Deep learning-based lung sound analysis for intelligent stethoscope

Auscultation is crucial for the diagnosis of respiratory system diseases.However,traditional stethoscopes have inherent limitations,such as inter-listener variability and subjectivity,and they cannot record respiratory sounds for offline/retrospective diagnosis or remote prescriptions in telemedicine.The emergence of digital stethoscopes has overcome these limitations by allowing physicians to store and share respiratory sounds for consultation and education.On this basis,machine learning,particularly deep learning,enables the fully-automatic analysis of lung sounds that may pave the way for intelligent stethoscopes.This review thus aims to provide a comprehensive overview of deep learning algorithms used for lung sound analysis to emphasize the significance of artificial intelligence(AI)in this field.We focus on each component of deep learning-based lung sound analysis systems,including the task categories,public datasets,denoising methods,and,most importantly,existing deep learning methods,i.e.,the state-of-the-art approaches to convert lung sounds into two-dimensional(2D)spectrograms and use convolutional neural networks for the end-to-end recognition of respiratory diseases or abnormal lung sounds.Additionally,this review highlights current challenges in this field,including the variety of devices,noise sensitivity,and poor interpretability of deep models.To address the poor reproducibility and variety of deep learning in this field,this review also provides a scalable and flexible open-source framework that aims to standardize the algorithmic workflow and provide a solid basis for replication and future extension:https://github.com/contactless-healthcare/Deep-Learning-for-Lung-Sound-Analysis.

Evaluating patients' perception of service quality at hospitals in nine Chinese cities by use of the ServQual scale

Objective: To investigate patients' perception of service quality at hospitals in nine Chinese cities and propose some measures for improvement. Methods: The ServQ ual scale method was used in a survey involving patients at out-patient and in-patient facilities in Shanghai, Chongqing, Chengdu, Nanning, Guilin and Laibin of Guangxi, Honghezhou of Yunnan, Wulumuqi of Xinjiang and Zhongshan of Guangdong. The data collected were entered and analyzed using SPSS 20.0. Statistical analyses included descriptive statistics, factor analyses, reliability analyses, product-moment correlations, independent-sample t-tests, One-way ANOVA and regression analyses. Results: The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.979. The Cronbach's α for the reliability analysis was 0.978. All the Pearson correlation coei cients were positive and statistically signii cant. Visitors to out-patient facilities reported more positive perception tacilities on tangibles(t = 4.168, P(t = 1.979, P <han visitors to in-patient f 0.05). Patients of 60 years of age and above reported mor< 0.001) and reliability e positive perception th<an those between 40 and 49 on reliability(F = 3.311, P = 0.010), assurances(F = 2.751, P 0.05) and empathy(F = 4.009, P = 0.003). For the i ve dimensions of the scale, patients in Laibin, Guangxi reported the most positive perceived service quality, followed by patients in Shanghai. On the other hand, patients in Chongqing and Nanning and Guilin of Guangxi reported relatively poor perceptions of service quality. Standardized regression coei cients showed statistically significant(P < 0.001) positive values for all Serv Qual dimensions. Empathy(β = 0.267) and reliability(β uality. = 0.239) most strongly predicted perception of service qConclusions: Chinese patients perceived service quality as satisfactory. Hospitals in various regions of China should enhance their awareness and ability to serve their patients.

The implementation and evaluation of HIV symptom management guidelines: A preliminary study in China

Objective:The overarching objective of this study was to examine the effectiveness of HIV symptom management guidelines in China in reducing the incidence and severity of symptoms and improving patients'quality of life.Methods:We conducted a controlled,pre-and post-implementation design in the HIV/AIDS inpatient unit in Shanghai.Patients recruited from November 2014 to February 2015 were in the intervention group and those from October 2013 to February 2014 were in the control group.There were 74 patients in each group.Participants in the intervention group received interventions based on the HIV symptom management guidelines.Overall symptom severity,depression,and quality of life were measured in two groups at baseline,week 4,and week 8.Results:Totally 126 patients completed the research,65 in the intervention group and 61 in the control group.The total symptom severity scores showed a statistically significant difference between groups across time(P<0.05).It showed that frequencies of fatigue(36.9%vs.44.3%),fever(6.2%vs.11.5%),loss in weight(9.2%vs.16.4%),mouth ulcers(12.3%vs.16.4%),headaches(9.2%vs.19.7%)and depression(F=1.09,P>0.05)in the intervention group were lower than those in the control group in week 8 without statistical significance.The multilevel growth mixture model indicated a greater increase in the total score of quality of life for the group treated according to the symptom management guidelines(P=0.04).Conclusion:The evidence-based HIV symptom management guidelines can improve a patient's quality of life and relieve negative symptoms.The guidelines can be applied in a similar context to other HIV/AIDS units or clinics.

