Publications by authors named "Ruiyang Li"

34 Publications

Improving the Generalizability of Infantile Cataracts Detection via Deep Learning-Based Lens Partition Strategy and Multicenter Datasets.

Front Med (Lausanne) 2021 7;8:664023. Epub 2021 May 7.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Infantile cataract is the main cause of infant blindness worldwide. Although previous studies developed artificial intelligence (AI) diagnostic systems for detecting infantile cataracts in a single center, its generalizability is not ideal because of the complicated noises and heterogeneity of multicenter slit-lamp images, which impedes the application of these AI systems in real-world clinics. In this study, we developed two lens partition strategies (LPSs) based on deep learning Faster R-CNN and Hough transform for improving the generalizability of infantile cataracts detection. A total of 1,643 multicenter slit-lamp images collected from five ophthalmic clinics were used to evaluate the performance of LPSs. The generalizability of Faster R-CNN for screening and grading was explored by sequentially adding multicenter images to the training dataset. For the normal and abnormal lenses partition, the Faster R-CNN achieved the average intersection over union of 0.9419 and 0.9107, respectively, and their average precisions are both > 95%. Compared with the Hough transform, the accuracy, specificity, and sensitivity of Faster R-CNN for opacity area grading were improved by 5.31, 8.09, and 3.29%, respectively. Similar improvements were presented on the other grading of opacity density and location. The minimal training sample size required by Faster R-CNN is determined on multicenter slit-lamp images. Furthermore, the Faster R-CNN achieved real-time lens partition with only 0.25 s for a single image, whereas the Hough transform needs 34.46 s. Finally, using Grad-Cam and t-SNE techniques, the most relevant lesion regions were highlighted in heatmaps, and the high-level features were discriminated. This study provides an effective LPS for improving the generalizability of infantile cataracts detection. This system has the potential to be applied to multicenter slit-lamp images.
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http://dx.doi.org/10.3389/fmed.2021.664023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137827PMC
May 2021

Automatic classification of heterogeneous slit-illumination images using an ensemble of cost-sensitive convolutional neural networks.

Ann Transl Med 2021 Apr;9(7):550

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Background: Lens opacity seriously affects the visual development of infants. Slit-illumination images play an irreplaceable role in lens opacity detection; however, these images exhibited varied phenotypes with severe heterogeneity and complexity, particularly among pediatric cataracts. Therefore, it is urgently needed to explore an effective computer-aided method to automatically diagnose heterogeneous lens opacity and to provide appropriate treatment recommendations in a timely manner.

Methods: We integrated three different deep learning networks and a cost-sensitive method into an ensemble learning architecture, and then proposed an effective model called CCNN-Ensemble [ensemble of cost-sensitive convolutional neural networks (CNNs)] for automatic lens opacity detection. A total of 470 slit-illumination images of pediatric cataracts were used for training and comparison between the CCNN-Ensemble model and conventional methods. Finally, we used two external datasets (132 independent test images and 79 Internet-based images) to further evaluate the model's generalizability and effectiveness.

Results: Experimental results and comparative analyses demonstrated that the proposed method was superior to conventional approaches and provided clinically meaningful performance in terms of three grading indices of lens opacity: area (specificity and sensitivity; 92.00% and 92.31%), density (93.85% and 91.43%) and opacity location (95.25% and 89.29%). Furthermore, the comparable performance on the independent testing dataset and the internet-based images verified the effectiveness and generalizability of the model. Finally, we developed and implemented a website-based automatic diagnosis software for pediatric cataract grading diagnosis in ophthalmology clinics.

Conclusions: The CCNN-Ensemble method demonstrates higher specificity and sensitivity than conventional methods on multi-source datasets. This study provides a practical strategy for heterogeneous lens opacity diagnosis and has the potential to be applied to the analysis of other medical images.
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http://dx.doi.org/10.21037/atm-20-6635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105862PMC
April 2021

A high-quality bonobo genome refines the analysis of hominid evolution.

Nature 2021 Jun 5;594(7861):77-81. Epub 2021 May 5.

National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.

The divergence of chimpanzee and bonobo provides one of the few examples of recent hominid speciation. Here we describe a fully annotated, high-quality bonobo genome assembly, which was constructed without guidance from reference genomes by applying a multiplatform genomics approach. We generate a bonobo genome assembly in which more than 98% of genes are completely annotated and 99% of the gaps are closed, including the resolution of about half of the segmental duplications and almost all of the full-length mobile elements. We compare the bonobo genome to those of other great apes and identify more than 5,569 fixed structural variants that specifically distinguish the bonobo and chimpanzee lineages. We focus on genes that have been lost, changed in structure or expanded in the last few million years of bonobo evolution. We produce a high-resolution map of incomplete lineage sorting and estimate that around 5.1% of the human genome is genetically closer to chimpanzee or bonobo and that more than 36.5% of the genome shows incomplete lineage sorting if we consider a deeper phylogeny including gorilla and orangutan. We also show that 26% of the segments of incomplete lineage sorting between human and chimpanzee or human and bonobo are non-randomly distributed and that genes within these clustered segments show significant excess of amino acid replacement compared to the rest of the genome.
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http://dx.doi.org/10.1038/s41586-021-03519-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172381PMC
June 2021

Optically Driven Gold Nanoparticles Seed Surface Bubble Nucleation in Plasmonic Suspension.

Nano Lett 2021 May 3. Epub 2021 May 3.

Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, United States.

