Medicine Advances最新文献

{"title":"Automated assessment of necrosis tumor ratio in colorectal cancer using an artificial intelligence-based digital pathology analysis","authors":"Huifen Ye,&nbsp;Yunrui Ye,&nbsp;Yiting Wang,&nbsp;Tong Tong,&nbsp;Su Yao,&nbsp;Yao Xu,&nbsp;Qingru Hu,&nbsp;Yulin Liu,&nbsp;Changhong Liang,&nbsp;Guangyi Wang,&nbsp;Ke Zhao,&nbsp;Xinjuan Fan,&nbsp;Yanfen Cui,&nbsp;Zaiyi Liu","doi":"10.1002/med4.9","DOIUrl":"https://doi.org/10.1002/med4.9","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With the advance in digital pathology and artificial intelligence (AI)-powered approaches, necrosis is proposed as a marker of poor prognosis in colorectal cancer (CRC). However, most previous studies quantified necrosis merely as a tissue type and patch-level segmentation. Thus, it was worth exploring and validating the prognostic and predictive value of necrosis proportion with a pixel-level segmentation in large multicenter cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A semantic segmentation model was trained with 12 tissue types labeled by pathologists. Segmentation was performed using the U-net model with a subsequently derived necrosis tumor ratio (NTR). We proposed the NTR score (NTR-low or NTR-high) to evaluate the prognostic and predictive value of necrosis for disease-free survival (DFS) and overall survival (OS) in the development (<i>N</i> = 443) and validation cohorts (<i>N</i> = 333) using 75% as a threshold.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 2-category NTR was an independent prognostic factor and NTR-low was associated with significant prolonged DFS (unadjusted HR for high vs. low 1.72 [95% CI 1.19–2.49] and 1.98 [1.22–3.23] in the development and validation cohorts). Similar trends were observed for OS. The prognostic value of NTR was maintained in the multivariate analysis for both cohorts. Furthermore, a stratified analysis showed that NTR-high was a high risk with adjuvant chemotherapy for OS in stage II CRC (<i>p</i> = 0.047).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI-based pixel-level quantified NTR has a stable prognostic value in CRC associated with unfavorable survival. Additionally, adjuvant chemotherapy provided survival benefits for patients with a high NTR score in stage II CRC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100913,"journal":{"name":"Medicine Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/med4.9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50140060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should Paxlovid be prescribed for patients with severe COVID-19 in the late course of infection? A case report","authors":"Qiang Li,&nbsp;Yibo He,&nbsp;Jin Liu,&nbsp;Xiaozhao Lu,&nbsp;Ziyou Zhou,&nbsp;Yu Kang,&nbsp;Wanying Wu,&nbsp;Jielan Wu,&nbsp;Feng Wang,&nbsp;Yinghao Sun,&nbsp;Wei Wang,&nbsp;Chengyi Hui,&nbsp;Wenting Wei,&nbsp;Miaoyun Wen,&nbsp;Jingjing Chen,&nbsp;Yong Liu","doi":"10.1002/med4.12","DOIUrl":"https://doi.org/10.1002/med4.12","url":null,"abstract":"<p>The infection of the coronavirus disease 2019 (COVID-19) is often accompanied by pneumonia with both high incidence and mortality. Paxlovid is commonly prescribed in patients with mild and normal pneumonia within 5 days from the symptom onset. Herein, we report a practically effective use of Paxlovid compensatively in patients with COVID-19 and severe pneumonia after 5 days of infection in a typical case in China. In this case, a 75-year-old man was diagnosed with severe COVID-19 complicated with a pulmonary bacterial infection. After treatment with oxygen inhalation, Cefoperazone-sulbactam and ambroxol, fever and upper respiratory symptoms were alleviated, except for the Oxygenation index (OI) remaining worse, Coronavirus was detected as positive, and levels of interleukin-6 remained high. Paxlovid was prescribed for 5 days subsequently though it was 14 days since symptom onset. Thereafter, the nucleic acid of the patient turned negative in 7 days and the symptoms resolved. This case showed that Paxlovid can be considered in patients with COVID-19 and severe pneumonia even in the later course of infection in clinical practice in China.</p>","PeriodicalId":100913,"journal":{"name":"Medicine Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/med4.12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50152787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}