Penicillium marneffei chylous ascites in acquired immune deficiency syndrome:A case report

Penicillium marneffei （R marneffei） infection usually occurs with skin, bone marrow, lung or hepatic involve- ment. However, no cases of P. mameffei infection with chylous ascites have been reported thus far. In this re- port, we describe the first case of acquired immune de- ficiency syndrome （AIDS） which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with am- photericin B for 3 mo, while receiving concomitant ther- apy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole （400 mg every 12 h） for 3 too. R marneffei should be considered in the differential di- agnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with R marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.

Overviews of reviews on patient compliance with medication protocols used in highly active antiretroviral therapy

Purpose:To provide evidence support for the development of clinical practice guidelines regarding patient adherence to medication protocols used in highly active antiretroviral therapy(HAART)in China.Methods:We analyzed information contained in recent systematic reviews and metaanalyses regarding patient compliance with medication protocols used in HAART.Results:Nine systematic reviews and one meta-analysis were included in our study which involved three different aspects of patient compliance:influencing factors,assessment methods,and interventions.Conclusions:The high quality data obtained from our study was suitable for use in developing clinically useful guidelines for patent compliance with HAART medication protocols.

Concomitant and sequential administration of nirmatrelvir-ritonavir and azvudine in patients with COVID-19 caused by the Omicron variant: Safety and efficacy

Background:This study assessed the safety and efficacy of nirmatrelvir-ritonavir(Paxlovid®)and azvudine when administered sequentially or concomitantly in patients with coronavirus 2019(COVID-19)caused by the Omicron variant.Methods:Ninety-three patients confirmed to be infected with the Omicron variant by nucleic acid detection were retrospectively investigated.Informa-tion was collected on general health status,medication,and adverse drug reactions(ADRs)according to whether nirmatrelvir-ritonavir and azvudine were administered sequentially or concomitantly.Data on times of onset,clinical manifestations,and outcomes of ADRs and on conversion to a nega-tive nucleic acid test were also recorded.Results:Possible ADRs were recorded in 41 patients(44.1%).There were 22 gastrointestinal reactions in 18 patients and 18 hematological abnormalities in 16 after sequential or concomitant treatment with nirmatrelvir-ritonavir and azvudine.Liver enzyme levels increased in nine cases and creatinine clearance decreased in two.Cases of atrial fibrillation(n=1),sleep disorder(n=2),rash(n=2),dizziness(n=1),and weakness(n=5)were also documented.Only vomiting,poor appetite,diarrhea,xerostomia,bitter taste,and rash were considered probable ADRs;others were thought to be possible ADRs.In all cases,the nucleic acid test did not turn negative after the first antiviral was applied.The nucleic acid test of 28 patients did not turn negative before discharge.The remaining 65 patients(69.9%)returned a negative nucleic acid test after receiving the second antiviral agent.Conclusions:Treatment with nirmatrelvir-ritonavir and azvudine is safe and effective whether administered sequentially or concomitantly in patients with COVID-19 caused by the Omicron variant.

Hydrogen Embrittlement of Advanced High-Strength Steel for Automobile Application:A Review

The hydrogen embrittlement(HE)fracture of advanced high-strength steels used in lightweight automobiles has received increasing public attention.The source,transmission,and movement of hydrogen,characterization parameters,and test methods of HE,as well as the characteristics and path of HE fractures,are introduced.The mechanisms and modes of crack propagation of HE and hydrogen-induced delayed fracture are reviewed.The recent progress surrounding micro and macro typical fracture characteristics and the influencing factors of HE are discussed.Finally,methods for improving HE resistance can be summarized as follows:(1)reducing crystalline grain and inclusion sizes(oxides,sulfides,and titanium nitride),(2)controlling nano-precipitates(niobium carbide,titanium carbide,and composite precipitation),and(3)increasing residual austenite content under the reasonable tension strength of steel.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients

Background:A patient’s infectivity is determined by the presence of the virus in different body fluids,secretions,and excreta.The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease(COVID-19)remain unclear.This study analyzed the clearance time and factors influencing 2019 novel coronavirus(2019-nCoV)RNA in different samples from patients with COVID-19,providing further evidence to improve the management of patients during convalescence.Methods:The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20,2020 to February 10,2020 were collected retrospectively.The reverse transcription polymerase chain reaction(RT-PCR)results for patients’oropharyngeal swab,stool,urine,and serum samples were collected and analyzed.Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive(minimum 24 h sampling interval)negative RT-PCR results for viral RNA from oropharyngeal swabs.The effects of cluster of differentiation 4(CD4)+T lymphocytes,inflammatory indicators,and glucocorticoid treatment on viral nucleic acid clearance were analyzed.Results:In the 292 confirmed cases,66 patients recovered after treatment and were included in our study.In total,28(42.4%)women and 38 men(57.6%)with a median age of 44.0(34.0-62.0)years were analyzed.After in-hospital treatment,patients’inflammatory indicators decreased with improved clinical condition.The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5(6.0-11.0)days.By February 10,2020,11 convalescent patients(16.7%)still tested positive for viral RNA from stool specimens and the other 55 patients’stool specimens were negative for 2019-nCoV following a median duration of 11.0(9.0-16.0)days after symptom onset.Among these 55 patients,43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs,with a median delay of 2.0(1.0-4.0)days.Results for only four(6.9%)urine samples were positive for viral nucleic acid out of 58 cases;viral RNA was still present in three patients’urine specimens after throat swabs were negative.Using a multiple linear regression model(F=2.669,P=0.044,and adjusted R2=0.122),the analysis showed that the CD4+T lymphocyte count may help predict the duration of viral RNA detection in patients’stools(t=-2.699,P=0.010).The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group(15 days vs.8.0 days,respectively;t=2.550,P=0.013)and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group(20 days vs.11 days,respectively;t=4.631,P<0.001).There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results(P>0.05).Conclusions:In brief,as the clearance of viral RNA in patients’stools was delayed compared to that in oropharyngeal swabs,it is important to identify viral RNA in feces during convalescence.Because of the delayed clearance of viral RNA in the glucocorticoid treatment group,glucocorticoids are not recommended in the treatment of COVID-19,especially for mild disease.The duration of RNA detection may relate to host cell immunity.

Very high baseline HIV viremia impairs efficacy of non-nucleoside reverse transcriptase inhibitor-based ART:a longterm observation in treatment-naïve patients

Background:It is not completely clear whether a very high pre-therapy viral load(≥500000 copies/ml)can impair the virological response.The aim of this study was to examine the influence of very high baseline HIV-RNA levels on long-term virological responses under one type of regimen.Methods:A retrospective study was performed based on data from two multicenter cohorts in China from January to November 2009,and from May 2013 to December 2015.Untreated HIV infected adults between 18 and 65 years old were recruited before receiving non-nucleoside reverse transcriptase inhibitor-based regimen.All patients had baseline HIV-RNA levels over 500 copies/ml,good adherence,and were followed for at least 24 weeks.Virological suppression was defined as the first HIV-RNA<50 copies/ml.Virological failure was defined as any of incomplete viral suppression(HIV-RNA≥200 copies/ml without virological suppression within 24 weeks of treatment)and viral rebound(confirmed HIV-RNA level≥50 copies/ml after virological suppression).Chi-square test,Kaplan–Meier analysis,Cox proportional hazards model and Logistic regression were used to compare virological response between each pretreated viral load stratum.Results:A total of 758 treatment-naïve HIV patients in China were enlisted.Median follow-up time(IQR)was 144(108–276)weeks.By week 48,rates of virological suppression in three groups(<100000,100000–500000 and≥500000 copies/ml)were 94.1,85.0,and 63.8%,respectively(P<0.001).Very high baseline HIV viremia over 500000 copies/ml were found to be associated with delayed virological suppression(≥500000 vs<100000,adjusted relative hazard=0.455,95%CI:0.32–0.65;P<0.001)as well as incomplete viral suppression(≥500000 vs<100000,adjusted odds ratio[aOR]=6.084,95%CI:2.761–13.407;P<0.001)and viral rebound(≥50000 vs<100000,aOR=3.671,95%CI:1.009–13.355,P=0.048).Conclusions:Very high levels of pre-treatment HIV-RNA were related with delayed efficacy of NNRTI-based ART and increased risk of treatment failure.More potent initial regimens should be considered for those with this clinical character.

Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1:interim analysis of the randomized,controlled,phase 3,non-inferiority TALENT study

Background:Albuvirtide is a once-weekly injectable human immunodeficiency virus(HIV)-1 fusion inhibitor.We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.Methods:We carried out a 48-week,randomized,controlled,open-label non-inferiority trial at 12 sites in China.Adults on the World Health Organization(WHO)-recommended first-line treatment for>6 months with a plasma viral load>1000 copies/mL were enrolled and randomly assigned(1:1)to receive albuvirtide(once weekly)plus ritonavir-boosted lopinavir(ABT group)or the WHO-recommended second-line treatment(NRTI group).The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks.Non-inferiority was prespecified with a margin of 12%.Results:At the time of analysis,week 24 data were available for 83 and 92 patients,and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups,respectively.At 48 weeks,80.4%of patients in the ABT group and 66.0%of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL,meeting the criteria for non-inferiority.For the per-protocol population,the superiority of albuvirtide over NRTI was demonstrated.The frequency of grade 3 to 4 adverse events was similar in the two groups;the most common adverse events were diarrhea,upper respiratory tract infections,and grade 3 to 4 increases in triglyceride concentration.Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.Conclusions:The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug.This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.Trial registration:ClinicalTrials.gov Identifier:NCT02369965;https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No.ChiCTR-TRC-14004276;http://www.chictr.org.cn/enindex.aspx.

Risk factors affecting the mortality of HIVinfected patients with pulmonary tuberculosis in the cART era:a retrospective cohort study in China

Background:Tuberculosis infection still places a great burden on HIV-infected individuals in China and other developing countries.Knowledge of the survival of HIV-infected patients with pulmonary tuberculosis(PTB)would provide important insights for the clinical management of this population,which remains to be well described in current China.Methods:HIV-infected patients with PTB admitted to Shanghai Public Health Clinical Center from January 2011 to December 2015 were retrospectively enrolled.In this cohort,the survival prognosis was estimated by the Kaplan-Meier method,while univariate and multivariate Cox proportional hazards models were used to determine the risk factors affecting mortality.Results:After reviewing 4914 admitted patients with HIV infection,359 PTB cases were identified.At the time of PTB diagnosis,the patients’median CD4+T cell count was 51/mm3(IQR:23-116),and 27.30%of patients(98/359)were on combination antiretroviral therapy(cART).For the 333 cases included in the survival analysis,the overall mortality was 15.92%(53/333)during a median 27-month follow-up.The risk factors,including age older than 60 years(HR:3.18;95%CI:1.66-6.10),complication with bacterial pneumonia(HR:2.64;95%CI:1.30-5.35),diagnosis delay(HR:2.60;95%CI:1.42-4.78),CD4+T cell count less than 50/mm3(HR:2.38;95%CI:1.27-4.43)and pulmonary atelectasis(HR:2.20;95%CI:1.05-4.60),might independently contribute to poor survival.Among patients without cART before anti-TB treatment,the later initiation of cART(more than 8 weeks after starting anti-TB treatment)was found to increase the mortality rate(OR:4.33;95%CI:1.22-15.36),while the initiation of cART within 4-8 weeks after starting anti-TB treatment was associated with the fewest deaths(0/14).Conclusions:The subjects in this study conducted in the cART era were still characterized by depressed immunological competence and low rates of cART administration,revealing possible intervention targets for preventing TB reactivation in HIV-infected individuals under current circumstances.Furthermore,our study indicated that the timely diagnosis of PTB,prevention of secondary bacterial pneumonia by prophylactic management and optimization of the timing of cART initiation could have significant impacts on decreasing mortality among HIV/PTB co-infected populations.These findings deserve further prospective investigations to optimize the management of HIV/PTB-co-infected patients.Trial registration:NCT01344148,Registered September 14,2010.

Routinely detected indicators in plasma have a predictive effect on the identification of HIV-infected patients with non-tuberculous mycobacterial and tuberculous infections

