Efficacy and safety of low-dose cyclophosphamide combined with lenvatinib, pembrolizumab and TACE for unresectable hepatocellular carcinoma:A single-center, prospective,single-arm clinical trial

Objective: Unresectable hepatocellular carcinoma(uHCC) continues to pose effective treatment options. The objective of this study was to assess the efficacy and safety of combining low-dose cyclophosphamide with lenvatinib, pembrolizumab and transarterial chemoembolization(TACE) for the treatment of uHCC.Methods: From February 2022 to November 2023, a total of 40 patients diagnosed with uHCC were enrolled in this small-dose, single-center, single-arm, prospective study. They received a combined treatment of low-dose cyclophosphamide with lenvatinib, pembrolizumab, and TACE. Study endpoints included progression-free survival(PFS), objective response rate(ORR), and safety assessment. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors(mRECIST), while survival analysis was conducted through KaplanMeier curve analysis for overall survival(OS) and PFS. Adverse events(AEs) were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events(version 5.0).Results: A total of 34 patients were included in the study. The median follow-up duration was 11.2 [95% confidence interval(95% CI), 5.3-14.6] months, and the median PFS(mPFS) was 15.5(95% CI, 5.4-NA) months.Median OS(mOS) was not attained during the study period. The ORR was 55.9%, and the disease control rate(DCR) was 70.6%. AEs were reported in 27(79.4%) patients. The most frequently reported AEs(with an incidence rate >10%) included abnormal liver function(52.9%), abdominal pain(44.1%), abdominal distension and constipation(29.4%), hypertension(20.6%), leukopenia(17.6%), constipation(17.6%), ascites(14.7%), and insomnia(14.7%). Abnormal liver function(14.7%) had the most common grade 3 or higher AEs.Conclusions: A combination of low-dose cyclophosphamide with lenvatinib, pembrolizumab, and TACE is safe and effective for u HCC, showcasing a promising therapeutic strategy for managing uHCC.

Comparative Analysis of Statistical Thickness Models for the Determination of the External Specific Surface and the Surface of the Micropores of Materials: The Case of a Clay Concrete Stabilized Using Sugar Cane Molasses

In this work, four empirical models of statistical thickness, namely the models of Harkins and Jura, Hasley, Carbon Black and Jaroniec, were compared in order to determine the textural properties (external surface and surface of micropores) of a clay concrete without molasses and clay concretes stabilized with 8%, 12% and 16% molasses. The results obtained show that Hasley’s model can be used to obtain the external surfaces. However, it does not allow the surface of the micropores to be obtained, and is not suitable for the case of simple clay concrete (without molasses) and for clay concretes stabilized with molasses. The Carbon Black, Jaroniec and Harkins and Jura models can be used for clay concrete and stabilized clay concrete. However, the Carbon Black model is the most relevant for clay concrete and the Harkins and Jura model is for molasses-stabilized clay concrete. These last two models augur well for future research.

Composite Panels from the Combination of Rice Husk and Wood Chips with a Natural Resin Based on Tannins Reinforced with Sugar Cane Molasses Intended for Building Insulation: Physico-Mechanical and Thermal Properties

The objective of this work is to develop new biosourced insulating composites from rice husks and wood chips that can be used in the building sector. It appears from the properties of the precursors that rice chips and husks are materials which can have good thermal conductivity and therefore the combination of these precursors could make it possible to obtain panels with good insulating properties. With regard to environmental and climatic constraints, the composite panels formulated at various rates were tested and the physico-mechanical and thermal properties showed that it was essential to add a crosslinker in order to increase certain solicitation. an incorporation rate of 12% to 30% made it possible to obtain panels with low thermal conductivity, a low surface water absorption capacity and which gives the composite good thermal insulation and will find many applications in the construction and real estate sector. Finally, new solutions to improve the fire reaction of the insulation panels are tested which allows to identify suitable solutions for the developed composites. In view of the flame tests, the panels obtained are good and can effectively combat fire safety in public buildings.