Photothermal surface bubbles play important roles in applications like microfluidics and biosensing, but their formation on transparent substrates immersed in a plasmonic nanoparticle (NP) suspension has an unknown origin. Here, we reveal NPs deposited on the transparent substrate by optical forces are responsible for the nucleation of such photothermal surface bubbles. We show the surface bubble formation is always preceded by the optically driven NPs moving toward and deposited to the surface. Interestingly, such optically driven motion can happen both along and against the photon stream. The laser power density thresholds to form a surface bubble drastically differ depending on if the surface is forward- or backward-facing the light propagation direction. We attributed this to different optical power densities needed to enable optical pulling and pushing of NPs in the suspension, as optical pulling requires higher light intensity to excite supercavitation around NPs to enable proper optical configuration.
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http://dx.doi.org/10.1021/acs.nanolett.0c04913DOI Listing
May 2021

The associations of population mobility in HIV disease severity and mortality rate in China.

Ann Transl Med 2021 Feb;9(4):315

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Background: Human immunodeficiency virus (HIV) infection has become a chronic disease and attracted public attention globally. Population migration was considered hindering the control and management of HIV infection, but limited studies have explored how population mobility could influence the development of HIV-related complications and overall prognosis.

Methods: We enrolled hospitalized HIV patients in this cross-sectional study between January 1, 2006, and December 31, 2016. We extracted demographic, hospitalization, and patient diagnosis data. Patients were divided into three groups according to the population type: (I) resident of Guangzhou City (local resident); (II) migrant outside of Guangzhou City but within Guangdong Province (migrant within the province); and (III) migrant outside of Guangdong Province (migrant outside the province). To represent the prognosis of HIV, in-hospital death was defined as the worst outcome, whereas vision-related events were considered moderate-to-severe complications. Logistic regression models were used to analyze factors influencing the prognosis of HIV.

Results: Eight thousand and six hundred thirty-one inpatients (14,954 cases) were enrolled. The overall mortality was 7.9%, decreasing from 21.5% in 2006 to 3.8% in 2016. The prevalence of vision-related events was 14.4% between 2015 and 2016. Compared to local patients, migrant patients (within and outside the province) were younger, had significantly less access to health insurance, fewer hospitalization admissions, longer hospital stays, and a higher proportion of physical work (P<0.01). Furthermore, they had a higher prevalence of vision-related events (16.2% and 17.4% in migrant patients within the province and outside the province, respectively 9.5%) and infectious diseases, but lower in-hospital mortality (5.9% and 7.0% 12.3%) than local patients. Migrants correlated negatively with in-hospital death [odds ratio (OR) 95% CI, 0.37 (0.29-0.48) and 0.52 (0.40-0.68)] but correlated positively with vision-related events [OR (95% CI), 2.08 (1.54-2.80) and 2.03 (1.47-2.80)].

Conclusions: Migrant patients have significantly poorer access to health insurance, with an increased risk of developing moderate-to-severe HIV infection but a decreased risk of in-hospital death, indicating a trend toward withdrawing treatment in migrant patients when they have advanced diseases. Managements such as optimizing access to health insurance and improving follow-up visits for HIV infection should be considered in the context of the population mobility of HIV patients.
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http://dx.doi.org/10.21037/atm-20-4514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944320PMC
February 2021

Biomechanical evaluation of different types of lateral hinge fractures in medial opening wedge high tibial osteotomy.

Clin Biomech (Bristol, Avon) 2021 Mar 21;83:105295. Epub 2021 Feb 21.

Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China. Electronic address:

Background: Lateral hinge fractures are common complications in the medial opening wedge high tibial osteotomy for treatment of knee osteoarthritis. The rehabilitation protocols are decided depending on the remaining stability following these fractures. This study aimed to evaluate the biomechanical properties of different types of lateral hinge fractures in medial opening wedge high tibial osteotomy.

Methods: Twenty synthetic tibia models were used as test samples. A 10-mm bone wedge was removed from the medial side of the proximal tibias to create the bone defect. The samples were then divided into 4 groups: (1) intact lateral hinge; (2) Takeuchi type I fractures; (3) type II fractures; and (4) type III fractures. After fixation with a locking plate, the stability parameters including construct stiffness, wedge displacement, and construct strength were tested under compressive forces and compared among the 4 groups.

Findings: No statistical difference was found in the construct stiffness among the 4 groups (P = 0.78). The type III fractures had the largest wedge displacement compared with the other 3 groups. The failure loads on average were significantly reduced in the type III fractures compared with those with intact hinge (P < 0.01) and in type I fractures (P = 0.04). No statistical difference was observed between the type I fractures and the intact hinge in terms of wedge displacement or failure loads.

Interpretation: The type III fractures were the most unstable and patients with these fractures should be managed cautiously. Delayed weightbearing and/or additional fixation should be considered.
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http://dx.doi.org/10.1016/j.clinbiomech.2021.105295DOI Listing
March 2021

The value and implementation of routine ophthalmic examination in the era of HAART.

EClinicalMedicine 2021 Jan 22;31:100646. Epub 2020 Dec 22.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China.

Background: The high prevalence of ocular manifestations (OMs) in patients with human immunodeficiency virus (HIV) infection and chronic diseases such as diabetes has become a global health issue. However, there is still a lack of an appropriate ophthalmic diagnostic procedure for the early detection of OMs in this population, leading to the risk of an irreversible visual impairment that substantially affects the quality of life of these patients.

Methods: The Guangzhou HIV Infection Study was a retrospective study that enrolled hospitalised HIV-infected patients in Guangzhou between January 2005 and December 2016, period corresponding to the highly active antiretroviral therapy (HAART) era in China. We collected data on OMs, systemic diseases, hospitalisation, and demographic characteristics. We classified the patients into 3 groups according to the ophthalmic examination mode they underwent: the non-ophthalmologist examination group (patients hospitalised in 2005-2011 who were only treated by infectious disease physicians), the on-demand ophthalmic examination group (patients hospitalised in 2012-2013 who were referred for a consultation with an ophthalmologist), and the routine ophthalmic examination group (patients hospitalised in 2014-2016 who routinely underwent standard ophthalmic examinations). Binary logistic regression models were used to investigate the factors related to OMs.