Background:It is difficult to quickly distinguish non-tuberculous mycobacterial(NTM)infection from tuberculosis(TB)infection in human immunodeficiency virus(HIV)-infected patients because of many similarities between these diseases.A simple and effective way to determine the differences using routine blood tests is necessary in developing countries.Methods:A retrospective cohort study was conducted to recruit HIV-infected patients with either NTM infection or TB infection diagnosed for the first time according to mycobacterial culture and microscopic identification from May 2010 to March 2016.These data included the analysis of blood cells,liver function,renal function,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR),and were compared between the HIV/TB and HIV/NTM groups.Results:A total of 240 patients were enrolled.The number of HIV/TB and HIV/NTM patients was 113 and 127,respectively.There were no significant differences in the CD4 T-cell count,age,sex,percentage of patients initiating antiretroviral therapy(ART)before the explicit diagnosis of TB or NTM infection.NTM infection was more likely to be restricted in the pulmonary while TB infection also involves extra-pulmonary sites.Both the leukocyte count(5.60×109/L)and the proportion of neutrophils in the leukocyte count(76.70%)in the HIV/TB group were significantly higher than those in the HIV/NTM group(4.40×10^(9)/L[P=0.0014]and 69.30%[P<0.001].The analysis of liver function markers indicated that the concentration of albumin but not ALT and AST was significantly lower in the HIV/TB group than in the HIV/NTM group(P<0.001).The creatinine and urea levels were not significantly different between the two groups.The ESR(84.00 mm/h)and the concentration of CRP(59.60 mg/L)were significantly higher in the HIV/TB group than in the HIV/NTM group(52.00 mm/h and 19.60 mg/L,respectively)(P<0.001).To distinguish TB infection from NTM infection,the best cut-off value was 69.5 mm/h for ESR,with a positive predictive value(PPV)of 0.740 and negative predictive value(NPV)of 0.721,and 48.8 mg/L for CRP,with a PPV of 0.676 and NPV of 0.697.Conclusion:The dissemination character as well as stronger immune response characterized by higher inflammation markers(e.g.WBC,ESR,CRP)can help distinguish TB from NTM infection in HIV-infected patients who need empirical therapy or diagnostic therapy immediately in low-income areas.

Effect of vanadium on hydrogen embrittlement susceptibility of high-strength hot-stamped steel

Based on the chemical composition of traditional hot-stamped steel(e.g.,22MnB5 and 30MnB5),Nb and V microalloying elements are added into 30MnB5 steel to meet the requirements of ultra-high strength,excellent ductility and potent resistance to hydrogen embrittlement(HE)at the same time.The influence of hot-stamped steel on HE was studied by conducting a hydrogen permeation method and pre-charged hydrogen slow strain rate test.Meanwhile,the experimental steel microstructures and corresponding fracture surfaces are observed and analyzed to characterize HE behavior.The results show that a finer microstructure,a lower apparent diffusion coefficient of hydrogen and a smaller percentage of strength and plasticity reduction are obtained due to the addition of the vanadium element into hot-stamped steel.Compared to the V free experimental steel,the steel with 0.14 wt.% V has a large number of dispersive precipitates and more grain boundary areas,which makes hydrogen atoms dispersedly distribute.

Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis:a 2-year retrospective analysis

Background:Cryptococcal meningitis(CM)is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus(HIV)-infected patients,and is complicated with significant morbidity and mortality.This study retrospectively analyzed the clinical features,characteristics,treatment,and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.Methods:Data from all patients(n=101)of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.Results:Of the 101 patients,86/99(86.9%)of patients had CD4 count<50 cells/mm^3,57/101(56.4%)were diagnosed at≥14 days from the onset to diagnosis,42/99(42.4%)had normal cerebrospinal fluid(CSF)cell counts and biochemical examination,30/101(29.7%)had concomitant Pneumocystis(carinii)jiroveci pneumonia(PCP)on admission and 37/92(40.2%)were complicated with cryptococcal pneumonia,50/74(67.6%)had abnormalities shown on intracranial imaging,amongst whom 24/50(48.0%)had more than one lesion.The median time to negative CSF Indian ink staining was 8.50 months(interquartile range,3.25-12.00 months).Patients who initiated antiretroviral therapy(ART)before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients(7 vs.12 months,χ^2=15.53,P<0.001).All-cause mortality at 2 weeks,8 weeks,and 2 years was 10.1%(10/99),18.9%(18/95),and 20.7%(19/92),respectively.Coinfection with PCP on admission(adjusted odds ratio[AOR],3.933;95%confidence interval[CI],1.166-13.269,P=0.027)and altered mental status(AOR,9.574;95%CI,2.548-35.974,P=0.001)were associated with higher mortality at 8 weeks.Conclusion:This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data.Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.

Correction to: Routinely detected indicatorsin plasma have a predictive effect on theidentification of HIV-infected patients withnon-tuberculous mycobacterial andtuberculous infections

Correction After publication of this article[1]it came to our attention that the affiliation of Jun Chen and Hong-zhou Lu were incorrectly shown.Jun Chen’s affiliation should have been given as Department of Infectious Diseases,Shanghai Public Health Clinical Center,Fudan University,Shanghai,China.Hong-zhou Lu should have been given as Department of Infectious Diseases,Shanghai Public Health Clinical Center,Fudan University,Shanghai,China.Huashan Hospital affiliated to Fudan University,Shanghai,China.Medical College of Fudan University,Shanghai,China.The original article has been updated to reflect this change.