Analysis of the Efficacy of Low-Dose Betaloc Combined with Amiodarone in Treating Ventricular Arrhythmia

Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department of Cardiology of our hospital between August 2022 and August 2023 were selected as research subjects.They were divided into two groups using the coin-tossing method:the combination group(n=35)and the reference group(n=35).The combination group was treated with low-dose Betaloc and amiodarone,and the control group was treated with low-dose Betaloc alone.The treatment efficacy,cardiac function indicators,and related tested indicators of the two groups were compared.Results:The total efficacy of the treatment received by the combination group was much higher than that of the control group(P<0.05).Besides,after treatment,the cardiac function indicators such as left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and cardiac index(CI)of the patients in the combination group were significantly better than those of the reference group(P<0.05).Furthermore,the high-sensitivity C-reactive protein(Hs-CRP),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),adiponectin(APN),and other related test indicators of the patients in the combination group were significantly better than those of the reference group(P<0.05).Conclusion:Low-dose Betaloc combined with amiodarone has a noticeable effect in treating ventricular arrhythmia and deserves to be widely promoted.

Successful treatment of patients with refractory idiopathic membranous nephropathy with low-dose Rituximab:A single-center experience

BACKGROUND The recognition of idiopathic membranous nephropathy(IMN)as an autoimmune disease has paved the way for the use of B-cell-depleting agents,such as Rituximab(RTX),which is now a first-line drug for treating IMN with proven safety and efficacy.Nevertheless,the usage of RTX for the treatment of refractory IMN remains controversial and challenging.AIM To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of patients with refractory IMN.METHODS A retrospective study was performed on refractory IMN patients that accepted a low-dose RTX regimen(RTX,200 mg,once a month for five months)in the Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences’Department of Nephrology from October 2019 to December 2021.To assess the clinical and immune remission data,we performed a 24 h urinary protein quantification(UTP)test and measured the serum albumin(ALB)and serum creatinine(SCr)levels,phospholipase A2 receptor(PLA2R)antibody titer,and CD19+B-cell count every three months.RESULTS A total of nine refractory IMN patients were analyzed.During follow-up conducted twelve months later,the results from the 24 h UTP decreased from baseline[8.14±6.05 g/d to 1.24±1.34 g/d(P<0.05)]and the ALB levels increased from baseline[28.06±8.42 g/L to 40.93±5.85 g/L(P<0.01)].Notably,after administering RTX for six months,the SCr decreased from 78.13±16.49μmol/L to 109.67±40.87μmol/L(P<0.05).All of the nine patients were positive for serum anti-PLA2R at the beginning,and four patients had normal anti-PLA2R titer levels at six months.The level of CD19+B-cells decreased to 0 at three months,and CD19+B-cell count remained at 0 up until six months of follow-up.CONCLUSION Our low-dose RTX regimen appears to be a promising treatment strategy for refractory IMN.

Viscosity reduction of tapioca starch by incorporating with molasses hydrocolloids

As a low cost non-staple food resource,the high-viscosity paste and poor gel-forming ability of tapioca starch limit its industrial application.Herein,molasses hydrocolloids that is a by-product of the sugar refining process was applied as a blending modifier to reduce the viscosity of tapioca starch paste.The test results of paste and rheological properties show that molasses hydrocolloids exhibited a good physical viscosity-reducing effect on tapioca starch paste.The irregular network structure and high K^(+)/Ca^(2+)ion contents of molasses hydrocolloids exerted wrapping,adhesion,barrier,and hydration effects on starch,leading to the reduction of viscosity.The scanning electron microscope images and textural analysis demonstrated that this strategy also improve the structure of tapioca starch gel and enhanced its puncture strength by 75.46%.This work shows the great potential of molasses hydrocolloids as a lowcost and desirable material for the viscosity reduction of tapioca starch.