Findings: A total of 8,743 hospitalised HIV-infected patients were enrolled. The prevalence of detected OMs were 1.5% in the non-ophthalmologist examination group, 1.9% in the on-demand ophthalmic examination group, and 12.8% in the routine ophthalmic examination group. The odds of detection of OMs were highest in the routine ophthalmic examination group (adjusted odds ratio [aOR]=9.24, [95%CI, 6.51-13.12], compared to the non-ophthalmologist examination group). The detection of all types of OMs increased substantially, with keratitis, retinitis and vascular abnormalities increased the most (by 15.8-20.0 times). In the routine examination group, patients who were older than 50 years, males, with medical insurance, and were not resident in Guangzhou, had higher odds to have OMs. Several systemic diseases also increased the odds of OMs, with the highest odds among patients with a cytomegalovirus infection (aOR=5.59, [95%CI, 4.12-7.59]). Patients with retinitis, retinopathy and conjunctivitis had higher odds of having a CD4 T cell counts less than 200 cells/μL compared to the patients that did not have these referred OMs.

Interpretation: The implementation of a routine ophthalmic examination has improved the odds of OM detection by approximately 9 times and increased the diagnosis rates of all types of OMs. Therefore, we encourage all HIV-infected patients to undergo regular ophthalmic examinations. Patients with OMs, especially retinopathy and retinitis, need to be evaluated for immune function (such as CD4 T cell counts) and systemic diseases.
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http://dx.doi.org/10.1016/j.eclinm.2020.100646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772547PMC
January 2021

Dynamic Change in Serum Alpha-fetoprotein Level Predicts Treatment Response and Prognosis of Alpha-fetoprotein-producing Gastric Cancer.

Medicine (Baltimore) 2020 Nov;99(47):e23326

Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City.

Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is rare and associated with a suboptimal prognosis. The aim of this retrospective study was to identify prognostic factors, with a particular focus on the dynamics of serum AFP levels during treatment, in AFPGC patients.Data of patients with pathologically diagnosed primary gastric cancer treated with various modalities electronically collected in the medical management systems of 2 hospitals (ie, Shihezi People's Hospital and Shihezi Hospital) in Shihezi city, northwest China, from January 2007 to October 2018 were reviewed. Patients with AFPGC were identified based on serum AFP levels. Associations of the change in serum AFP levels and clinicopathological parameters with treatment response, including the overall response rate and disease control rate, and outcomes, including overall survival (OS) and progression-free survival (PFS), were compared among different groups.Of 2354 patients diagnosed with gastric cancer, 96 patients with AFPGC were identified. The objective response rate and disease control rate were significantly higher in patients whose AFP level decreased by ≥50% than in patients whose AFP level decreased by <50% (68.8% vs. 40.6%, and 87.5% vs. 53.1%, respectively, both P < .05). The median OS and PFS were 32.0 (4-74) and 24.0 (1-66) months, respectively, in patients with a ≥50% decline in AFP, and 12.5 (0-69) and 9.0 (0-63) months, respectively, in those with a <50% decline in AFP (both P < .05). On univariate and multivariate analyses, tumor, node, metastasis staging classification stage, liver metastasis, curable surgery, and the decline in the serum AFP level were associated with OS and PFS.A significant decline in the serum AFP level was associated with good treatment response and prognosis in AFPGC. Along with a decline in the serum AFP level, tumor, node, metastasis staging classification stage, liver metastasis, and curable surgery were also independent factors associated with prognosis.
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http://dx.doi.org/10.1097/MD.0000000000023326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676545PMC
November 2020

Chloramphenicol biodegradation by enriched bacterial consortia and isolated strain Sphingomonas sp. CL5.1: The reconstruction of a novel biodegradation pathway.

Water Res 2020 Dec 9;187:116397. Epub 2020 Sep 9.

Guangdong Provincial Engineering Research Center for Urban Water Recycling and Environmental Safety, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; Shenzhen Engineering Research Laboratory for Sludge and Food Waste Treatment and Resource Recovery, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China. Electronic address:

Figuring out the comprehensive metabolic mechanism of chloramphenicol (CAP) is critical to improving CAP removal in the bioremediation process. In this study, CAP biodegradation by six consortia and isolated Sphingomonas sp. CL5.1 were systematically investigated using the combination of high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry, second-generation, and third-generation sequencing technologies. The CAP-degrading capability of six consortia was enhanced while CAP mineralization rate declined after long-term enrichment. The microbial community structures of six consortia were all simplified with 69%-82% decline in species richness after continuous passages for one year. The core genera of consortia CL and CH included Sphingomonas, Cupriavidus, Burkholderia, Chryseobacterium, and Pigmentiphaga, which accounted for over 98% of the total population. Sphingomonas was discovered as a new CAP degrader that could subsist on CAP as the sole carbon, nitrogen, and energy sources. Sphingomonas sp. CL5.1 was able to completely remove 120 mg/L CAP within 48 hours with a mineralization rate of 50.4%. The presence of acetate or nitrite could inhibit CAP metabolization by strain CL5.1. Four CAP metabolic pathways were constructed, including modification of the C hydroxyl group of CAP via acetylation, oxidization, dehydration and the bond cleavage between C and C. C hydroxyl group dehydration and C-C bond-cleavage were first reported regarding to CAP biotransformation. Strain CL5.1 played a core role in the consortia and was responsible for C3 hydroxyl oxidation, C3 dehydration, and C1-C2 bond cleavage. Genomic information of strain CL5.1 revealed the further mineralization pathways of downstream product p-nitrobenzoic acid via ortho- and meta-cleavage.
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http://dx.doi.org/10.1016/j.watres.2020.116397DOI Listing
December 2020

Local Percolation of a Binary Particle Mixture in a Rectangular Hopper with Inclined Bottom during Discharging.