Application potential of high performance steels for weight reduction and efficiency increase in commercial vehicles

The fast-growing economy and the gradually established highway system have boosted the road trans- portation for both passenger and cargo over the last decade in China. From 2000 to 2010 Chinese GDP increased by around 10.15% annually and the sales of medium and heavy trucks by around 18.87% （sales increased from 0.2 million in 2000 to 1.3 million in 2010） according to the National Bureau of Statistics of People＇s Republic of China. Today commercial vehicles consume almost the same amount of fuel as pas- senger cars in China although the number of commercial vehicles is only about one fourth of passenger cars. It is estimated that around 50% of imported fuel to China each year will be consumed by vehicle transportation. This si- tuation will worsen fuel shortage problems in the long run and at the same time it is partially responsible for the ever- worsening air pollution in China. Due to the widespread overloading in China, lightweight development in commer- cial vehicles has fallen far behind that of passenger cars with the consequences that Chinese commercial vehicles consume in average about 20% more fuel, especially the heavy trucks, compared to European models. Under these circumstances it is essential to reduce the vehicle fuel consumption and in- crease the transport efficiency. The key solution thereby is to implement lightweight design in commercial vehicles as it has been successfully practiced over the last decade in the passenger cars. This paper summarizes highlights given in presentations during the ＂International seminar on the ap- plication of high strength steels in light weight commercial vehicles＂ with the focus on the development and application of Nb alloyed high performance steels made for lightweight commercial vehicles.

Disseminated nontuberculous mycobacteria infection in human immunodeficiency virus-infected patients

Nontuberculous mycobacteria(NTM)infection can occur in both immunocompetent and immunocompromised patients,but disseminated NTM infection is mostly occurred in immunocompromised patients such as people using long-term immunosuppressants or patients with human immunodeficiency virus(HIV)infection,particular-ly in those with CD4+T lymphocyte count<50 cells/mm3.Disseminated infection by NTM is considered a fatal acquired immunodeficiency syndrome(AIDS)-defining opportunistic infection with high mortality in this population.

A practical community-based response strategy to interrupt Ebola transmission in sierra Leone, 2014–2015

Background:The Ebola virus disease spread rapidly in West Africa in 2014,leading to the loss of thousands of lives.Community engagement was one of the key strategies to interrupt Ebola transmission,and practical community level measures needed to be explored in the field and tailored to the specific context of communities.Methods:First,community-level education on Ebola virus disease(EVD)prevention was launched for the community’s social mobilizers in six districts in Sierra Leone beginning in November 2014.Then,from January to May of 2015,in three pilot communities,local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures,by involving them in alert case report,contact tracing,and social mobilization.The epidemiological indicators of transmission interruption in three study communities were evaluated.Results:A total of 6016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts,and EVD message reached an estimated 631680 residents.In three pilot communities,72 EVD alert cases were reported,with 70.8%of them detected by trained local community members,and 14 EVD cases were finally identified.Contact tracing detected 64.3%of EVD cases.The median duration of community infectivity for the cases was 1 day.The secondary attack rate was 4.2%,and no third generation of infection was triggered.No health worker was infected,and no unsafe burial and noncompliance to EVD control measures were recorded.The community-based measures were modeled to reduce 77 EVD cases,and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra Leone.Conclusions: The community-based strategy of social mobilization and community engagement was effective in casedetection and reducing the extent of Ebola transmission in a country with weak health system. The successfullypractical experience to reduce the risk of Ebola transmission in the community with poor resources would potentiallybe helpful for the global community to fight against the EVD and the other diseases in the future.

Immune profiles of a COVID-19 adolescent with mild symptoms and anti anti-viral antibody deficiency

1.Introduction.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has led to the outbreak of COVID-19 syndrome since December 2019,becoming prevalent worldwide afterward[1,2].Unlike severe acute respiratory syndrome(SARS)and Middle East respiratory syndrome(MERS),which cause severe symptoms and high mortality[1],the morbidity from COVID-19 is relatively low,especially in young people[3].In China,the mortality rate was 1023 of 44,672 confirmed cases by the end of Februaryl 1,2020[4].However,there were no cases of death among 416 patients aged 0-9 years,and only 1 in 549 patients aged 10-19 years[4].The exact reasons for this clinical phenomenon remain unclear.