Thermo-Mechanical Properties Study of Stabilized Soil Bricks to Sugar Cane Molasses and Cassava Starch Binders

The current study deals Swith thermo-mechanical properties of stabilized soil small bricks with the help of organic binders of sugar cane molasses and cassava starch. Different formulations of soil concrete have been suggested after the geotechnical characterization of samples of soil was taken. From these, it arises that the studied soil is the most plastically clay (of type A3) according to GTR classification. Samples made of small bricks and measured out at 4%, 6% and 8% of binders (molasses, starch or molasses + starch) have been warmed up to different temperatures (100°C, 150°C, 200°C and 250°C) for the rising of the thermic behavior under different conditions and submitted to crushing testings for the estimation of characteristic resistances to the compression. According to the mechanical behavior, we note an improvement of resistances for small bricks measured 4%, 6% and 8%, of molasses respectively of 32.44%, 32.06% and 23.43% against the value of reference for small bricks without molasses. In the same way, the binder (molasses + starch) also reveals an improvement of resistance to the compression of 13.27%, 26.17% and 26.17%. On the contrary, the stabilization with the starch binder did not bring a significative improvement. According to the thermic influence, the heating at 100°C of stabilized small bricks at 4%, 6% and 8% of molasses, reveals a significative improvement of resistances. Moreover, the stabilization with the starch reveals on the contrary a good behavior for heatings at 150°C and 250°C. In short, for the binder (molasses + starch), it is the heating at 200°C that shows some improvements of remarkable resistances. Different analyses of realized statistics also show the effectivity of obtained results. For all realized formulations, the measuring out at 6% of binders (molasses, or molasses + starch) seems as optimal in front of the best thermo-mechanical revealed properties.

Hformer:highly efficient vision transformer for low-dose CT denoising

In this paper,we propose Hformer,a novel supervised learning model for low-dose computer tomography(LDCT)denoising.Hformer combines the strengths of convolutional neural networks for local feature extraction and transformer models for global feature capture.The performance of Hformer was verified and evaluated based on the AAPM-Mayo Clinic LDCT Grand Challenge Dataset.Compared with the former representative state-of-the-art(SOTA)model designs under different architectures,Hformer achieved optimal metrics without requiring a large number of learning parameters,with metrics of33.4405 PSNR,8.6956 RMSE,and 0.9163 SSIM.The experiments demonstrated designed Hformer is a SOTA model for noise suppression,structure preservation,and lesion detection.

Effects of molasses on the fermentation characteristics of mixed silage prepared with rice straw, local vegetable by-products and alfalfa in Southeast China

This experiment was conducted to study the effect of molasses on the fermentation characteristics of mixed silage ensiled rice straw and vegetable by-products with alfalfa.Mixture（202 g kg^-1 dry matter（DM））consisting of rice straw,broccoli residue and alfalfa at the ratio of 5：4：1 was ensiled with three experimental treatments：（1）no additives（control）;（2）molasses at 2.5%（M1）;（3）molasses at 5%（M2）on a fresh matter basis of mixture,respectively.All treatments were packed into laboratory-scale silos,and three silos per treatment were sampled on days 1,3,5,14 and 30.The result showed that the p H value of all mixed silages decreased gradually with the time of ensiling except for the control silage,in which a significant increase（P〈0.05）on day 30 occurred.The lactic acid content increased gradually with the time of ensiling and reached the highest value on day 14,and a marked decrease（P〈0.05）was found in the control silage on day 30.The changes of acetic acid content showed similar pattern with lactic acid content.A trace amount of propionic and butyric acid contents were found in the three mixed silages during the fermentation period.Comparing to the control,M1 and M2 treatments improved the fermentation quality of mixed silages as indicated by higher（P〈0.05）lactic acid contents and lower（P〈0.05）p H and ammonia-N contents.The Flieg points also showed that M1 and M2 silages were well preserved,whereas the control silage had a bad quality.Overall,the findings of this study suggested that adding molasses could improve fermentation quality of mixed silage,and M1 was more suitable for practical application.