ACS Omega 2020 Aug 11;5(33):20773-20783. Epub 2020 Aug 11.

School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.

To reveal the local percolation characteristics of a binary particle mixture in a rectangular hopper with inclined bottom, the discrete element method (DEM) is used to simulate the discharging process. A local percolation evaluation method is proposed, and the percolation strength grid maps are drawn. The effects of geometric parameters, particle properties, and interaction parameters on percolation are investigated. Apart from the free surface, percolation is mainly concentrated near the wall and at the bottom. With the increase in the orifice width, the average local percolation strength index (ALPSI) of the near-wall region increases and that of the bottom region decreases. The effect of the angle on percolation in the near-wall region can be ignored. The effect of friction on local percolation is significant. Increasing the fine particle mass fraction and reducing the difference in particle size can effectively avoid percolation.
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http://dx.doi.org/10.1021/acsomega.0c01514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450507PMC
August 2020

Estimating a Large Travel Time Matrix Between Zip Codes in the United States: A Differential Sampling Approach.

J Transp Geogr 2020 Jun 15;86. Epub 2020 Jun 15.

Department of Geography & Anthropology, Louisiana State University, Baton Rouge, LA 70803.

Estimating a massive drive time matrix between locations is a practical but challenging task. The challenges include availability of reliable road network (including traffic) data, programming expertise, and access to high-performance computing resources. This research proposes a method for estimating a nationwide drive time matrix between ZIP code areas in the U.S.-a geographic unit at which many national datasets such as health information are compiled and distributed. The method (1) does not rely on intensive efforts in data preparation or access to advanced computing resources, (2) uses algorithms of varying complexity and computational time to estimate drive times of different trip lengths, and (3) accounts for both interzonal and intrazonal drive times. The core design samples ZIP code pairs with various intensities according to trip lengths and derives the drive times via Google Maps API, and the Google times are then used to adjust and improve some primitive estimates of drive times with low computational costs. The result provides a valuable resource for researchers.
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http://dx.doi.org/10.1016/j.jtrangeo.2020.102770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363032PMC
June 2020

Application of artificial intelligence in anterior segment ophthalmic diseases: diversity and standardization.

Ann Transl Med 2020 Jun;8(11):714

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Artificial intelligence (AI) based on machine learning (ML) and deep learning (DL) techniques has gained tremendous global interest in this era. Recent studies have demonstrated the potential of AI systems to provide improved capability in various tasks, especially in image recognition field. As an image-centric subspecialty, ophthalmology has become one of the frontiers of AI research. Trained on optical coherence tomography, slit-lamp images and even ordinary eye images, AI can achieve robust performance in the detection of glaucoma, corneal arcus and cataracts. Moreover, AI models based on other forms of data also performed satisfactorily. Nevertheless, several challenges with AI application in ophthalmology have also arisen, including standardization of data sets, validation and applicability of AI models, and ethical issues. In this review, we provided a summary of the state-of-the-art AI application in anterior segment ophthalmic diseases, potential challenges in clinical implementation and our prospects.
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http://dx.doi.org/10.21037/atm-20-976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327317PMC
June 2020

Using artificial intelligence to improve medical services in China.

Ann Transl Med 2020 Jun;8(11):711

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Artificial intelligence (AI) is one hotspot of research in the field of modern medical technology. Medical AI has been applied to various areas and has two main branches including virtual and physical. Recently, Chinese State Council issued a guideline on developing AI and indicated that the widespread application of AI will improve the level of precision in medical services and achieve the intelligent medical care. Medical resources, especially the high-quality resources, are deficient across the entire health service system in China. AI technologies, such that virtual AI and telemedical technology, are expected to overcome the current limitations of the distribution of medical resources and relieve the pressure associated with obtaining high-quality health care.
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http://dx.doi.org/10.21037/atm.2019.11.108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327308PMC
June 2020

Automatic identification of myopia based on ocular appearance images using deep learning.

Ann Transl Med 2020 Jun;8(11):705

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Background: Myopia is the leading cause of visual impairment and affects millions of children worldwide. Timely and annual manual optometric screenings of the entire at-risk population improve outcomes, but screening is challenging due to the lack of availability and training of assessors and the economic burden imposed by the screenings. Recently, deep learning and computer vision have shown powerful potential for disease screening. However, these techniques have not been applied to large-scale myopia screening using ocular appearance images.

Methods: We trained a deep learning system (DLS) for myopia detection using 2,350 ocular appearance images (processed by 7,050 pictures) from children aged 6 to 18. Myopia is defined as a spherical equivalent refraction (SER) [the algebraic sum in diopters (D), sphere + 1/2 cylinder] ≤-0.5 diopters. Saliency maps and gradient class activation maps (grad-CAM) were used to highlight the regions recognized by VGG-Face. In a prospective clinical trial, 100 ocular appearance images were used to assess the performance of the DLS.

Results: The area under the curve (AUC), sensitivity, and specificity of the DLS were 0.9270 (95% CI, 0.8580-0.9610), 81.13% (95% CI, 76.86-5.39%), and 86.42% (95% CI, 82.30-90.54%), respectively. Based on the saliency maps and grad-CAMs, the DLS mainly focused on eyes, especially the temporal sclera, rather than the background or other parts of the face. In the prospective clinical trial, the DLS achieved better diagnostic performance than the ophthalmologists in terms of sensitivity [DLS: 84.00% (95% CI, 73.50-94.50%) versus ophthalmologists: 64.00% (95% CI, 48.00-72.00%)] and specificity [DLS: 74.00% (95% CI, 61.40-86.60%) versus ophthalmologists: 53.33% (95% CI, 30.00-66.00%)]. We also computed AUC subgroups stratified by sex and age. DLS achieved comparable AUCs for children of different sexes and ages.

