines.