Effect of molasses binder on the physical and mechanical properties

Molasses was used as an alternative binder to the bentonite binder. The change in moisture absorption by pellets prepared with different iron ores and different molasses contents were investigated. Iron ore properties exerted the major effect on pellet behavior and final pellet quality. The absorbed moisture content of pellets prepared without binder, bentonite-added pellets, and molasses-added pellets were in the range of 7.72%–9.95%, 9.62%–10.84%, and 6.14%-6.69%, respectively. The wet pellet compressive strength of molasses-added pellets(43–230 N/pellet) was superior to that of bentonite-added pellets(9.47–11.92 N/pellet). The compressive strength of dried molasses-modified pellets increased to 222–394 N/pellet, which is currently the highest value achieved for dried pellets.

In vitro Ruminal Gas Production Kinetics of Four Fodder Trees Ensiled With or Without Molasses and Urea

This study investigated if the addition of urea （U）, molasses （M） or their 1：1 （v/v） mixture during ensiling increases the nutritional value of forage from four fodder trees （Prunus persica, Leucaena esculenta, Acacia farnesiana, and Prunus domestica）. Forage samples of fodder trees were collected in triplicate （three individual samples of each species） and subjected to an in vitro gas production （GP） procedure. Fermentation at 24 h （GP 24）, short-chain volatile fatty acids （SCFA）, and microbial crude protein production （MCP）, in vitro organic matter digestibility （OMD）, metabolizable energy （ME） and dry matter degradability （DMD） were estimated. Forage samples were incubated for 72 h in an incubator at 39oC and the volume of GP was recorded at 2, 4, 6, 8, 10, 12, 24, 48, and 72 h of incubation using the reading pressure technique. The rumen fermentation profiles were highest for P. persica, which showed the highest （P〈0.0001） DMD, ME, OMD, SCFA, GP 24 and MCP. On the other hand L. esculenta had the lowest （P〈0.0001） DMD, SCFA, MCP; P. domestica had the lowest （P〈0.0001） OMD. The addition of M to silage increased （P〈0.0001） ME and OMD, as well as GP. However, the addition of U and the mixture of U and M reduced （P〈0.0001） DMD, ME, OMD, SCFA, GY 24 and MCP. These results show that P. persica has the highest nutritive value and L. esculenta the lowest for ruminants. Additionally, the addition of M to forage from fodder trees increases rumen GP and fermentation, which may improve nutrient utilization in ruminants.

Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy

Low-dose aspirin(LDA) is clinically used for the prevention of cardiovascular and cerebrovascular events with the advent of an aging society.On the other hand,a very low dose of aspirin(10 mg daily) decreases the gastric mucosal prostaglandin levels and causes significant gastric mucosal damage.The incidence of LDAinduced gastrointestinal mucosal injury and bleeding has increased.It has been noticed that the incidence of LDA-induced gastrointestinal hemorrhage has increased more than that of non-aspirin non-steroidal anti-inflammatory drug(NSAID)-induced lesions.The pathogenesis related to inhibition of cyclooxygenase(COX)-1 includes reduced mucosal flow,reduced mucus and bicarbonate secretion,and impaired platelet aggregation.The pathogenesis related to inhibition of COX-2 involves reduced angiogenesis and increased leukocyte adherence.The pathogenic mechanisms related to direct epithelial damage are acid back diffusion and impaired platelet aggregation.The factors associated with an increased risk of upper gastrointestinal(GI) complications in subjects taking LDA are aspirin dose,history of ulcer or upper GI bleeding,age > 70 years,concomitant use of non-aspirin NSAIDs including COX-2-selective NSAIDs,and Helicobacter pylori(H.pylori) infection.Moreover,no significant differences have been found between ulcer and non-ulcer groups in the frequency and severity of symptoms such as nausea,acid regurgitation,heartburn,and bloating.It has been shown that the ratios of ulcers located in the body,fundus and cardia are significantly higher in bleeding patients than the ratio of gastroduodenal ulcers in patients taking LDA.Proton pump inhibitors reduce the risk of developing gastric and duodenal ulcers.In contrast to NSAIDinduced gastrointestinal ulcers,a well-tolerated histamine H2-receptor antagonist is reportedly effective in prevention of LDA-induced gastrointestinal ulcers.The eradication of H.pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding.Continuous aspirin therapy for patients with gastrointestinal bleeding may increase the risk of recurrent bleeding but potentially reduces the mortality rates,as stopping aspirin therapy is associated with higher mortality rates.It is very important to prevent LDA-induced gastroduodenal ulcer complications including bleeding,and every effort should be exercised to prevent the bleeding complications.