Conclusions: This study for the first time applied deep learning to myopia screening using ocular images and achieved high screening accuracy, enabling the remote monitoring of the refractive status in children with myopia. The application of our DLS will directly benefit public health and relieve the substantial burden imposed by myopia-associated visual impairment or blindness.
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http://dx.doi.org/10.21037/atm.2019.12.39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327333PMC
June 2020

[Unnatural amino acid orthogonal translation: a genetic engineering technology for the development of new-type live viral vaccine].

Sheng Wu Gong Cheng Xue Bao 2020 May;36(5):891-898

College of Animal Sciences, Southwest University, Chongqing 402460, China.

Unnatural amino acid orthogonal translation machinery can insert unnatural amino acids at desired sites of protein through stop codon by means of foreign orthogonal translation system composed of aminoacyl-tRNA synthetase and orthogonal tRNA genes. This new genetic engineering technology is not only a new tool for biochemical researches of proteins, but also an epoch-making technology for the development of new-type live viral vaccines. The mutated virus containing premature termination codon in genes necessary for replication can be propagated in transgenic cells harboring unnatural amino acid orthogonal translation machinery in media with corresponding unnatural amino acid, but it cannot replicate in conventional host cells. This replication-deficient virus is a new-type of live viral vaccine that possesses advantages of high efficacy of traditional attenuated vaccine and high safety of killed vaccine. This article reviews the application and prospect of unnatural amino acid orthogonal translation machinery in the development of novel replication-deficient virus vaccines.
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http://dx.doi.org/10.13345/j.cjb.190388DOI Listing
May 2020

Recurrent inversion toggling and great ape genome evolution.

Nat Genet 2020 08 15;52(8):849-858. Epub 2020 Jun 15.

Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA.

Inversions play an important role in disease and evolution but are difficult to characterize because their breakpoints map to large repeats. We increased by sixfold the number (n = 1,069) of previously reported great ape inversions by using single-cell DNA template strand and long-read sequencing. We find that the X chromosome is most enriched (2.5-fold) for inversions, on the basis of its size and duplication content. There is an excess of differentially expressed primate genes near the breakpoints of large (>100 kilobases (kb)) inversions but not smaller events. We show that when great ape lineage-specific duplications emerge, they preferentially (approximately 75%) occur in an inverted orientation compared to that at their ancestral locus. We construct megabase-pair scale haplotypes for individual chromosomes and identify 23 genomic regions that have recurrently toggled between a direct and an inverted state over 15 million years. The direct orientation is most frequently the derived state for human polymorphisms that predispose to recurrent copy number variants associated with neurodevelopmental disease.
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http://dx.doi.org/10.1038/s41588-020-0646-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415573PMC
August 2020

Bulk-like Intrinsic Phonon Thermal Conductivity of Micrometer-Thick AlN Films.

ACS Appl Mater Interfaces 2020 Jul 22;12(26):29443-29450. Epub 2020 Jun 22.

Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia 22904, United States.

Aluminum nitride (AlN) has garnered much attention due to its intrinsically high thermal conductivity. However, engineering thin films of AlN with these high thermal conductivities can be challenging due to vacancies and defects that can form during the synthesis. In this work, we report on the cross-plane thermal conductivity of ultra-high-purity single-crystal AlN films with different thicknesses (∼3-22 μm) via time-domain thermoreflectance (TDTR) and steady-state thermoreflectance (SSTR) from 80 to 500 K. At room temperature, we report a thermal conductivity of ∼320 ± 42 W m K, surpassing the values of prior measurements on AlN thin films and one of the highest cross-plane thermal conductivities of any material for films with equivalent thicknesses, surpassed only by diamond. By conducting first-principles calculations, we show that the thermal conductivity measurements on our thin films in the 250-500 K temperature range agree well with the predicted values for the bulk thermal conductivity of pure single-crystal AlN. Thus, our results demonstrate the viability of high-quality AlN films as promising candidates for the high-thermal-conductivity layers in high-power microelectronic devices. Our results also provide insight into the intrinsic thermal conductivity of thin films and the nature of phonon-boundary scattering in single-crystal epitaxially grown AlN thin films. The measured thermal conductivities in high-quality AlN thin films are found to be constant and similar to bulk AlN, regardless of the thermal penetration depth, film thickness, or laser spot size, even when these characteristic length scales are less than the mean free paths of a considerable portion of thermal phonons. Collectively, our data suggest that the intrinsic thermal conductivity of thin films with thicknesses less than the thermal phonon mean free paths is the same as bulk so long as the thermal conductivity of the film is sampled independent of the film/substrate interface.
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http://dx.doi.org/10.1021/acsami.0c03978DOI Listing
July 2020

Electron-phonon coupling mechanisms of broadband near-infrared emissions from Cr in the CaScSiO garnet.

Phys Chem Chem Phys 2020 May 4;22(18):10343-10350. Epub 2020 May 4.

College of Physics and Optoelectronics, Taiyuan University of Technology, Taiyuan 030024, P. R. China.

Cr in the CaScSiO garnet (CSSG) has the ability to convert blue light to broadband near-infrared (NIR) emissions, which is a promising strategy for next-generation smart NIR light sources based on blue LEDs. The Cr luminescence strongly depends on temperature due to electron-phonon coupling (EPC). We reveal the EPC mechanism of Cr in CSSG for the first time by temperature-dependent photoluminescence measurement from 77 to 573 K and cathodoluminescence using a scanning electron microscope. Cr occupies the Sc site and experiences a weak crystal field in CSSG, manifesting a broad NIR emission in the 700-900 nm range that originates from the T→A transition. The zero phonon line (ZPL) of the T state is observed at ∼713 nm with a vibrational energy of ∼310 cm. A strong EPC leads to a large Stokes shift (∼2900 cm). The Huang-Rhys parameter (S = 4), crystal field strength (D/B), and Racah parameters (B and C) are estimated.
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http://dx.doi.org/10.1039/d0cp00240bDOI Listing
May 2020

DTI Study on Brain Structure and Cognitive Function in Patients with Chronic Mountain Sickness.