High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding:A meta-analysis

AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

Mortality outcomes of low-dose computed tomography screening for lung cancer in urban China:a decision analysis and implications for practice

Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.Methods: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.Results: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.Conclusions: In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China.However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.

Mitochondrial Modulation of Apoptosis Induced by Low-dose Radiation in Mouse Testicular Cells

Objective To investigate whether apoptosis induced by low-dose radiation （LDR） is regulated by mitochondrial pathways in testicular cells. Methods Male mice were exposed to whole-body LDR, and changes in mitochondrial function and in expression of apoptotic factors were analyzed in the testicular cells as follows. Total nitric-oxide synthase （T-NOS） and Na＋/K＋ ATPase activities were biochemically assayed. Reactive oxygen species （ROS） and mitochondrial membrane potential （Adjm） were determined by flow cytometry using fluorescent probes. Levels of mRNAs encoding cytochrome c （Cyt c） and apoptosis-inducing factor （AIF） were quantified by real-time reverse-transcription PCR （RT-PCR）. Expression of Cyt c, AIF, caspase-9, and caspase-3 at the protein level was assessed by western blotting and immunohistochemistry. Results LDR induced an increase in T-NOS activity and ROS levels, and a decrease in Na＋/K~ ATPase activity and mitochondrial A^m, in the testicular cells. The intensity of these effects increased with time after irradiation and with dose. The cells showed remarkable swelling and vacuolization of mitochondria, and displayed a time- and dose-dependent increase in the expression of Cyt c, AIF, procaspase-9, and procaspase-3. Activation of the two procaspases was confirmed by detection of the cleaved caspases. The changes in expression of the four apoptotic factors were mostly limited to spermatogonia and spermatocytes. Conclusion LDR can induce testicular cell apoptosis through mitochondrial signaling pathways

Systematically investigating the polarization gradient cooling in an optical molasses of ultracold cesium atoms

We systematically investigate the polarization gradient cooling （PGC） process in an optical molasses of ultracold cesium atoms. The SR mode for changing the cooling laser, which means that the cooling laser frequency is stepped to the setting value while its intensity is ramped, is found to be the best for the PGC, compared with other modes studied. We verify that the heating effect of the cold atoms, which appears when the cooling laser intensity is lower than the saturation intensity, arises from insufficient polarization gradient cooling. Finally, an exponential decay function with a statistical explanation is introduced to explain the dependence of the cold atom temperature on the PGC interaction time.

Feasibility of gastric endoscopic submucosal dissection with continuous low-dose aspirin for patients receiving dual antiplatelet therapy

BACKGROUND Endoscopic submucosal dissection(ESD) for gastric neoplasms during continuous low-dose aspirin(LDA) administration is generally acceptable according to recent guidelines. This retrospective study aimed to investigate the effect of continuous LDA on the postoperative bleeding after gastric ESD in patients receiving dual antiplatelet therapy(DAPT).AIM To investigate the feasibility of gastric ESD with continuous LDA in patients with DAPT.METHODS A total of 597 patients with gastric neoplasms treated with ESD between January2010 and June 2017 were enrolled. The patients were categorized according to type of antiplatelet therapy(APT).RESULTS The postoperative bleeding rate was 6.9%(41/597) in all patients. Patients were divided into the following two groups: no APT(n = 443) and APT(n = 154). APT included single-LDA(n = 95) and DAPT(LDA plus clopidogrel, n = 59)subgroups. In the single-LDA and DAPT subgroups, 56 and 39 patients were received continuous LDA, respectively. The bleeding rate with continuous singleLDA(10.7%) was similar to that with discontinuous single-LDA(10.3%)(P >0.99). Although the bleeding rate with continuous LDA in patients receiving DAPT(23.1%) was higher than that with discontinuous LDA in patients receiving DAPT(5.0%), no significant difference was observed(P = 0.141).CONCLUSION The bleeding rate with continuous LDA in patients receiving DAPT was not statistically different from that with discontinuous LDA in patients receiving DAPT. Therefore, continuous LDA administration may be acceptable for ESD in patients receiving DAPT, although patients should be carefully monitored for possible bleeding.