Sci Rep 2019 12 18;9(1):19334. Epub 2019 Dec 18.

Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.

In chronic mountain sickness (CMS) patients, the structure of the brain, memory and cognition are often irreversibly damaged by chronic hypoxia due to red blood cell overcompensation, elevated haemoglobin and blood stasis. In this study, we aimed to evaluate this damage using diffusion tensor imaging (DTI) and to study the correlations among the fractional anisotropy (FA),the apparent diffusion coefficient (ADC) value, the severity index of CMS and the simple Mental State Examination (MMSE) score in CMS patients. A total of 17 patients with CMS and 15 healthy controls were recruited for conventional brain magnetic resonance imaging (MRI) and DTI scans, and ADC images were reconstructed along with FA and FA colour maps. The FA and ADC values of the selected regions of interest (ROIs) were measured and compared. The FA and ADC values were also compared with the haemoglobin (Hb) and MMSE scores. CMS patients are prone to intracranial ischaemia, infarction and haemorrhage. Multiple structural changes occur in the brain of CMS patients, and these changes are related to the severity of the disease and cognitive function variation. The white matter fibre bundles of CMS patients showed no obvious damage, except in the ischaemic site.
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http://dx.doi.org/10.1038/s41598-019-55498-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920146PMC
December 2019

Optimizing the study design of clinical trials to identify the efficacy of artificial intelligence tools in clinical practices-Authors' reply.

EClinicalMedicine 2019 Nov 24;16:12-13. Epub 2019 Oct 24.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China.

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http://dx.doi.org/10.1016/j.eclinm.2019.09.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890964PMC
November 2019

Development and validation of deep learning algorithms for scoliosis screening using back images.

Commun Biol 2019 25;2:390. Epub 2019 Oct 25.

2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China.

Adolescent idiopathic scoliosis is the most common spinal disorder in adolescents with a prevalence of 0.5-5.2% worldwide. The traditional methods for scoliosis screening are easily accessible but require unnecessary referrals and radiography exposure due to their low positive predictive values. The application of deep learning algorithms has the potential to reduce unnecessary referrals and costs in scoliosis screening. Here, we developed and validated deep learning algorithms for automated scoliosis screening using unclothed back images. The accuracies of the algorithms were superior to those of human specialists in detecting scoliosis, detecting cases with a curve ≥20°, and severity grading for both binary classifications and the four-class classification. Our approach can be potentially applied in routine scoliosis screening and periodic follow-ups of pretreatment cases without radiation exposure.
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http://dx.doi.org/10.1038/s42003-019-0635-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814825PMC
April 2020

Human-specific tandem repeat expansion and differential gene expression during primate evolution.

Proc Natl Acad Sci U S A 2019 11 28;116(46):23243-23253. Epub 2019 Oct 28.

Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195;

Short tandem repeats (STRs) and variable number tandem repeats (VNTRs) are important sources of natural and disease-causing variation, yet they have been problematic to resolve in reference genomes and genotype with short-read technology. We created a framework to model the evolution and instability of STRs and VNTRs in apes. We phased and assembled 3 ape genomes (chimpanzee, gorilla, and orangutan) using long-read and 10x Genomics linked-read sequence data for 21,442 human tandem repeats discovered in 6 haplotype-resolved assemblies of Yoruban, Chinese, and Puerto Rican origin. We define a set of 1,584 STRs/VNTRs expanded specifically in humans, including large tandem repeats affecting coding and noncoding portions of genes (e.g., , ). We show that short interspersed nuclear element-VNTR- (SVA) retrotransposition is the main mechanism for distributing GC-rich human-specific tandem repeat expansions throughout the genome but with a bias against genes. In contrast, we observe that VNTRs not originating from retrotransposons have a propensity to cluster near genes, especially in the subtelomere. Using tissue-specific expression from human and chimpanzee brains, we identify genes where transcript isoform usage differs significantly, likely caused by cryptic splicing variation within VNTRs. Using single-cell expression from cerebral organoids, we observe a strong effect for genes associated with transcription profiles analogous to intermediate progenitor cells. Finally, we compare the sequence composition of some of the largest human-specific repeat expansions and identify 52 STRs/VNTRs with at least 40 uninterrupted pure tracts as candidates for genetically unstable regions associated with disease.
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http://dx.doi.org/10.1073/pnas.1912175116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859368PMC
November 2019

Discrimination of the behavioural dynamics of visually impaired infants via deep learning.

Nat Biomed Eng 2019 11 21;3(11):860-869. Epub 2019 Oct 21.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.

Sensory loss is associated with behavioural changes, but how behavioural dynamics change when a sensory modality is impaired remains unclear. Here, by recording under a designed standardized scenario, the behavioural phenotypes of 4,196 infants who experienced varying degrees of visual loss but retained high behavioural plasticity, we show that behaviours with significantly higher occurrence in visually impaired infants can be identified, and that correlations between the frequency of specific behavioural patterns and visual-impairment severity, as well as variations in behavioural dynamics with age, can be quantified. We also show that a deep-learning algorithm (a temporal segment network) trained with the full-length videos can discriminate, for an independent dataset from 400 infants, mild visual impairment from healthy behaviour (area under the curve (AUC) of 85.2%), severe visual impairment from mild impairment (AUC of 81.9%), and various ophthalmological conditions from healthy vision (with AUCs ranging from 81.6% to 93.0%). The video dataset of behavioural phenotypes in response to visual loss and the trained machine-learning algorithm should help the study of visual function and behavioural plasticity in infants.
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http://dx.doi.org/10.1038/s41551-019-0461-9DOI Listing
November 2019

Effect of light atoms on thermal transport across solid-solid interfaces.

Phys Chem Chem Phys 2019 Aug 29;21(31):17029-17035. Epub 2019 Jul 29.

Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA. and Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA and Center for Sustainable Energy of Notre Dame (ND Energy), University of Notre Dame, Notre Dame, Indiana 46556, USA.

Thermal transport across solid interfaces is of great importance for applications like power electronics. In this work, we perform non-equilibrium molecular dynamics simulations to study the effect of light atoms on the thermal transport across SiC/GaN interfaces, where light atoms refer to substitutional or interstitial defect atoms lighter than those in the pristine lattice. Various light atom doping features, such as the light atom concentration, mass of the light atom, and skin depth of the doped region, have been investigated. It is found that substituting Ga atoms in the GaN lattice with lighter atoms (e.g. boron atoms) with 50% concentration near the interface can increase the thermal boundary conductance (TBC) by up to 50%. If light atoms are introduced interstitially, a similar increase in TBC is observed. Spectral analysis of interfacial heat transfer reveals that the enhanced TBC can be attributed to the stronger coupling of mid- and high-frequency phonons after introducing light atoms. We have also further included quantum correction, which reduces the amount of enhancement, but it still exists. These results may provide a route to improve TBC across solid interfaces as light atoms can be introduced during material growth.
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http://dx.doi.org/10.1039/c9cp03426aDOI Listing
August 2019

Diagnostic Efficacy and Therapeutic Decision-making Capacity of an Artificial Intelligence Platform for Childhood Cataracts in Eye Clinics: A Multicentre Randomized Controlled Trial.

EClinicalMedicine 2019 Mar 17;9:52-59. Epub 2019 Mar 17.

The First Affiliated Hospital of the University of South China, Hengyang, Hunan 421001, China.

Background: CC-Cruiser is an artificial intelligence (AI) platform developed for diagnosing childhood cataracts and providing risk stratification and treatment recommendations. The high accuracy of CC-Cruiser was previously validated using specific datasets. The objective of this study was to compare the diagnostic efficacy and treatment decision-making capacity between CC-Cruiser and ophthalmologists in real-world clinical settings.

Methods: This multicentre randomized controlled trial was performed in five ophthalmic clinics in different areas across China. Pediatric patients (aged ≤ 14 years) without a definitive diagnosis of cataracts or history of previous eye surgery were randomized (1:1) to receive a diagnosis and treatment recommendation from either CC-Cruiser or senior consultants (with over 5 years of clinical experience in pediatric ophthalmology). The experts who provided a gold standard diagnosis, and the investigators who performed slit-lamp photography and data analysis were blinded to the group assignments. The primary outcome was the diagnostic performance for childhood cataracts with reference to cataract experts' standards. The secondary outcomes included the evaluation of disease severity and treatment determination, the time required for the diagnosis, and patient satisfaction, which was determined by the mean rating. This trial is registered with ClinicalTrials.gov (NCT03240848).

Findings: Between August 9, 2017 and May 25, 2018, 350 participants (700 eyes) were randomly assigned for diagnosis by CC-Cruiser (350 eyes) or senior consultants (350 eyes). The accuracies of cataract diagnosis and treatment determination were 87.4% and 70.8%, respectively, for CC-Cruiser, which were significantly lower than 99.1% and 96.7%, respectively, for senior consultants ( < 0.001, OR = 0.06 [95% CI 0.02 to 0.19]; and  < 0.001, OR = 0.08 [95% CI 0.03 to 0.25], respectively). The mean time for receiving a diagnosis from CC-Cruiser was 2.79 min, which was significantly less than 8.53 min for senior consultants ( < 0.001, mean difference 5.74 [95% CI 5.43 to 6.05]). The patients were satisfied with the overall medical service quality provided by CC-Cruiser, typically with its time-saving feature in cataract diagnosis.

Interpretation: CC-Cruiser exhibited less accurate performance comparing to senior consultants in diagnosing childhood cataracts and making treatment decisions. However, the medical service provided by CC-Cruiser was less time-consuming and achieved a high level of patient satisfaction. CC-Cruiser has the capacity to assist human doctors in clinical practice in its current state.

Funding: National Key R&D Program of China (2018YFC0116500) and the Key Research Plan for the National Natural Science Foundation of China in Cultivation Project (91846109).
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http://dx.doi.org/10.1016/j.eclinm.2019.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510889PMC
March 2019

The Rate Stabilizing Tool: Generating Stable Local-Level Measures of Chronic Disease.

Prev Chronic Dis 2019 03 28;16:E38. Epub 2019 Mar 28.

Children's Environmental Health Initiative, Rice University, Houston, Texas.

Accurate and precise estimates of local-level epidemiologic measures are critical to informing policy and program decisions, but they often require advanced statistical knowledge, programming/coding skills, and extensive computing power. In response, we developed the Rate Stabilizing Tool (RST), an ArcGIS-based tool that enables users to input their own record-level data to generate more reliable age-standardized measures of chronic disease (eg, prevalence rates, mortality rates) or other population health outcomes at the county or census tract levels. The RST uses 2 forms of empirical Bayesian modeling (nonspatial and spatial) to estimate age-standardized rates and 95% credible intervals for user-specified geographic units. The RST also provides indicators of the reliability of point estimates. In addition to reviewing the RST's statistical techniques, we present results from a simulation study that illustrates the key benefit of smoothing. We demonstrate the dramatic reduction in root mean-squared error (rMSE), indicating a better compromise between accuracy and stability for both smoothing approaches relative to the unsmoothed estimates. Finally, we provide an example of the RST's use. This example uses heart disease mortality data for North Carolina census tracts to map the RST output, including reliability of estimates, and demonstrates a subsequent statistical test.
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http://dx.doi.org/10.5888/pcd16.180442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464039PMC
March 2019

Comparison of chlorination behaviors between norfloxacin and ofloxacin: Reaction kinetics, oxidation products and reaction pathways.