Effi cacy and safety of low-dose corticosteroids for acute respiratory distress syndrome:A systematic review and meta-analysis

BACKGROUND:There are confl icting results regarding whether corticosteroids have better effi cacy than placebo in acute respiratory distress syndrome(ARDS)patients.Therefore,we aim to further evaluate the effi cacy and safety of corticosteroids in adult ARDS patients.METHODS:The databases,including Medline,EMBASE,and Cochrane Central Register of Controlled Trials(CENTRAL)in the Cochrane Library,were searched from their inception to May 2,2020.Randomized controlled trials(RCTs)and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients.The quality of the results was judged by the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)methodology.The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio(OR),standardized mean diff erence(SMD),and their 95%confi dence interval(CI).RESULTS:Eight eligible RCTs and six cohort studies were included.The use of corticosteroids was associated with reduced mortality(OR 0.57,95%CI 0.43-0.76,I2=35.1%,P=0.148)in ARDS patients,and the result was confirmed in the included cohort studies(OR 0.51,95%CI 0.27-0.95,I2=66.7%,P=0.010).The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had signifi cant survival benefits in the RCTs.The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients.CONCLUSIONS:The low-dose corticosteroid therapy may be safe and reduce mortality,especially in patients with prolonged treatment and early ARDS.

Gender differences of low-dose aspirin-associated gastroduodenal ulcer in Japanese patients

AIM:To clarify the gender differences about the clini-cal features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese patients.METHODS: There were 453 patients under treatment with LDA (298 males, 155 females) who underwent esophagogastroduodenoscopy at the Department of Gastroenterology and Hepatology of Hiratsuka City Hospital between January 2003 and December 2007. They had kept taking the LDA or started treatmentduring the study period and kept taking LDA during the whole period of observation. Of these, 119 patients (87 males, 32 females) were diagnosed as having LDA-associated peptic ulcer. We examined the clinical factors associated with LDA-associated peptic ulcer in both sexes.RESULTS: A history of peptic ulcer was found to be the risk factor for LDA-associated peptic ulcer common to both sexes. In female patients, age greater than 70 years (prevalence ORs 8.441, 95% CI: 1.797-33.649, P = 0.0069) was found to be another significant risk fac-tor, and the time to diagnosis as having LDA-associat-ed peptic ulcer by endoscopy was significantly shorter than that in the male patients (P = 0.0050). CONCLUSION: We demonstrated gender differences about the clinical features and risk factors of LDA-asso-ciated peptic ulcer. Special attention should be paid to aged female patients taking LDA.

Sinogram denoising via attention residual dense convolutional neural network for low-dose computed tomography

The widespread use of computed tomography(CT)in clinical practice has made the public focus on the cumulative radiation dose delivered to patients.Low-dose CT(LDCT)reduces the X-ray radiation dose,yet compromises quality and decreases diagnostic performance.Researchers have made great efforts to develop various algorithms for LDCT and introduced deep-learning techniques,which have achieved impressive results.However,most of these methods are directly performed on reconstructed LDCT images,in which some subtle structures and details are readily lost during the reconstruction procedure,and convolutional neural network(CNN)-based methods for raw LDCT projection data are rarely reported.To address this problem,we adopted an attention residual dense CNN,referred to as AttRDN,for LDCT sinogram denoising.First,it was aided by the attention mechanism,in which the advantages of both feature fusion and global residual learning were used to extract noise from the contaminated LDCT sinograms.Then,the denoised sinogram was restored by subtracting the noise obtained from the input noisy sinogram.Finally,the CT image was reconstructed using filtered back-projection.The experimental results qualitatively and quantitatively demonstrate that the proposed AttRDN can achieve a better performance than state-of-the-art methods.Importantly,it can prevent the loss of detailed information and has the potential for clinical application.