Chemosphere 2019 Jan 18;215:124-132. Epub 2018 Sep 18.

School of Environment, Tsinghua University, Beijing 100084, China; Civil and Environmental Engineering Programs, Pennsylvania State University, Middletown, PA 17057, USA.

Fluoroquinolones (FQs) are very ubiquitous in water environment in China. The commonly application of free available chlorine (FAC) during water treatment stimulated the focus on the transformation of FQs during chlorination. Among these FQs, norfloxacin (NOR) and ofloxacin (OFL) are the representatives of secondary amine FQs and tertiary amine FQs, respectively. To better understand the difference between secondary amine FQs and tertiary amine FQs during chlorination, reaction kinetics, products and mechanisms were determined. The maximum k of NOR were four orders of magnitude higher than that of OFL. Moreover, eleven products of NOR and twelve products of OFL were obtained by LC-MS/MS analysis. For the two FQs, the common reactive sites were three nitrogen atoms, benzene ring, carboxyl group and double bond by chlorination. For OFL, the ether ring was also active in aqueous system. The formation mechanisms of these products were presented in this study. The main reaction pathways were electrophilic addition to nitrogen, nucleophilic substitution to benzene ring, halodecarboxylation of carboxyl group and hydrolysis of ether ring. NaSO as a reducing agent had large effect on the chlorination of secondary amine FQ, but no effect on tertiary amine FQ. Be different to secondary amine FQ, the opening of quinolone ring happened in tertiary amine FQ after halodecarboxylation of carboxyl group.
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http://dx.doi.org/10.1016/j.chemosphere.2018.09.100DOI Listing
January 2019

A proteomics landscape of circadian clock in mouse liver.

Nat Commun 2018 04 19;9(1):1553. Epub 2018 Apr 19.

State Key Laboratory of Genetic Engineering, Human Phenome Institute, Institutes of Biomedical Sciences, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

As a circadian organ, liver executes diverse functions in different phase of the circadian clock. This process is believed to be driven by a transcription program. Here, we present a transcription factor (TF) DNA-binding activity-centered multi-dimensional proteomics landscape of the mouse liver, which includes DNA-binding profiles of different TFs, phosphorylation, and ubiquitylation patterns, the nuclear sub-proteome, the whole proteome as well as the transcriptome, to portray the hierarchical circadian clock network of this tissue. The TF DNA-binding activity indicates diurnal oscillation in four major pathways, namely the immune response, glucose metabolism, fatty acid metabolism, and the cell cycle. We also isolate the mouse liver Kupffer cells and measure their proteomes during the circadian cycle to reveal a cell-type resolved circadian clock. These comprehensive data sets provide a rich data resource for the understanding of mouse hepatic physiology around the circadian clock.
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http://dx.doi.org/10.1038/s41467-018-03898-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908788PMC
April 2018

[Analysis of transcriptional factors expression profile during dedifferentiation of liver cell cultured in vitro].

Sheng Wu Gong Cheng Xue Bao 2018 Feb;34(2):294-302

School of Life Sciences, Fudan University, Shanghai 200438, China.

Primary hepatocytes are widely used in drug metabolism and toxicity assessment. As the culture of primary hepatocytes in vitro is a process of dedifferentiation, hepatocytes lose normal metabolic detoxification function gradually. The mechanism of hepatocyte dedifferentiation has been not clear so far. TFs play an important role in the dedifferentiation and non-parenchymal cells can maintain the function of hepatocytes in vitro. However, the current methods cannot be used in effective identification and quantitative analysis of a large number of TFs. In this paper, the mo-culture system (only primary hepatocytes) and co-culture system (primary hepatocytes and non-parenchymal cells) were established. The cells were cultured for 24 h, 48 h, 72 h as monolayer. The changes of TFs during the culture were obtained by TOT (Transcription factor response elements on tip) transcription factor enrichment method and mass spectrometry. A total of 219 TFs were identified in three individual replicates. The result revealed that up-regulated TFs were enriched in cell proliferation, death and immune response pathways, and down-regulated TFs were involved in metabolism pathway. The establishment of such culture-TFs identification system is of great significance to reveal the mechanism of primary hepatocyte dedifferentiation and crosstalk between hepatocytes and non-parenchymal cells.
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http://dx.doi.org/10.13345/j.cjb.170168DOI Listing
February 2018

Access to Ophthalmologists in States Where Optometrists Have Expanded Scope of Practice.

JAMA Ophthalmol 2018 01;136(1):39-45

Children's Environmental Health Initiative, Rice University, Houston, Texas.

Importance: As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice.

Objective: To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014.

Design, Setting, And Participants: This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017.

Main Outcomes And Measures: The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office.

Results: The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the nearest ophthalmology office. Among Medicare beneficiaries who received surgery by optometrists, 58.3%, 51.1%, and 46.9% in Kentucky, Oklahoma, and New Mexico, respectively, lived within an ETT of 30 minutes from the nearest ophthalmologist office.

Conclusions And Relevance: In the states where optometrists have expanded scope of practice, most residents lived within an ETT of 30 minutes of the nearest ophthalmologist office, as do half of Medicare beneficiaries who received surgical care from optometrists. These results can help inform policy makers when weighing the pros and cons of scope of practice expansion for optometrists.
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http://dx.doi.org/10.1001/jamaophthalmol.2017.5081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833600PMC
January 2018